INP final - HYPERTENSION

Question 1

What is blood pressure?

Answer 1

• the force of your blood pushing against the walls of your blood vessels
• BP = Cardiac output x peripheral vascular resistance

Question 2

What is systolic BP?

Answer 2

pressure in your blood vessels when your heart beats

top number of BP

Question 3

What is diastolic BP?

Answer 3

pressure in your blood vessels when your heart rests between beats

bottom number of BP

Question 4

How should BP be measured in adults?

Answer 4

• Average reading on >2 occasions at two different times
• Take BP in both arms at heart level
• Have patient seated with feet on the floor
• Out of office measurement by ambulatory blood pressure monitoring or home blood pressure monitor to confirm using an automated cuff

Question 5

What are the diagnostic criteria for the stages of hypertension?

Answer 5

Normal BP: <120/80

Elevated BP: 120-129/<80

Stage 1 Hypertension: 130-139/80-89

Stage 2 Hypertension: ≥140/90

Question 6

What comorbidities and complications are associated with hypertension?

Answer 6

Comorbidities: Hyperlipidemia, T2D, obesity

Complications: brain and neural complications, kidney damage, hypertrophy of the heart, retinopathy

Question 7

How do different classes of medication reduce blood pressure? (don’t need to know the names of the medications)?

Answer 7

Diuretics
- Increase sodium excretion & decrease reabsorption

Potassium channel blockers
- Vasodilation of peripheral vessels

ACE inhibitors
- Block conversion of angiotensin I to II reducing vasoconstriction

Angiotensin II receptor blockers

Ca channel blockers & beta blockers
- Slow pulse, reduce work of heart to reduce blood pressure

Question 8

What are some nutrient interactions with hypertensions medications?

Answer 8

Thiazide diuretics
↓ Na reabsorption
↑ K secretion
↓ Mg reabsorption
↑ Ca reabsorption

“Loop” diuretics
↓ Mg
↓ Ca reabsorption
↑ K secretion

K-sparing diuretics
↓ K secretion
no effect on Mg

Question 9

Summarize the lifestyle and dietary interventions recommended for those with hypertension.

Answer 9

• Weight loss: 5 kg reduces BP 3-4 mmHg
• Diet: DASH diet– note also for CVD management
• decrease Na, increase K, decrease alcohol & caffeine
• Exercise/relaxation techniques
• get active: 50-150 min aerobic exercise/week
• reduce stress: Yoga, Tai-Qi, meditation, breathing techniques

Question 10

How does the kidney’s regulation of Na relate to or lead to hypertension?

Answer 10

• Something happens: “insult” or “injury”
• Normal sodium handling
• Subtle renal injury
• Decreased sodium filtration
• Increased sodium reabsorption
• Increased blood pressure
• Normal sodium handling at higher threshold
• Reducing sodium consumption can reduce blood pressure

Question 11

What is the DASH diet?

Answer 11

· 58% Carbs, 15% Protein, 27% Fat
· rich in fruits, vegetables, fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds, and nuts (which provide potassium, magnesium, calcium, protein, and fiber)
· low in Na, sweets, added sugars, and beverages containing sugar, red meat, saturated fat, trans fat

Question 12

How effective is the DASH diet?

Answer 12

· Multiple studies have demonstrated lowered blood pressure
· Greater in African Americans
· High in protein, K and P
· NOT recommended for px with CKD Stage 3 or 4 (eGFR <60ml/min)

Question 13

What other diets have been shown to reduce blood pressure?

Answer 13

· Mediterranean diet: lots of overlap with DASH
· Plant-based diets (especially with soy plant protein)
· Atkins, weight watchers, zone and ornish (plant based) diets
· Absolutely no difference in blood pressure
· All groups showed a decrease in blood pressure coincident with weight loss