Hypertension Part II Flashcards
(69 cards)
1
Q
PA recommendations HTN
A
Accumulation of moderate PA of 30-60mins/day on most days (4-7 days) in addition to daily living activities. Increasing PA should be GRADUAL to avoid stressing out the heart
2
Q
Nutriton Diagnosis HTN
A
- Excessive E
- Excessive fats
- Excessive sodium
- Inadequate PA
- Overweight/obese
3
Q
Nutrition Intervention HTN (What to do in conjunction with anti-hypertensives?)
A
- DASH
- Weight-loss
- Sodium
- Increase K+/Ca2+/Mg2+
- PA
- Smoking cessation
- Stress management
4
Q
Key nutrients to increase in HTN
A
- Potassium
- Magnesium
- Calcium
- Fibres
5
Q
Weight-loss of 10-15%
A
SBP decrease by 5-20 mmHg
6
Q
DASH diet
A
SBP decrease by 8-14 mmHg
7
Q
Lower sodium diet
A
SBP decrease by 2-8 mmHg
8
Q
Sources of fibre/energy
A
Whole grains
9
Q
Sources of K+/Mg/Fibre
A
Dark green and orange veg, apples, apricots, grapes, tangerines
10
Q
Sources of calcium/protein
A
Low-fat dairy
11
Q
Sources of protein/Mg
A
Lean trimmed meats, opt for broil/poach/roasted poultry
12
Q
Sources of energy/fibre/protein/mg2+
A
Nuts, lentils, legumes
13
Q
How was DASH diet evidenced to be effective against HTN?
A
When compared to control, and control with high fruit and veg, “mixed diet” (dash diet) showed negative correlation with BP
14
Q
What happened when subjects consumed the high fruits/veg control diet (SAD diet but more fruits and veg)
A
Saw 1/2 amounts of decreased BP compared to DASH diet
15
Q
Is dash-diet a sodium restrictive diet?
A
NO
16
Q
DASH diet - sodium =
A
Moderate
17
Q
Dash diet - potassium =
A
High
18
Q
DASH diet - calcium =
A
Meet DRI
19
Q
DASH diet - magnesium =
A
HIGH
20
Q
DASH diet - fibre =
A
HIGH
21
Q
DASH diet - fat AMDR =
A
27%
22
Q
DASH diet - SFA AMDR =
A
6% (low)
23
Q
DASH diet - protein AMDR =
A
18%
24
Q
DASH diet - CHO AMDR =
A
55%
25
What would be the first dietary intervention?
Switch to DASH like diet, THEN reduce sodium intake to the UL
26
(T/F) Once all patients start DASH diet, they should work towards consuming a low-sodium dash diet
False, unless they have refractory HTN (all other lifestyle mods without reaching target goals)
27
What did the Omni-heart study reveal?
That DASH diets rich in protein and rich is unsaturated FA (Mostly MUFA) further reduced BP in hypertensive individuals, but increasing CHO did not.
28
What were the effects of high-fat/low-CHO DASH diet?
- Similar decrease in BP
- Deceased TG
- Decrease large/medium VLDL
- Did NOT decrease LDL, but increased diameter (less atherogenic)
29
What does the HF/LC DASH diet suggest?
That low fat dairy products may not be required to reap benefits (recall SFA and dairy does not increase CVD risk), and patient can consume "high" fat of they do not need to lose weight
30
Ultimately, what does the DASH diet do?
Deceased BP and CVD risk
31
What is first-line treatment?
Medications
32
What is ALWAYS recommended to go with first-line treatment?
Health behavioural management
33
In Low-risk patient (no TOD or CVD risk) what is the threshold to begin drug treatment?
160/100
34
In patient with TOD or CVD risk factors, what is the threshold to begin drug treatment?
140/90
35
In the very elderly, what is the threshold to begin drug treatment?
160 (Due to high risk:benefit ratio)
36
Why increase threshold for elderly HTN treatment?
Since side-effect may be more serious than benefits, and does not have an optimal risk:benefit ratio
37
```
Arrange the following anti-HTN in order of prescription:
Single-Pill combination
ACE-1
B-Blockers
ARB
Thiazide/Loop-diuretics
Calcium Channel Blockers
```
```
Thiaide/Loop-diuretics
ACE-1
ARB
Calcium Channel Blockers
B-Blockers
Single-Pill combination
```
38
(T/F) When a patient is not responsive to a medication, physician may add on another medication rather than increasing dosage
True - better to act on more than one mechanism and is the rationale behind the single-pill combination
39
What are some considerations when prescribing anti-hypertensives?
- Metabolized by kidney and liver --> Issues with organs?
- Drug/nutrient interaction --> Avoid natural licorice, grapefruit
- Nutritional status --> Low albumin may impact drug transport
- Physiological status --> Age, pregnancy, lactation
40
anti-HTN appropriate for diabetics? (ADA)
ACE-I
Diuretics
ARB
41
anti-HTM appropriate for Coronary Artery Disease?
All but diuretics
42
What should NOT be used in Heart Failure?
Calcium channel blockers
| Diuretics
43
Mechanism of loop/thiazide diuretics
Decrease Na+/K+ reabsorption and cause osmotic diuresis. Na, K+ and H+ losses, must monitor potassium levels --> Risk of HYPOKALEMIA
44
K-sparing diuretics mechanism
Inhibit aldosterone, less Na+ into blood stream while retaining potassium. Risk of HYPERKALEMIA if taking supplements at the same time
45
Loop diuretics example
Furosemide/Lasix
46
Loop diuretics side-effects
Hypokalemia, hyperglycemia, anorexia
47
Thiazide diuretic examples
Hydrochlorthiazide/Apo-Hydro
48
Thiazide diuretic side-effects
Hypokalemia, hyperlgycemia, anorexia, malaise, muscle weakness
49
Guidleines for booth loop/thiazide diuretics? (K losing)
Provide potassium rich foods or supplementation (Note supplements could induce N/V - take with food)
50
K+ SPARING diuretics example
Spirinolactin (Aldactone), Triamterene, Amiloride
51
Guideline for K+ sparing diuretics?
AVOID EXCESS POTASSIUM THROUGH DIET AND SUPPLEMENTATION. Avoid salt-supplements, excess water, natural liquorice and take with food.
52
Should those on K+ sparing diuretics reduce consumption of dietary potassium?
No, but don't consume in excess amounts
53
ACE-I example
Ramipiril/Altace
54
ACE-I mechanism
Inhibits conversion of Ang I --> Ang II, decreases vasoconstriction and vasopressin/aldosterone release
55
ACE-I side effects
Hypotension, dry cough, decreased renal function, hyperkalemia. Side effects exacerbated in African-Americans?
56
Ace-I guidelines
Avoid salt-substitutes and natural liquorice
57
When would ARB be prescribed? What it it? What effect?
When ACE-I cannot be tolerated.
Ang II blocker
Same downstream effects of ACE-I
58
ARB mechanism
Blocks the binding of ANG-II to receptors, decrease vasoconstriction and vasopressin/aldosterone release
59
Side effects of ARB
Hyperkalemia, N/V
60
ARB guidelines
Avoid salt-substitutes, natural liquorice, grapefruit
61
Long acting CCB examples
Amlodipline/Norvasc
62
CCB mechanism
Affect movement of Ca through channels, cause vasodilation and inhibit contraction of myoepithelium
63
CCB side effects
Edema, nausea, heartburn (GERD?)
64
CCB guidelines
AVOID IN HF, limit caffeine, avoid completely
65
Which CCB should grapefruit be avoided?
Felodipine/Plendil
66
B-blocker examples
Proponolol/Atenolol/Metoprolol
67
B-blocker mechanism
Block B-adrenergic recpetor in heart (epi/norepi), decrease CO and heart rate .
68
What are the severe side effects of B-blocker?
Can mask/mimic symptoms of hypoglycemia, dangerous for those w/ DM. Dizziness, fatigue, CHF, hallucinations, insomnia.
69
B-blocker guidelines
Caution with DM, avoid natural liquorice and NOT recommended as initial therapy for those over 60 y/o.
