Hypertension PDF

Hypertension HTN Hypertension is correlated with the leading killer in NA Associated with: – CHF – Renal disease – Heart and blood vessel disease Normal, healthy BP should be ~120/80 mmHg Hypertension is >140/90 Determinants of Blood Pressure 1. Blood...

Hypertension HTN Hypertension is correlated with the leading killer in NA Associated with: – CHF – Renal disease – Heart and blood vessel disease Normal, healthy BP should be ~120/80 mmHg Hypertension is >140/90 Determinants of Blood Pressure 1. Blood volume * Relative to the elasticity of the circulatory system 2. Vascular resistance to pressure 3. Heart stroke volume HTN The lowest risk of HTN related complications is at a BP 180/>110 Risk Factors for HTN Smoking Hyperlipidemia Diabetes Obesity Stress >60 years of age Gender (men and postmenopausal women) Family Hx of CVD and HTN NHANES III National Health and Nutrition Examination Survey – found: 32% of individuals were hypertensive and unaware. 15% were aware, but untreated. 26% were treated but didn‘t reach the recommended goals. Only ~27% of North American adults had adequate blood pressure control! Related Conditions Cardiovascular Disease  Heart attack  Stroke  Cerebrovascular accident  Aneurism  Congestive heart failure Renal Disease Vascular dementia Hypertensive retinopathy Peripheral arterial disease What causes HTN? Pathophysiology: Combination of – Electrolytes/minerals – Water – Inelasticity of blood vessel walls What leads to these changes? – Kidney disease/failure – Dietary intake Particularly sodium – Atherosclerosis Thirst Is a Response to Decreasing Water Concentration The Kidneys Reabsorb More Water when sodium (solute) concentration increases  Sodium Excesses Excess amounts of sodium in the diet have been linked with hypertension and heart disease. Salt is 40% sodium Populations where people consume less than 4.5 grams of salt (~1800 mg sodium) per day have relatively low blood pressure. Populations where average consumption is more than 5.8 grams of salt (~2300 mg sodium) per day have increased average blood pressure. Nutritional Care Goal is to prevent or control increases in BP, and regain a healthy range of BP Reduce the morbidity (or mortality) caused by HTN: – Stroke, MI, renal dysfunction, aneurysm Encourage wt. loss – Independent risk factor for HTN Restrict total sodium intake to 2300 mg/day (by 2016) – Less than 1800 mg if HTN is severe Limit alcohol intake Treatment guidelines Blood No risk At least 1 risk Evidence of Pressure factors factor organ damage No evidence No evidence – with or of organ of organ without risk damage damage factors High-normal Lifestyle Lifestyle Drug Therapy 130-139/85-89 Modification Modification Stage 1 Lifestyle Lifestyle Drug Therapy Modification Modification (up to 12 (up to 6 months) months) Stage 2 & 3 Drug Therapy Drug Therapy Drug Therapy Lifestyle modification Dietary changes – Reduced total energy, fat and sodium – DASH diet Limit alcohol to 2 drinks/day – 1 for women and smaller men Lose 5% of body weight Get 60 minutes of “breathless” activity 5+ times per week. – Aim for most days Stop smoking Stress Management DASH diet Take a look online and tell me the basic components of the DASH diet. Dietary Strategies to Stop Hypertension Diet is low in salt and cholesterol High in fibre, potassium, calcium, & magnesium Liberal amounts of protein Based on a 2000 kcal diet plan Potassium Potassium is correlated with a reduction in blood pressure. Potassium has a direct vasodilatory effect Helps increase water loss from the kidneys Suppresses renin and angiotensin secretion However, there is no need to supplement with high doses of potassium, simply make healthy food choices and include potassium rich foods. Classification of Antihypertensive Drugs Diuretics —Thiazides —Loop diuretics —Potassium-sparing diuretics Beta blockers Alpha-beta blockers Alpha1 receptor blockers ACE inhibitors Calcium antagonists – Issue with furanocoumarin Direct vasodilators ACE = Angiotensin - Converting Enzymes Possible drug-nutrient interaction Calcium antagonists and grapefruit. Grapefruit contains furanocoumarin. Furanocoumarin can bind to some GI tract enzymes which typically slow medication uptake into the blood. Thus, calcium antagonists could spike in the blood  cardiac arrest. Similar issues with some statins used to treat hypercholesterolemia.