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NUTR 344: Clinical Nutrition 1 > 9. Hypertension 2 > Flashcards

9. Hypertension 2 Flashcards

1
Q

How is HTN assessed globally?

A
  • Routine lab testing: urinalysis, blood chems (K, Na, Creatinine), fasting blood glucose, serum lipid profile)
  • ECG
  • TOD
  • CV risk score
  • Physical activity
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2
Q

What is involved in a nutritional assessment for patients with HTN?

A
  • identification of dietary patterns and factors (esp. concerning nutrients of interest)
  • evaluate need for weight control
  • alcohol intake
  • prioritize methods to meet DASH diet goals
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3
Q

What are possible nutrition diagnoses associated with HTN patients?

A
  • Excessive EI
  • Excessive/inappropriate intake of fats
  • Excessive Na intake
  • Inadequate Ca, fiber, K, or Mg
  • Overweight/obesity
  • Food/nutrition knowledge deficit
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4
Q

Specify the following health behavior recommendations for HTN therapy:

  • Being more physically active (lowers BP by 4-9 mmHg)
  • Weight reduction (lowers BP by 5-20 mmHg/ 10kg lost)
  • Moderate alcohol intake (lowers BP 2-4 mmHg)
  • Eating healthier (lowers BP 8-14 mmHg)
  • Relaxation therapies
  • Stop smoking
A
  • Physical activity: 30-60mins accumulated moderate intensity, dynamic exercise 4-7 days/week (weight training and resistance not shown to affect)
  • Weight: healthy BMI (18.5-24.9), waist circumference (<102 cm in men, <88 cm in women)
  • Alcohol: abstain or <2 drinks/day
  • Eating healthy: DASH-like diet
  • Relaxation: individualized cognitive therapies
  • Smoking: quitting, smoke-free environment
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5
Q

What is a DASH-like diet?

A
  • high in fresh fruit and vegetables
  • high in dietary fiber
  • high in non-animal protein
  • high in low-fat dairy products
  • low in sat. fats and cholesterol
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6
Q

Are exercise intensities higher than moderate levels more effective in reducing BP?

A

No

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7
Q

A reduction of at least _______ mg of sodium will lower BP, even if desired daily intake of NA is not acheived.

A

1000

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8
Q

What does DASH stand for?

A

Dietary Approach to Stop Hypertension

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9
Q

What is the rationale behind the DASH diet?

A

The negative correlations between BP and intake of certain nutrients (K, Ca, Mg, fiber, and proteins)

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10
Q

The OmniHeart study includes a set of DASH-derivative diets. All of them were shown to result in decreased blood pressure, LDL-C and CVD risk.

What are the 3 kinds of diets, that all have similar sodium levels to the DASH?

A
  • Rich in CHO
  • Rich in protein (25% of EI, 1:1 animal:plant)
  • Rich in US fatty acids (mostly mono)
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11
Q

Diets high in protein and unsaturated fatty acids are shown to _______ BP in HTN individuals.

A

Decrease

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12
Q

What were the effects of a higher-fat (dairy based) and lower CHO DASH diet compared to the typical DASH diet?

A
  • Similar decrease in BP
  • Lower TGs and large+medium [VLDL particle]
  • Did not lower LDL-cholesterol; but increased LDL peak particle diameter
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13
Q

What are the following drugs used for?

  • Thiazide diuretics
  • Distal tubule diuretics
  • ACE inhibitors (angiotensin converting enzyme)
  • ARBs (angiotensin II receptor blockers)
  • CCBs (calcium channel blockers)
  • Beta blockers
  • SPC (single pill combinations)
A

They are antihypertensive drugs

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14
Q

Concerning the following antihypertensive drugs, what are the mechanisms for diuretics?

  • Loop and thiazides
  • K-sparing
A

Loop and thiazides:

  • decreased reabsorption of Na and K
  • production of osmotic diuresis
  • increased excretion of Na and K (and H)

K-sparing:

inhibit action of aldosterone

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15
Q

Both loop diuretics and thiazides are associated with loss of ____ and have a common side effect of _______. What is recommended when taking these antihypertensive drugs.

A

Loss of potassium; hypokalemia

  • provide potassium rich foods
  • provide potassium supplements
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16
Q

What is recommended when taking potassium-sparing drugs for HTN?

A
  • avoid excess dietary K and supplements
  • avoid salt substitutes
  • avoid excess water consumption
  • take with food
  • avoid natural licorice
17
Q

What is the mechanism of ACE inhibitors?

What are the potential side effects/interactions?

A

Mechanism: inhibit conversion of angiotensin I to angiotensin II; decreases vasoconstriction, vasopressin, and inhibits aldosterone release

Side effects (increased in Af. americans):

  • hypotension in older patients
  • dry cough
  • can worsen renal functions
  • hyperkalemia
18
Q

What should be avoided when taking ACE inhibitors?

A
  • salt substitutes
  • natural licorice
19
Q

Why should natural licorice be avoided when taking antihypertensive medications?

A

Glycyrrhinic acid

  • can cause depletion of K (increasing Na retention)
  • depletion of K causes amplified side effects of antihypertensive drugs
  • can reduce effectiveness of certain drugs or break them down (ex: Coumadin), increasing risks of clotting
20
Q

When are ARBs prescribed to HTN patients?

What is the mechanism of these drugs?

What are the side effects?

A
  • When ACEs aren’t tolerated
  • Blocks angiotensin II receptors (decreasing activity); leads to vasodilation, reduced vasopressin and aldosterone

Side effects:

  • hyperkalemia
  • nausea, dizziness
21
Q

What should be avoided when taking ARBs?

A
  • salt substitutes
  • natural licorice
  • Caution with grapefruit (alter metabolism of these drugs)
22
Q

What is the mechanism of CCBs?

What are the side effects?

What is a contraindication?

A
  • Affect Ca movement through Ca channels; lead to relaxation of blood vessels (esp. larger ones)

Side Effects:

  • edema
  • nausea
  • heartburn

Contraindication:

  • heart failure
23
Q

What should be avoided when taking CCBs?

A
  • natural licorice
  • limit caffeine
  • limit/avoid alcohol
  • grapefruit (with felodipine, Plendil)
24
Q

What is the mechanism of beta-blockers?

What are the side effects?

What should be avoided when taking them?

Who are they not recommended for?

A

Mechanism: block adrenergic beta-receptors in heart; decrease rate and cardiac output

Side effects: constipation/diarrhea, bloating, hides hypoglycemia (careful for DM), dizziness, fatigue, CHF, hallucinations, insomnia

Avoid: natural licorice

Not recommended for: those over 60 years (as initial therapy)

25
Q

What must be considered when prescribing antihypertensive drugs?

A
  • Location of drug metabolism/excretion (liver and kidney)
  • Drug/nutrient reactions (metabolism, excretion, effects on each other)
  • Drug/drug interactions
  • Nutritional status (ex: low albumin may increase drug behavior)
  • Physiological status
26
Q

ACEs and ARBs can be prescribed to complicated HTN patients with diabetes, CAD, and heart failure. For the 3 diseases mentioned, what other antihypertensive drugs can be prescribed?

A
  • Diabetes (no HTN complications): CCBs, diuretics
  • CAD: beta-blockers, or CCB (stable angina)
  • Heart failure: beta-blockers

NUTR 344: Clinical Nutrition 1 (15 decks)

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