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Clinical Nutrition 1 > Hypertension Part 1 > Flashcards

Hypertension Part 1 Flashcards

1
Q

What are the major forms of CD? (HIP-HA)

A 
Hypertension
Ischemic heart disease
Peripheral vascular disease
Heart failure
Atherosclerosis
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2
Q

What is the leading cause of death in Canada? Second leading cause?

A

Cancer

CVD

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3
Q

Why are CVD now second leading?

A

CVD much better diagnosed, better medications and medical treatment

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4
Q

What was they key point in the graph comparing men and women and prevalence of HTN?

A
  • Men linearly increases

- Women increase, but flatten over time

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5
Q

Why are both trends upwards in HTN and gender?

A

Probably associated with the increase in obesity, as obesity is a major cause of hypertension

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6
Q

Are most people aware of their HTN?

A

Yes 65% treated and aware, but 18% unaware - meaning that the prevalence of HTN could actually be greater

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7
Q

Development of HTN is very much based on what?

A

Age

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8
Q

Stat of HTN and Age?

A

Lifetime risk for adults aged 55-65 y/o with NORMAL BP to develop HTN is 90%

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9
Q

HTN Affect …

A

1/5 of Canadians

22% of adults > 20 y/o

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10
Q

HTN risk similar between ….

A

Men and post-menopausal women

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11
Q

1 reason of doctor visits Canada?

A

HTN

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12
Q

Rates of HTN increase and decrease in which ethnicities?

A

Increase in blacks

Decrease in chinese, korean

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13
Q

BP=

A

Cardiac output x peripheral resistance

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14
Q

CO=

A

Heart rate x stroke volume

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15
Q

PR=

A

Length of vessel x viscosity of blood / radius ^4

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16
Q

How is radius determined?

A

By vasonconstriction or vasodilation of blood vessels

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17
Q

An increase in ____ will increase BP

A
  • Heart rate
  • Stroke volume
  • Viscosity of blood
  • Length of vessel
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18
Q

A decrease in ___ will increase BP

A

-Radius of blood vessel

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19
Q

What are some major factors involved in the regulation of Mean Arterial Blood Pressure?

A
  • Sympathetic nervous system
  • RAAS
  • Renal function
  • Epi, vasopressin, Ang II
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20
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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21
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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22
Q

Main effects of increase SNS and Epi

A
  • Increase HR
  • Increase SV
  • Increase extrinsic vasoconstriction
  • Decrease radius
  • Increase BP
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23
Q

Explain RAAS in 3-4 sentences

A

Decrease in sodium in ECF and circulation - where baroreceptors in Kindey detects decrease in BP. Kidneys secrete renin, allow for conversion of ANG (Liver) –> Ang I. Ang-1 –> Ang II possible by ACE-1 released by lungs. ANG-II is a potent vasoconstrictor, will increase BP.

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24
Q

Effects of ANG II

A
  • Stimulate adrenal cortex to release aldosterone (increase sodium pumps)
  • Vasonstriction
  • Thirst
  • Pituitiary to release vasopressin (more water reabsorption, increase BV_
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25
Q

HTN is ….

A

Asymptomatic

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26
Q

Primary HTN

A

Unknown etiology or gene/environment, dietary, behavioural causes

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27
Q

Secondary HTN

A

Symptom from another disease - renal, endocrine, neurological

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28
Q

Non-modifiable risk factors?

A
  • Age < 60y/o
  • Men, post-menopausal women, ethnicity
  • Family history
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29
Q

Modifiable risk factors?

A
  • Smoking
  • Sedentary
  • Abdominal Obesity
  • Excessive Sodium
  • Poor diet quality
  • Stress
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30
Q

Normal SBP

A

90-119

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31
Q

Pre HTN SBP

A

120-139

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32
Q

Stage 1 SBP

A

140-159

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33
Q

Stage 2 SPB

A

160-179

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34
Q

Stage 3 SBP

A

> 180

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35
Q

Normal DBP

A

60-79

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36
Q

Pre HTN DBP

A

80-89

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37
Q

Stage 1 DBP

A

90-99

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38
Q

Stage 2 DBP

A

100-109

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39
Q

Stage 3 DBP

A

> 110

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40
Q

What is TOD?

A

Target Organ Damage

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41
Q

What kind of major TOD may result from HTN or may put patients at a higher risk for HTN complications?

A
  • Coronary Artery Disease
  • Left-ventricular hypertrophy
  • Heat Failure
  • Stroke
  • Transient Ischemic Attack
  • Hemorrhage
  • Demential
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42
Q

What kind of mino TOD may result from HTN or may put patients at a higher risk for HTN complications?

A

Retinopathy
Peripheral Artery Resistance
Nephropathy (Albuminuria, Chronic Kidney Disease)

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43
Q

What classifies a high risk patient?

A

One or more of the following:

  • Clinical or subclinical CVD risk
  • Chronic Kidney Disease
  • FRS global CVD risk >15%
  • Age >/= 75
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44
Q

What is considered Chronic Kidney Disease?

A
  • Non-diabetic neuropathy
  • Proteinuria <1g/dl
  • GFR 20-59 ml/min/1.73m^2
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45
Q

What classifies a moderate/high risk patient?

A

-Multiple CVD risk FACTORS

and FRS global CVD risk >15%

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46
Q

What classifies a low risk patient?

A

-No CVD risk factors or TOD

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47
Q

How is DM classified?

A

High Risk

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48
Q

Initiation of treatment for High Risk patient

A

130 SBP

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49
Q

Initiation of treatment for DM patient

A

130/80

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50
Q

Initiation of treatment for Mod/High risk patient

A

140/90

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51
Q

Initiation of treatment for Low risk patient

A

150/100

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52
Q

Target for High Risk Patient

A

120 SBP

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53
Q

Target for DM

A

130/80

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54
Q

Target for Mod/High risk

A

140/90

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55
Q

Target for Low risk

A

140/90

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56
Q

(T/F) BP Threshold and targets for High Risk patient based on non-AOBP

A

False, based on AOBP

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57
Q

(T/F) BP Threshold targets for DM, Mod/High and Low risk patient based on non-AOBP

A

True

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58
Q

Effects of increased vasopressin and ANG II on HTN

A

May be due to gene mutation

Increase aldosterone, thirst, vasopressin release, vasoconstriction, water and sodium retention to increase BP

59
Q

Effects of smoking on HTN

A

Will inhibit NO, limit vasodilation

60
Q

Effects of renal disease on HTN

A

Decrease blood flow through kidney will increase ANG I (recall RAAS and baroreceptors), increase in BP

61
Q

Effect of adrenal disorders on HTN

A

Increase epi/norepi to increase cardiac output (stroke volume, heart rate), vasoconstriction (peripheral resistance)

62
Q

What else may contribute to the pathogenesis of HTN?

A
  • Hyperinsulinemia

- Neurological disorders

63
Q

AOBP

A

Automated Office Blood Pressure

64
Q

Preferred method?

A

AOBP

65
Q

AOPB uses …

A

Electric –> Oscillometric

66
Q

What are some general guidelines when measuring BP?

A
  • Supine position
  • Quiet room
  • Cuff 3 cm above elbow and at brachial artery
  • Arm at heart level
  • Take BP at both arms, higher BP should be used as actual measurement
67
Q

AOBP threshold HTN

A

135/85

68
Q

NON-AOBP uses what?

A

Non electronic, sphygomanometer and tends to overestimate BP

69
Q

Non-AOBP threshold HTN

A

140/90

70
Q

Non-AOBP threshold HTN for diabetics

A

130/80

71
Q

When is home blood pressure monitoring used?

A

When HTN is DIAGNOSED and often used in patients w/:

  • Chronic Kidney Disease
  • DM
  • Suspected non-adherence
  • White coat HTN
  • BP controlled in office, not at home
72
Q

Home BP threshold HTN

A

Two reading taken each morning/evening for 7 days, where the first reading is discarded and average is equal or greater to:
135/85

73
Q

What is Ambulatory BP monitoring?

A

At home, will serve to measure BP every 20 mins over 24 hours

74
Q

When is Amb BP used?

A
  • Not responsive to HTN therapy
  • Symptoms are suggestive of HTN
  • Inconsistent readings
75
Q

Amb threshold HTN? (2)

A

Mean 24 hr: 130/80 (and/or)

Mean day-time: 135/85 (and/or)

76
Q

Explain the HTN diagnostic algorithm for adults

A

Patient has concern of HTN, makes appointment with doctor where 180/110 is an immediate positive for HTN/ If no, both diabetics and diabetics must then exceed non-AOBP/AOBP. If diabetics exceed, positive for HTN. If non-diabetics exceed, require final at-home BP monitoring to confirm HTN.

77
Q

Patient comes on with BP of 170/100, and has diabetes, what is the next step?

A

170/100 exceeds thresholds for AOBP and non-AOBP for diabetics –> Intervention

78
Q

Non-diabetic patient reports BP of 140/90 on non-AOBP, and then doctor sends for Amb-BP, where patient reports daytime mean BP of 135/85. What is the diagnostic?

A

HTN

79
Q

Non-diabetic patient reports BP of 135/85 on non-AOBP and then doctor suggests home BP where patient reports 130/80. What is the diagnostic? What if the same result was achieved on Amb BP?

A

If home BP –> White Coat HTN

If Amb BP –> HTN

80
Q

What would be needed for the doctor to prescribe Home or Amb monitoring according to the algorithm?

A

Non-diabetic patient that exceeds non-AOBP of 140/90 or AOBP of 135/85

81
Q

When is White Coat HTN ruled out?

A

If after home BP and AmbBP, patient stays above 135/85 and 130/80 (24 hour AmbP)

82
Q

(T/F) Mean 24-hour Amb BP is 130/82 patient has HTN

A

True (Recall threshold fro 24-hr is 130/80)

83
Q

(T/F) Mean Daytime Amb BP is 130/82 patient has HTN

A

False (Recall threshold for daytime is 135/85)

84
Q

What are the key nutritional factors in HTN?

A
  • Excess cal, weight, obesity
  • Potassium, sodium, calcium, magnesium, fibre
  • Alcohol
85
Q

What is the most potent non-pharmacological agent for HTN reduction?

A

Weight loss

86
Q

Decease of ____ per 10 kg weight loss

A

15-20 mmHg SBP

87
Q

(T/F) Decrease BP will only be seen when a healthy weight is acheived

A

False, 5-15% weight loss has a significant impact

88
Q

Why does obesity contribute to HTN?

A
  • Insulin resistance
  • Leptin will increased SNS activity (vasoconstriction, heart rate, stroke volume)
  • RAAS alteration
89
Q

Link between leptin and HTN

A

Increased leptin will increases SNS activity, recall leptin resistance in obesity where although it wont affect satiety, large amount that remain in circulation affect BP

90
Q

General recommendation for HTN and weight loss

A

Aim for normal BMI, waist circumference

All OW patients should aim for 5% weight loss to reduce BP and TOD

91
Q

What may impede weight loss?

A

B-blockers

92
Q

Key point of intersalt study

A

Linear relationship between increased urinary sodium excretion and BP, where urinary sodium excretion is a very accurate marker of sodium intake

93
Q

According to intersalt study, each increase of 100mmol/sodium increased SBP by ____ and DBP by ____

A

3-6

0-3

94
Q

Key point of intersalt study and decreased sodium intake?

A

Linear relationship between decreased urinary sodium excretion and BP, where more drastic reductions in BP were seen in hypertensive individuals despite same urinary sodium excretion (same sodium intake)

95
Q

Key FINDING from study that compared SAD an DASH diet at 3 levels of sodium intake?

A

That SAD diet and reducing sodium had the most drastic decrease, where DASH remained relatively linear when decreasing sodium.

96
Q

What was the key POINT from study that compared SAD and DASH diet at 3 levels of sodium intake?

A

The composition of the diet as a whole is more important than the salt reduction, as evidenced by those who consumed the DASH diet + high salt demonstrated similar reduction on BP as those on SAD + low salt.

97
Q

Reduction of BP stems from the ___ and not ____ only

A

Composition of the diet as a whole

Sodium reduction

98
Q

Define salt sensitivity

A

The increase in BP as a dose-dependant response to sodium chloride intake

99
Q

Whats is the issue with reducing salt?

A

Not all individuals are salt-sensitive, and will not reduce their BP in response to a decrease in salt (1/3 of population)

100
Q

What can induce salt-sensitivity?

A

Increased potassium

101
Q

When is decreased salt-sensitivity a good thing?

A

When induced by an increase in potassium, where the HTN effects of sodium are blunted

102
Q

When is decreased sensitivity a bad thing?

A

When we reduce our sodium intake with no change in BP, or even an increase in BP

103
Q

What influences salt-sensitivity?

A
  • Genetics
  • Age
  • Severity of HTN
  • Low RENIN
  • High Epi/SNS
  • Increased K+
104
Q

Sodium AI 14-50 y/o

A

1500 mg/day

105
Q

Sodium AI 51-70 y/o

A

1300 mg/day

106
Q

Sodium AI 71 y/o

A

1200 mg/day

107
Q

UL Sodium?

A

2300 mg/day

108
Q

Usual sodium consumption in Canada?

A

3.5 g

109
Q

Recommendations for salt intake?

A

Decrease intake towards UL (2300 mg/day) or 5 g of salt (2.5 g of Na+ and 2.5 g of Cl-)

110
Q

How much sodium in 1/2 tsp of salt?

A

1120 mg

111
Q

____ sodium from processed foods

A

80%

112
Q

____ from “conscious” sodium and natural content of foods

A

20% (~10% each)

113
Q

Official recommendations on Salt

A

Choose unsalted, lower sodium or sodium reduced foods with <120 mg sodium, serving or <5% DV

114
Q

Why are there official recommendations on reducing salt although large amount of population is salt insensitive?

A

Large insensitive, but majority (2/3) is sensitivity which is grounds for Public Health Messaging

115
Q

3000 mg sodium hospital diet discludes …

A

High Na+ processed foods and bev

Allow 1/4 salt added during cooking/table

116
Q

2000 mg sodium diet discludes …

A
  • High Na processed foods/bev
  • Limit milk/milk products <2 cups/day
  • NO salt added in cooking/table
117
Q

1000 mg sodium diet discludes …

A

Same as 2000 mg

  • No canned, frozen foods
  • No deli, cheese, margarines
  • Limit regular bread to <2 servings/day
118
Q

When are 1000 mg diets prescribed?

A

Chronic renal diseases only

119
Q

As dietary potassium increases what happens? (2)

A

Salt sensitivity decreases

BP decreases

120
Q

As dietary sodium increases, what happens?

A

Potassium excretion increases

BP increases

121
Q

Explain why increased K+ may decrease BP

A
  • Increase natriuresis
  • Suppression of renin
  • Attenuates vascular constriction
  • Decreases SNS
  • Protect against familial susceptibility
122
Q

What will increase the impact of increasing dietary potassium in the diet?

A

If the patient is salt sensitive, and has a high sodium intake

123
Q

The relationship between sodium and potassium is ____

A

interpendent (Effects of BP dependant on the relationship between sodium and potassium)

124
Q

What are the consequences of long-term exposure to high sodium diet?

A

Retention of sodium, excretion of potassium

125
Q

Chronic high sodium impairs _____, and a deficit of potassium encouraged the retention of ____

A

potassium conservation

sodium

126
Q

Explain what happens in the kidney cell when there is high amounts of sodium and a deficit of potassium

A

Digitalis-like-factor and aldosterone released from the kidney to STIMULATE sodium pump activity. Results in more Na+ to bloodstream and more K+ to tubule lumen for excretion –> Increase BP

127
Q

Explain what happens in the vascular endothelium smooth muscle cell when there is an excess of sodium and deficit of potassium?

A

Digitalis-like factor will INHIBIT sodium pump, causing even more retention of sodium. Causes depolarization of membrane, and opening of Na+/calcium channels. Calcium allows for contraction, and upon depolarization K+ channels open, more depletion of K+ –> Increase BP

128
Q

(T/F) Potassium supplements are recommended to prevent HTN in normotensives or in the treatment of HTN

A

False, potassium should be easily obtained through dietary intake

129
Q

(T/F) Potassium supplements are recommended if patient on K+ losing diuretic to reduce risk/treat hypokalemia

A

True, and also recommend increasing dietary potassium

130
Q

Intake of K+ associated with decreased risk of stroke/mortality?

A

> 60mmol/day

131
Q

Average intake of K+ in adults?

A

2800 mg/day for women and 330 mg/day for men

132
Q

What is the RDA for potassium?

A

4700 mg

133
Q

Risk factors for hyperkalemia

A

RAAS inhibitors
Chronic Kidney Disease
Medications
Basal serum levels >4.5 mmol/L

134
Q

(T/F) Increase in calcium associated with increase in BP

A

False, opposite effects

135
Q

Why does calcium reduce BOP?

A
  • Parahormone suppression
  • Natriuresis
  • NO sensitivity
  • Recuced vasoconstrictors
136
Q

How does magnesium reduce BP?

A

Reduces vascular reactivity and contractility

137
Q

Alcohol intake has a ______ relationship with BP, where an intake greater than ____ increased BP

A

Dose-responsive

2 drink/day

138
Q

(T/F) Alcohol has a vasodilation effect

A

TRUE - but will then be followed by an increase in BP 10-15 hours after

139
Q

Alcohol recommendations men

A

2 drinks/day

140
Q

Alcohol recommendations women

A

1 drink/day

141
Q

SD Bee @ 5%

A

12 oz/ 360 ml

142
Q

SD Wine @ 12%

A

5 oz / 150 ml

143
Q

SD Spirits @ 42%

A

1.5 oz/ 45 ml

Clinical Nutrition 1 (30 decks)

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