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6-Clinical Nutrition 1 > Hypertension Part 2 > Flashcards

Hypertension Part 2 Flashcards

1
Q

How does exercise affect HTN by numbers?

A
  • regular moderate P.A. of at least 30 min/day on most days: reduced BP by 4-9 mmHg independently from weight loss.
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2
Q

How does increasing physical activity decrease HTN?

A
  • decrease the relative workload on the heart: benefit for all CVD
  • may help reduce weight
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3
Q

Is resistance exercise benefit HTN?

A

resistance exercise does not negatively impact BP

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4
Q

How is the nutrition assessment done for HTN?

A
  • identify dietary factors and patterns
  • evaluate need for weight control
  • prioritize methods to meet DASH dietary goals
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5
Q

What are the diagnosis can be made in terms of nutrition therapy for HTN?

A
  • excessive energy intake
  • excessive or inappropriate intake of fats
  • excessive Na intake
  • Inadequate Ca, Fiber, K, or Mg intake
  • Overweight/obesity
  • Food nutrition knowledge deficit
  • Physical inactivity
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6
Q

What are the nutrition interventions that need to be considered for therapy for HTN?

A
  • comprehensive approach that addresses multiple lifestyle factors
  • DASH
  • Weight loss
  • Alcohol
  • K, Ca, Mg
  • Physical activity
  • Smoking cessation
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7
Q

What is the DASH diet?

A

Dietary approaches to stop HTN

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8
Q

What is the rationale behind the DASH diet?

A

Negative correlations between blood pressure and certain nutrients intake (Mg, K, Ca, Fibers, Proteins)

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9
Q

What were the three diets that were compared in the first study done on HTN in 1997?

A
  • control diet: poor in Ca, Mg, and K
  • Rich in veg & fruits diet (high in K, Mg, and Fibers)
  • Mixed diet: DASH diet, rich in veg and fruits, legumes and low-fat dairy (high K, Mg, Ca, fiber and poor in total fat, SFA, and dietary cholesterol)

** 3mg sodium in all

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10
Q

What are the benefits of the DASH diet in terms of numbers?

A
  • decrease in systolic BP by 5.5 mmHg and diastolic BP by 3.0 mmHg in all participants
  • further decrease in hypertensive subjects: -11.4 mmHg/5.5 mmHg
  • Half of these effects were observed for high fruits and vegetable diet
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11
Q

What is the DASH sodium diet?

A

in 2001, DASH sodium: 1500mg Na diet combines with DASH diet, recommended when refractory HTN –> greater combined effects on BP

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12
Q

What is the percentage of carbs recommended in DASH diet?

A

55%

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13
Q

What is the percentage of protein recommended in DASH diet?

A

18%

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14
Q

What is the percentage of fat recommended in DASH diet?

A

27% (6% saturated fat)

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15
Q

What is the OmniHeart Study?

A

3 diets similar to DASH-sodium were compared in prehypertensive and hypertensive adults:

  • rich in CHO
  • rich in PRO
  • mediterranean like (rich in unsat fat.)
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16
Q

What were the results in the OmniHeart Study?

A
  • all reduced blood pressure, LDL-C and CV risk

- high in PRO and unsat. fa. further decreased BP in hypertensive ppl

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17
Q

What are the major sources of energy and fiber in DASH diet?

A

whole wheat bread and rolls, whole wheat pasta, english muffin, pita bread, bagel, cereals, oatmeal, brown rice

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18
Q

What are the rich sources of potassium, magnesium and fiber in DASH diet?

A

broccoli, carrots, collards, green beans, green peas, kale, lima beans, potatoes, spinach, squash, sweet potatoes, tomatoes

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19
Q

What are the important sources of potassium, magnesium and fiber in DASH diet?

A

apples, apricots, bananas, dates, grapes, oranges, grapefruit, grapefruit juice, mangoes, melons, peaches, pineapple, raisins, strawberries, tangerines

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20
Q

What are the major sources of calcium and protein in DASH diet?

A

low fat dairy

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21
Q

What are the rich sources of protein and magnesium in DASH diet?

A

select only; lean trim away visible fats, broil roast, or poach; remove extra skin from poultry

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22
Q

What are the rich sources of energy, protein, fiber and magnesium in DASH diet?

A

nuts, seeds, nut butters, kidney beans, lentils, split beans

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23
Q

Where does the 27% fat should come from in DASH diet?

A

soft margarine, veg oil, low fat mayonnaise, light salad dressing

24
Q

What is the condition in sweets in DASH diet? Give examples

A

sweets should be low fat

fruit flavored gelatin, fruit punch, hard candy, jelly, maple syrup, sorbet and ices, sugar

25
What is the BOLD Study?
- done in healthy adults - comparison of US diet, DASH diet, DASH-like with lean beef (BOLD), DASH-like with lean beed and additional protein (BOLD+)
26
What is the Higher-Fat DASH Study?
- in healthy adults - comparison of control diet, typical DASH diet and higher-fat/low CHO DASH diet - Higher-fat/low CHO DASH diet vs DASH diet
27
What were the results of the BOLD Study?
- similar reduction in total cholesterol, LDL-C, HDL-C, in BOLD, BOLD+, and DASH diet
28
What were the results of the Higher-Fat DASH Study?
- similar reduction in BP - decreased TG and large medium VLDL particle concentrations - increased LDL peak particle diameter (beneficial effects)
29
What are the indications for drug treatment in HTN?
1. should be prescribed or average DBP>100 or avg. SBP>160 mmHg in pt without macrovascular target organ damage or other CVD risk factors 2. should strongly considered if: - avg. DBP > 90 or - avg. SBP > 140 mmHg in presence of macrovascular target organ damage or CVD risk factors - regardless of age 3. in the very elderly (>80yrs) who do not have diabetes or target organ damage, the SBP threshold for initiating drug therapy >160mmHg
30
What are antihypertensive drugs?
- Thiazide diuretics - Distal tubular diuretics - Beta blockers - Angiotensin converting enzyme (ACE) inhibitors - Calcium channel blockers - Angiotensin II Receptor Blockers
31
What are the treatment goals with patients and patients with extra diabetes or renal disease?
SBP < 140mmHg DBP < 90mmHg Diabetes and renal disease: SBP < 130mmHg DBP < 80mmHg
32
What are the considerations in prescribing the right drug?
- location of the drug metabolism and excretion (liver adn kidney) - drug/nutrient interactions - with ALL drugs AVOID natural licorice - nutritional status (ex. low albumin may increase drug effect bc of more free drug in the blood) - physiological state (ex. pregnancy, lactation, presence of other disease)
33
What are the complicated situations in HTN drug use and which drug should be used in those cases?
- Diabetes (ACEi or ARB; CCB or diuretics in absence of macro- and micro- albuminemia) - Coronary Heart Disease (ACEi or ARB; B-blockers or CCB for stable angina) - Heart Failure (ACEi or ARB + B-blockers)
34
What is the problem with micro or macro albuminemia in terms of HTN medications?
more leakage of albumin in the kidney means that there is an alteration of the kidney function and so the doctor will not prescribe diuretics to these people
35
What is the mechanism of loop and thiazide drugs (K-losing)?
- decreased reabsorption of Na and K - reduction of osmotic diuresis - increased excretion of Na and K (and H+)
36
What is the mechanism of K sparing drugs?
inhibits action of aldosterone
37
What is the generic name for loops diuretics (K-losing)?
furosemide (Lasix)
38
What is the generic name for thiazides (K-losing)?
hydrochlorothiazide (Apo-Hydro)
39
What are the side effects of loops diuretics (K-losing)?
hypokalemia, anorexia, N/V, constipation | - K supplements recommended
40
What are the side effects of thiazides (K-losing)?
hypokalemia, hypoglycemia, anorexia, malaise, muscle weakness
41
What are the considerations for loop diuretics and thiazides in terms of nutrition?
- provide K rich foods - provide K supplements - increased risk for ulceration, N/V/D
42
What is the generic name for K-sparing?
spironolactone (Aldactone) thiamterene amiloride
43
What are the considerations for K-sparing drugs in terms of nutrition?
- avoid excess dietary K and K supplements - avoid salt substitutes - avoid excess water consumption - take with food - avoid natural licorice
44
What is the generic name for Ace Inhibitors?
ramipril (Altace)
45
What is the mechanism of Ace inhibitors?
inhibit conversion of angiotensin I to angiotensin II | --> decrease vasoconstriction, ADH, inhibits aldosterone release
46
What are the side effects and interactions of Ace inhibitors?
- hypotension, dry cough, may worsen renal function, hyperkalemia - side effects are increased in African Americans - avoid salt substitutes - avoid natural licorice
47
What is the generic name for Angiotensin II Receptor Blockers (ARB)?
Valsartan (Diovan), losartan (cozaar)
48
When should ARB used?
usually used when ACEi are not tolerated
49
What is the mechanism of ARB?
block angiotensin II receptor and therefore decreases its activity --> vasodilation, reduced vasopressin and aldosterone
50
What are the side effects and interactions of ARB?
- hyperkalemia, nausea, dizziness - avoid salt substitutes - avoid licorice - caution with grapefruit
51
What is the generic name for Calcium channel blockers?
amlodipine (Norvasc)
52
What is the mechanism of CCB?
affect the movement of Ca through Ca channels causing blood vessel relaxation (especially large vessels)
53
What are the side effects and interactions of CCB?
- edema, nausea, heartburn - avoid natural licorice - limit caffeine - limit or avoid alcohol - avoid grapefruit with felodipine (plendil)
54
What is the contraindication of CCB?
Heart failure
55
What is the generic name for B-blockers?
propanolol (inderal), atenolol, metoprolol
56
What is the mechanism of B blockers?
block adrenergic beta-receptors in the heart (BI) --> decrease rate and cardiac output block epinephrine
57
What are the side effects and interactions of B-blockers?
- N/V, constipation/diarrhea, bloating, marks symptoms of hypoglycemia (caution w/DM), dizziness, fatigue, CHF, hallucinations, insomnia - avoid natural licorice - beta blockers are not recommended as intial therapy in those over 60 years of age.

6-Clinical Nutrition 1 (21 decks)

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