Cardiovascular Diseases: Hypertension

Cardiovascular Diseases

• Chronic non-communicable diseases characterized by persistently elevated arterial pressure.
• Systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg indicates arterial hypertension.
• Resistant hypertension is when BP remains above recommended levels despite using three different classes of antihypertensives.
• Hypertension leads to structural and functional changes in organs, increasing the risk of coronary artery disease, heart failure, stroke, dementia, chronic kidney disease, and peripheral artery disease.
• African descent is a non-modifiable risk factor for hypertension.

Pathophysiology

• Abnormal activation of the renin-angiotensin-aldosterone system = vasoconstriction = vascular resistance = increased renal reabsorption of Na+ (and feeling thirsty), increasing blood volume, and cardiac output.
• Sympathetic nervous system activation by adrenaline induces heightened BP due to tachycardia = increased cardiac output and vasoconstriction.
• Insulin resistance = enhanced renal sodium reabsorption = increased blood volume = increased cardiac output.
• Insulin, a natural natriuretic hormone, boosts sodium elimination naturally.
• Reduced nitric oxide production = reduced vasodilation = increased vascular resistance.

Non-Pharmacological Treatment

• Achieving and maintaining a healthy weight and waist circumference (men <90cm; women <80cm) proves a basic necessity.
• A healthy diet, specifically the DASH diet (rich in potassium, magnesium, calcium, and fiber, low in saturated fat, sodium, and sugar), is beneficial for hypertensive individuals.
• Daily sodium intake should be <2g.
• Daily potassium intake should be between 3.5 and 5g.
• Exercise stress control.
• Obese individuals have a 50% higher chance of uncontrolled BP compared to those with a BMI <25 – weight loss is advised.

DASH Die

• Based primarily on vegetables (grains, fruits, vegetables, and legumes) and skimmed dairy products, with reduced fat, salt, and sugars.
• Effective in controlling BP because of its high content of electrolytes with hypotensive characteristics such as calcium, potassium, and magnesium.
• The Mediterranean diet is also effective in treating cardiovascular diseases but has modest effects on BP.
• Sodium sensitivity and volume overload are the main pathophysiological mechanism in most hypertension cases; daily sodium intake should be <2g (<5g of salt per day).
• A diet rich in potassium also shows BP-lowering effects, and its intake should range between 3.5 and 5g/day (abundant in vegetables and skimmed dairy).

Effects of Specific Foods on Blood Pressure

• Skimmed dairy products are rich in calcium, magnesium, vitamin K, and whey protein, showing a hypotensive effect.
• Chocolates and cocoa derivatives are sources of polyphenols and has shown a reduction in systolic and diastolic BP in hypertensive patients.
• Coffee and caffeinated products is a source of polyphenols, magnesium, and potassium. Coffee can have an acute hypertensive effect, but regular consumption leads to tolerance. It's recommended that consumption not exceed low to moderate amounts (<200mg of caffeine).
• Vitamin D, vitamin C, garlic, soy, omega 3, magnesium supplementation, combined vitamins, teas and coenzyme Q10 have no proven efficacy.

Dyslipidemia

• Any alteration of serum lipid fractions.

After the digestive process

• Absorption of digestion products occurs. In the enterocyte, products are resynthesized into triglycerides, phospholipids, and cholesterol, then integrated into apoproteins, forming the lipoprotein chylomicron.
• Chylomicrons transport only dietary lipids, are released into the lymphatic stream then enter the bloodstream, and deliver free fatty acids to adipose and muscle tissues via lipoprotein lipase.
• Chylomicron remnants are metabolized by the liver and is also capable of endogenously producing cholesterol and triglycerides.

Lipoproteins

• Very low-density lipoprotein (VLDL): higher content of triglycerides and less cholesterol and phospholipids.
• Low-density lipoprotein (LDL): mainly formed of cholesterol and has the highest atherogenic potential because it's easily affected by free radicals and accumulates in the endothelium, forming atheroma plaques.
• High-density lipoprotein (HDL): characterized by the presence of apoprotein A, transports cholesterol from the endothelium to the liver for metabolism and excretion (reverse cholesterol transport). Thus, HDL is a cardiovascular protection lipoprotein, and reduced levels increase the risk of cardiovascular events.

Criteria for Classifying Dyslipidemias

• Isolated Hyperlipidemia: Increased LDL (>160mg/dL)
• Isolated Hypertriglyceridemia: Increased TG (>150mg/dL OR >175mg/dL fasting)
• Mixed Hyperlipidemia: Increased LDL and TG (above the limits) Consider Mixed Hyperlipidemia if TG > 400mg/dL and non-HDL > 190mg/dL
• Hypoalphalipoproteinemia: Reduced HDL in isolation or in association with increased TG or LDL Men: <40mg/dL and women: <50mg/dL

Etiologies

• Primary causes: genetic origin.
• Secondary causes: stem from inadequate lifestyle, certain morbid conditions, and/or medications.

Therapeutic Goals

• Total Cholesterol: <190 mg/dL (fasting and non-fasting)
• Triglycerides: <150 mg/dL fasting and <175 mg/dL non-fasting
• HDL: >40 mg/dL fasting and non-fasting
• LDL: <130 mg/dL fasting and non-fasting
• Non-HDL: <160 mg/dL fasting and non-fasting
• LDL < 70 and non-HDL < 100 indicate a risk of intracerebral hemorrhage.

Special Attention

• Very High-Risk patients include those: with subclinical atherosclerosis or atherosclerotic plaques; abdominal aortic aneurysm; chronic kidney disease with GFR <60ml/min and non-dialysis phase; and patients with LDL >190;
• High-Risk patients include DM types I or 2 with LDL between 70 and 189 and presence of risk factors
• Individuals who present significant atherosclerotic disease (coronary, cerebrovascular, peripheral vascular), with or without clinical events OR with >50% obstruction in any arterial territory are at a Very High-Risk.

Nutritional Treatment in Hyperlipidemia

• Increase isolated LDL

LDL within Recommendations

• Maintain a healthy weight.

LDL Above Target

• Weight loss of up to 5%.
• Carbohydrates: 50-60%.
• Protein: 15%.
• Lipids: 25-35%.
• Trans Fat: exclusion of trans fat from the diet.
• Saturated Fat: <10%.
• Fiber: 25g, with 6g being soluble since they have a probiotic action.
• Recommendation from the Brazilian Society of Cardiology.
• Saturated fatty acids like lauric, myristic, and palmitic have a higher atherogenic potential: red and processed meat, whole milk and derivatives, coconut and coconut oil, palm oil, bacon, and baked goods rich in fat;
• Soluble fiber fermentation forms short-chain fatty acids (acetate, butyrate, and propionate), which, are absorbed by enterohepatic circulation, stimulate cholesterol synthesis regulators.

Nutritional Treatment in Hypertriglyceridemia

• Dietary modifications for isolated increase of TG

TG Within Requirements

• Weight loss of 5 - 10%.
• Limiting Carbohydrates: 45 to 50%.
• Protein intake: 20%.
• Avoid trans and less saturated fats.
• EPA - DHA (g/day): > 2
• Limit fructose to avoid elevation of TG, reduce consumption of saturated acids
• Supplement with omega-3 is indicated for patients with hypertriglyceridemia

Atherosclerosis and Coronary Artery Disease

• Atherosclerosis: process of forming atheroma plaques that can partially or completely obstruct blood vessels.
• Coronary Artery Disease: a consequence of Atherosclerosis involving constriction of the coronary arteries.
• Impedes oxygen and nutrient arrival in cells, resulting in myocardial ischemia with symptoms of chest pain (angina pectoris) and infarction.

Pathophysiology of Atherosclerosis

• Progressive, inflammatory, and thrombotic process: Estría Formation: LDL accumulation in the arteries is the key first step Oxidation of LDL: deposited particles undergo oxidation reactions. Formation of Foam Cells: attract monocytes and other immune cells. Inflammation: cells undergo apoptosis. Smooth muscle: migrate protection cells to protect the muscle and deposit minerals
• Capillaries form a membrane around the plaque increasing risks of microlesions, a collection of platelets make up a formation that reduce flow.

Acute Myocardial Infarction

• Myocardial necrosis due to blockage of blood flow from the muscle, depriving the cardiomyocytes of nutrients and oxygen and resulting death.

Classifications

• IAMCSST (ST-segment elevation): total occlusion of arteries
• IAMSSST (no ST-segment elevation): partial blockage

Risk factors

• Smoking.
• Arterial Hypertension.
• Dyslipidemia.
• Diabetes.
• Abdominal obesity.
• Family history.
• Male gender.
• Sedentary lifestyle and stress.

Diagnosis and signs

• Chest is the first diagnosis to check for a strong intensity
• Fatigue

Treatment

• Utilizar Harris and Benedict added to injury and stress or utilize a 20 to 30 kcal/kg/da
• Give proteins, sodium, fibers, water and meals 4–6 times a day in patients

Heart Failure

• Characterized by the heart's inability to pump blood effectively to the rest of the body.
• Acute HL happens rapidly while chronic HL is progressive and consistent.
• Patient needs consistent tracking
• Class 1: absence.
• Class 2: phsycial activities causes a slight limitation, but it must be maintained.
• Class 3+4 no physical activities

Risk factors

• AMI/ Agudo MI.
• HAS.
• Daibetesm and aging.
• Low diagnostics and no treatment.

Diagnosis

• Low CO caracterize the HIC
• Evocardiogra[fia and X-Rays need constant evulation

How HL works

• Constant lesion compromise the functions diminishing the CO, hipertrofias remodel the heart
• It increases hemoidinmics
• increases citocinas
• NE angiotensina

Dietary treatment and recomandations

• Help minimize loss, and overcharge and maintain diet
• Should take 5-6 fractionated meals everyday
• consider supplements and nutrition.
• should take protein, normal glucose and normal lipididic diet.

Some diet recomendations for IC

• Carbohydratos
• Protein patients 2g/kg de nutritivos- 8g/kg/
• Micro nutrients and important to have a strong body

Avoid foods

• Ultra procesados
• Embudidos
• Conservas molhos prontas
• Ervas e arcomaticos e natureais
• Acidos graxos

AVC Acidente Vascular Cerebral

• or vascular encefalico
• Derrame cerebral
• Ocorre a rupura no vaso
• Pode ser isquemicos ou hemrogicos

Isquemicos

• The interruption of the blood flow

Hemorrogias

• Cased by the rommpiento do vaso
• Ceerebral can consicnt hemorogias

Cuses AVC and factor

• The idade avancada
• DM2
• Hipertolesterolemia
• Obesidade
• Tabigismo
• Etilismo
• Sedentarismo

Other causes

• Difficuldades, engullitinge, para falar, para caminhar.
• Cerebrais greves causem morte subita.

Oter fator

• The majority causes by has and diet

O QUE DIFERE

• The Avc trombolitico of avc embolica e a origen da trombos

Embolico:

• the trombo e proveniete de
• Avc trombatico e a tromobse rombeu
• Aves the hemorogico ruptoro o vaso,
• Principas complciatoes of avc, neumonia

Dienterpia

• the risco of over imc to cause avc