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Clinical nutrition > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Major forms of CVD

A
  • hypertension
  • atherosclerosis
  • ischemic heart disease
  • peripheral vascular disease
  • heart failure
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2
Q

leading cause of death? second one

A
  1. Cancer
  2. diseases of the heart
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3
Q

why cvd is the secod cause of death

A

better diagnosed and better treatments

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4
Q

who as a higher prevelance of hypertension male or females over the years? and age?

A

male right now has more hypertension than females
Age: male has more reported hypertension but after 65 years female has more hypertension than male

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5
Q

most people are aware or unaware of their hypertension

A

aware and controlled however 18% is unaware because this disease is not physically manifestated

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6
Q

what is the #1 visited reason that people go to the doctor

A

hyperntension

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7
Q

what is the age that normally adults start to have hypertension

A

55-65

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8
Q

what is the 2 phases of cardiac cycle

A

contraction and resting

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9
Q

what is the mean arterial pressure based on

A

cardiac output x peripheral resistance

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10
Q

cardiac output is based on

A

stroke volume x heart rate

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11
Q

resistance is based on

A

lenght of vessel x viscocity/ radius ^4

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12
Q

An increase in ____ will increase BP

A

Heart rate
Stroke volume
Viscosity of blood
Length of vessel

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13
Q

A decrease in ___ will increase BP

A

radius

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14
Q

what regulate blood pressure

A
  • sympathetic nervous system
  • renin angiotensin aldosterone system
  • renal function
  • hormons
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15
Q

Explain what influences cardiac output (SRC-B)

A

Primarily determined by heart rate and stroke volume. heart rate influenced by nervous system (sympathetic and parasympathetic), where the stroke volume is influenced by SNS and venous return, Venous return influenced by skeletal muscle, respiratory, cardiac suction and blood volume.

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16
Q

Explain what influences peripheral resistance

A

Radius is under local metabolic control which is influenced by skeletal muscle, and extrinsic vasoconstriction control which is mediated by SNS and epi, vasporessin, Ang II which will influence RAAS system. Viscosity will be determined by hydration status and # of RBCs.

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17
Q

explain Renin Angiotensin Aldosterone System (RAAS)

A

a decrease in NaCl, or ECF volume or in the arterial blood pressure will be detcetd by the kidney that will make an enzyme called renin that will convert angiotensinogen into angiotensin 1. The lungs will make an enzyme angiotensin converting enzyme that will convert angiotensin 1 to 2 and there will be an effect in the BP

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18
Q

what is the effect of angiotensin 2

A
  • it will increase vasopressin that will make water reabsorption.
  • Increase thrist that will increase fluid intake
  • increase vasoconstriction
  • make adrenal cortex make aldosterone
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19
Q

what is the primary cause of hypertension

A
  • genetic and env factor
  • dietary and behavior factor
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20
Q

what is the secondary cause of hypertension

A

occurs secondary to another condition such as renal, endocirne or neurological disorders

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21
Q

is hypertension asymptomatic?

A

yes - silent killer

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22
Q

what are the major non modifiable risk factors

A

-more than 60y old
-men, postmenopausal women, ethnicity
- family history

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23
Q

what are the modifiable risk of HTN

A
  • smoking
  • sedentary lifestyle
  • abdominal obesity
  • poor diet quality
  • stress
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24
Q

how vasopressin and angiotensin 2 impact hypertension

A

increases vasoconstrcition and fluid retension

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25
Q

what is the mechanism of smoking that interferes with hypertension

A

it interferes with NO –> impairs endothelial vasodilation

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26
Q

how adrenal disorder impact hypertension? and renal disease

A

adrenal disorders increase secretion of epinephrine and norepinephrine -> vasoconstriction and increase cardiac output

renal disease - reduced blood flow, increase angiotensis 2, vasoconstriction Na, Cl, water retention and blood volume

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27
Q

what are the target organ damage related to hypertension

A
  • hemorrage, stroke, dementia (brain)
  • retinopathy (eye)
  • peripheral vascular disease
  • renal failure, proteinuria
  • heart : LVH, CHD, CHF
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28
Q

How do we measure BP

A

sphygmamonometer in mmHG

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29
Q

what are the 3 risk regarding hypertension and explain each

A
  • low risk:
    no target over damage or cardiovascular risk factor and the risk is 10 years is less than 10%
  • moderate to high risk
    multiple cardiovascular risk factors and 10 year global risk of 10-14%
  • high risk
    50 years and more with 130-180 mmHG and with one of these :clinical cardiovascular disease, chronic kidney disease, estimated 10 year global cvd is more than 15% ad more than 75 years
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30
Q

people with diabetes where are they classified

A

between moderate and high risk but more for the high risk

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31
Q

when do we initiate antihypertensive therapy (drugs) for high risk patient and what is the target

A

sbp more than 130
target less 120

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32
Q

when do we initiate antihypertensive therapy (drugs) for diabetes mellitus patients and what is the target

A

130/80
less than 130/80

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33
Q

when do we initiate antihypertensive therapy (drugs) for moderate to high risk patient and what is the target

A

more than 140/90
less than 140/90

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34
Q

when do we initiate antihypertensive therapy (drugs) for low risk patient and what is the target

A

more than 160/100
less than 140/90

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35
Q

what is the preferred way to measure bp and what is advantages

A

automated office blood presure (AOBP) oscillometric
advanatges: more precise, you can take at home multiple times, the person do it

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36
Q

which device the doctors use to measure bp

A

non automated office bp auscultatory

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37
Q

how it works the out of office bp measurement methods - ambulatory

A

it is over 24h and it is a continuois measurement through your daily activities

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38
Q

how much in mmHg does the person needs to have to be considered hypertension

A

more or equal to 135/85

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39
Q

what are the goals of hypertension therapy

A
  • reduced risk of cvd and renal disease
  • lower bp to clinically appropriate level
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40
Q

what the hypertension therapy plan include

A
  • physcial activity
  • weight reduction
  • nutrition thrapy
  • moderation in alcohol, relaxation therapy, smoking cessation
  • pharmacological intervention
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41
Q

what are some dietary factors that are involved in hypertension

A
  • high calories, excess weight, obesity
  • sodium
  • potassium
  • calcium
  • magnesium
  • alcohol
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42
Q

what is the relation between obesity and hypertension

A

for adults who have more than 55 years old
- direct link between excess weight and hypertension

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43
Q

true or false
60% of adults with excess weight and normal bp will develop hypertension in the next 4 years

A

true

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44
Q

true or false
abdominal obesity is more associted with hypertension

A

true

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45
Q

what are the causes of hypertension associated with obesity

A
  • insulin resistance hyperinsulinemia
  • overactivity of the sns
  • alteration of the raas (major effect)
  • leptin increases sympathetic activity
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46
Q

what is the most potent non-pharmacological approach

A

weight loss

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47
Q

if you lose 10kg how much does it decreases the hypertension

A

5-20 mmgh

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48
Q

true or false
all overweight patients should achieve a weight loss of 5kg to reduce BP and risk for organ damage

A

true

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49
Q

what is the effect on sodium intake in systolic blood pressure

A

for every increase of 100 mmol Na/d there is an increase of 3-6/0-3 mmHg

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50
Q

it is better to measure sodium intake or excretion

A

excretion because it is hard to measure the intake

51
Q

when people decrease their consumption of salt who has a bigger impact people who are normal or hypertensives

A

hypertensives have a greater decrease than people who have a normal bp

52
Q

high sodium intake increases the risk of which complication compared to people who have a lower sodium intake

A
  • chd Congenital heart defects
  • cvd
  • all death
53
Q

decreasing sodium has a higher impact on decreasing blood pressure on people who have a American diet or a dash diet

A

American diet because people who consumes a dash diet has already lower blood pressure

54
Q

true or false
there are people that will not respond to an decrease of bp when lowering sodium

A

sodium

55
Q

who respond more to a decrease bp when decreasing salt

A

african american
middle aged
htn, diabetes, renal

56
Q

factors involved in heterogenous response to sodium reduction

A
  • familial/genetic factors
  • age
  • severy of hypertension
  • degree of restriction
  • renin-angiotensin-aldosterone (low renin)
  • sympathetic response
  • duration of trials
57
Q

the higher potassium intake the … Na sensitivity

A

lower

58
Q

true or false
everyone exceeds the UL (2300 mg) of sodium

A

true, average intake of sodium is 3400 mg/d

59
Q

how much do we need to decrease salt to decrease bp

A

2000 mg Na or 5g of salt

60
Q

where does the most of the sodium in our diet comes from

A

comes from processed foods

61
Q

what are the majors food group that as sodium

A
  • breads
  • processed meats
  • cheese
  • tomato
62
Q

how can you choose a foods that is low in sodium based on the label

A

food that have less than 120 mg sodium per serving or 5% or less

63
Q

benefits of reducing sodium intake

A
  • reduces BP
  • prevents hypertension
  • has an additive effect to antihypertensive medication (lower doses and better control)
  • reduce risk of complications
64
Q

what is the relation between potassium and blood pressure

A

there is an inverse relationship between K intake and blood pressure
- decreased mean blood pressure
- decreased prevalence of htn with higher K intake

65
Q

what are the mechanism of potassium that lower blood pressure

A
  • natriuresis
  • suppressed renin
  • attenuated vascular contraction (vasodilation)
  • reduce sympathetic activity and angiotensin
66
Q

the lower the potassium intake the … the Na

A

higher

67
Q

modern western diet is made of

A

high sodium intake and low potassium intake which can lead to hypertension

68
Q

deficit in K in the body causes

A

retention of Na by the kidneys

69
Q

explain how potassium depletion can cause the kidneys to retain Na

A

potassium depletion causes sumpathetic activity that makes angiotensin 2 which will stimulate Na transporter.
Aldosterone will retain Na by the NaCl pump and the K+Na.
THE SODIUM PUMP WILL MAKE 3 Na+ go into the blood and 2 K+ be secreted

70
Q

how can low K and high Na make the vascular contraction

A

By the Na/K+ ATPase (sodium pump) Na plus will increase in the cell there will be a depolarization of the membrane and Ca2+ will go out and it will make a vascular contraction that will increase resistance and hypertension

71
Q

what is the recommendation of potassium

A

consume more than 2300 mg (decrease stroke mortality)
+ 2000 mg it decreases -3.4/-1.9 BP

72
Q

when potassium supplements is useful

A

if you have diuretic induced hypokalemia if not fruits and vegetables will be sufficient for K intake

73
Q

what are the risk factors for hyperkalemia

A
  • patients using renin-angiotensin-aldosterone inhibitors
  • patients receiving other drugs causing hyperkalemia
  • chronic kidney disease
  • baseline serum potassium more than 45 mmol/l
74
Q

calcium intake is … associated with bp

A

inversely

75
Q

what are the potential mechanism of increased calcium intake

A
  • high sodium excretion
  • high sensitivity to NO (vasodilation)
  • reduced production of superoxyde and prostanoids (vasoconstrictors)
76
Q

is supplementation fo ca for normotensive people s recommended ?

A

no

77
Q

is supplementation for ca above the daily recommended dietary intake is recommended for treatment for hypertension?

A

no consuming 2-3 serving of milk products is sufficient

78
Q

… relationship between Mg intake and bp

A

inverse

79
Q

mechanism of Mg and bp

A

regulate vascular reactivity and contractility

80
Q

is supplement above DRIs recommend for Mg

A

no

81
Q

what are the dose-response relationship between alcohol intake and bp

A

over 2 drinks increase bp

82
Q

what are the first effects of alcohol? what happens after

A

there is a decrease of bp and then there is an elevated BP for the next 10-15h

83
Q

what are the potential mechanism of alcohol

A
  • stimulated sns
  • cortisol secretion
  • increase Ca uptake by cell membranes
84
Q

what is the problem with the public and alcohol

A

they don’t know the amounts so it is important to explain to them

85
Q

what is the global assessment that needs to be done

A
  • lab testing
  • ECG
  • target organ damage
  • cardiovascular risk score
  • physical activity
86
Q

what is the nutritional assessment when people have hypertension

A
  • identify dietary factors and patterns, specifically with nutrients of interest
  • evaluate the need for weight control
  • alcohol intake
  • prioritize methods t meet dahs dietary goals
87
Q

possible nutrition diagnoses

A
  • excessive energy intake
  • excessive or inappropriate intake of fats
  • excessive sodium intake
  • inadequate calcium, fiber, potassium or mg intake
  • overweight/obese
  • food and nutr deficit
88
Q

what are the behaviours recommendation and how much they decrease bp

A
  • more physically active (4-9mmHg)
  • weight reduction (5-20 mmhg) : healthy bmi + waist circumference
  • moderation of alcohol intake (2-4 mmHg): limit consumption of less than 2 drinks per day to lower bp
  • eating healthier (8-14 mmg) : dash diet - high in fruits, beg, low fat and low sat fat and cholesterol. High K
  • relaxation therapies
  • smoking cessation
89
Q

how can physical activity decrease hypertension

A

accumualtion of moderate physical activity 30-60 min/d + daily activities = reduces bp by 4-9 mmHg

90
Q

increase PA has an impact on

A

decreasing the relative workload on the heart ( goof for all CVD) and may help reduce weight

91
Q

what are the benefits of the dietary approach to stop hypertension (DASH) diet

A
  • average decrease of 5.5/3 mmHg vs control
92
Q

what is the daily nutrient goals used in the dash studies

A
  • low sodium
  • high potassium
  • high calcium
  • high mag
  • high fiber
93
Q

what are the food that have a good source of potassium, mg and fiber

A

broccoli, carrots, spinach, tomatoes, sweet potatoes etc

94
Q

what is the benefit of having a dash low sodium diet

A
  • greater combined effects on BP
  • recommended when there is a refractory hypertension
95
Q

there is a greater effect in dash diet or Mediterranean diet in bp

A

dash

96
Q

A study made with comparing dash diet + rich in CHO or rich in protein or rich in unsaturated fatty acids. What was their result

A
  • They found that all diets reduced blood pressure, LDL and cardiovascular risk
  • diet high in proteins and unsaturated fatty acids decreased further blood pressure in hypertensive individuals
97
Q

higher fat/low cho dash diet vs dash diet

A
  • similar decrease in bp
  • decrease triglycerides and large and medium VLDL particle concentrations
  • increase LDL diameter
98
Q

what is the changes in nutrients and improvements of the DASH diet

A
  • increase K, Mg, Ca, fiber
  • reduce sat fa, sodium
  • improve bp, LDL, VLDL, triglycerides
99
Q

what are the antihypertensive drugs

A
  • thiazide diuretics
  • distal tubular diuretics
  • angiotensin converting enzyme (ACE) inhibitors
  • angiotensin II receptor blockers (ARB)
  • calcium channel blockers (CCB)
  • beta blockers
  • single pill combinations (SPC)
100
Q

Diuretic mechanism

A
  • decreased reabsorption of Na and K
  • production of osmotic diuresis
  • increased excretion of NA and K
  • inhibit action of aldosterone
101
Q

what are some diuretics drugs

A
  • loop diuretics (K losing): furosemide (lasix)
  • thiazide : hydrochlorothiazide (apo-hydro)
  • potassium sparing : spironolactone (aldactone)
102
Q

side effects of furosemide (lasix)

A

hypokalemia, hyperglacemia, constipation

103
Q

side effects hydrochlorothiazide (apo-hydro)

A

hypokalemia, hyperglacemia

104
Q

for lasix and apo hydro what is nutritional needed

A

potassium rich foods and potassium supplements

105
Q
A
106
Q

what is the important to avoid when taking spironolactone (aldactone)

A
  • avoid excess potasium and supplements
  • avoid salt substitutes
  • avoid excess water consumption
  • avoid natural licorice
107
Q

example of ACE inhibitor drug

A

ramipril (altace)

108
Q

what is the mechanism of ACE inhibitor (altace)

A

inhibit conversion of angiotensin 1 to 2
decreases vasoconstriction, vasopressin, inhibits aldosterone release

109
Q

side effects of altace

A
  • hypotension, dry cough (side effects are increases in African Americans)
110
Q

examples of angiotensin 2 receptors blockers (ARB)

A

valsartan (diovan), losartan (cozaar)

111
Q

what is the mechanism of ARB

A

block angiotensin 2 and therefore decrease its activity

112
Q

side effects of ARB

A

hyperkalemia, nausea, dizziness

113
Q

what it needs to be avoid when taking ARB

A

avoid salt substitues
avoid natural licorice
caution with grapefruit

114
Q

examples of calcium channel blockers

A

amlodipine (norvasc)

115
Q

what is the mechanism of calcium channel blockers

A

affect the mvt of Ca through Ca channel causing blood vessel relaxation

116
Q

side effects of norvasc

A
  • edema, nause, heartburn
117
Q

what needs to be avoid when taking norvasc

A

limit caffeine, alcohol and grapefruit

118
Q

what is the contraindication for taking norvasc

A

heart failure

119
Q

example of drugs for beta blockers

A

propanolol (inderal)

120
Q

what is the mechanism of beta blockers

A

block adrenergic beta receptors in the eart -> decrease rate and CO

121
Q

what is the side effects of beta blockers

A

diziness, fatigue, insimnia

122
Q

beta blcokers is not recommended as

A

as an initial therapy for those over 60 years old

123
Q

diabetes, coronary and heart faiure cannot use

A

ACEi or ARB and b-blockers for heart failure

124
Q
A

Clinical nutrition (11 decks)

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