Presentation is loading. Please wait.

Presentation is loading. Please wait.

Medical Nutrition Therapy in Hypertension

Similar presentations

Presentation on theme: "Medical Nutrition Therapy in Hypertension"— Presentation transcript:

1 Medical Nutrition Therapy in Hypertension
Chapter 36 Medical Nutrition Therapy in Hypertension

2 Hypertension Persistently high arterial blood pressure, defined as systolic blood pressure above 140 mm Hg and/or diastolic blood pressure above 90 mm Hg

3 Circulatory Diseases/Problems
1. Hypertension (HTN) 2. Hyperlipidemias 3. Atherosclerosis 4. Coronary heart disease 5. Congestive heart failure 6. Cerebrovascular disease 7. Peripheral vascular atherosclerotic occlusive disease

4 Circulatory Systems in the Body
1. Coronary—supplies blood to heart muscle (can form collateral circulation) 2. Cerebral—supplies blood to head 3. Splanchnic—supplies blood to abdomen (exercise removes blood and food attracts blood to this area) 4. Pulmonary—supplies blood to lungs (O2 and CO2 exchange)

5 Measures of Heart Function
1. Beats or pulse 2. BP systolic and diastolic 3. ECG

6 Determinants of Blood Pressure
1. Blood volume 2. Vascular resistance to pressure 3. Heart stroke volume

7 Cardiac Output ■ Amount of blood pumped by heart (vol/min)
■ Stroke volume times heart rate

8 Vascular Resistance ■ Viscosity of blood
■ Width of vessels—(constriction or dilation)—controlled by muscle tone in vessel walls

9 Regulation of Blood Pressure
1. Sympathetic nervous system (SNS)—responds immediately; baroreceptors monitor BP Vasomotor center in brain SNS innervated tissues contract or dilate vascular bed 2. Renin-angiotensin system—retains Na and H2O to increase blood volume; constricts blood vessels; increases aldosterone 3. Kidneys—respond to renin-angiotensin system; aldosterone and antidiuretic hormone (ADH) are sent out as needed

10 Homeostatic Control of Blood Pressure
Short term —Sympathetic nervous system —Vasoconstriction —Vasodilation Long term —Fluid volume —Renin-angiotensin system

11 Hypertension 1. 90% HTN is essential HTN (cause unknown; perhaps prenatal impacts?) 2. 10% HTN is secondary to other diseases 3. HTN is a risk factor for MI, CVA, renal failure

12 Renin-Angiotensin Cascade
Redrawn from Guyton AC: Textbook of medical physiology, ed 8, Philadelphia, 1991, WB Saunders.

13 Classification of Blood Pressure for Adults Ages 18 Years and Older
From the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: Sixth Report (JNC VI), Arch Intern Med 157:2413, 1997. *Not taking antihypertensive drugs and not acutely ill. When systolic and diastolic blood pressures fall into different categories, the higher category should be selected to classify the individual’s blood pressure status. For example, 160/92 mm Hg should be classified as stage 2 hypertension, and 174/120 mm Hg should be classified as stage 3 hypertension. Isolated systolic hypertension is defined as systolic blood pressure 140 mm Hg or greater and diastolic blood pressure less than 90 mm Hg and staged appropriately (e.g., 170/82 mm Hg is defined as stage 2 isolated systolic hypertension). In addition to classifying stages of hypertension on the basis of average blood pressure levels, clinicians should specify presence or absence of target organ disease and additional risk factors. This specificity is important for risk classification and treatment. †Optimal blood pressure with respect to cardiovascular risk is less than 120/80 mm Hg. However, unusually low readings should be evaluated for clinical significance. ‡Based on the average of two orr more readings taken at each of two or more visits after an initial screening.

14 Treatment of Hypertension—Cause
Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.

15 Treatment of Hypertension— Pathophysiology
Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.

16 Treatment of Hypertension— Medical and Nutritional Therapy
Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.

17 Risk Factors for Developing Hypertension
(Adapted from National High Blood Pressure Education Program Working Group report on primary prevention of hypertension. Arch Intern Med 153:186, Copyright 1993, American Medical Association. Reprinted with permission.)

18 Components of Cardiovascular Risk Stratification in Patients with Hypertension
(From The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. sixth report (JNC VI). Arch Intern Med 157:2413, 1997.)

19 Untreated or Uncontrolled Hypertension
Leads to increased Workload on heart Damage to arteries Atherosclerosis Coronary heart disease esp. CHF Strokes Transient ischemic attacks (TIAs) Kidney damage Microvascular hemorrhages in brain and eye

20 Medical Management of Hypertension Based on Risk
High-normal BP and Stage 1 hypertension in low- or medium-risk group —Begin with trial of lifestyle modification for 6 to 12 months High-normal BP and Stage 1 hypertension in high-risk group —Begin with drug therapy in addition to lifestyle modification Stages 2 and 3 all risk groups

21 Steps to Manage High Blood Pressure
Weight management —If over 115% of ideal body weight, exercise and hypocaloric diet estimate 25 kcal/kg minus 500 to 1000kcal/day Salt restriction —6 g NaCl or 2400 mg Na/day

22 Levels of Na Restriction
g Na mEq Na Description No added salt Mild to moderate restriction Strict sodium restriction Severe sodium restriction

23 Response to Dietary Rx Salt sensitive respond well to sodium restriction Most respond to increased potassium in diet. 1.1 to 3.3 g Na is safe 1.9 to 5.6 g K is recommended to achieve ratio Na:K of 1, which is goal If taking a potassium-wasting diuretic drug, increased potassium in diet is essential. Most respond to increased calcium (at least the RDA)—use the DASH diet protocol

24 DASH Diet Works within 14 days Lowers BP quite well
Includes more potassium, calcium, other nutrients

25 DASH Diet —cont’d Pattern —7-8 whole grains —4-5 vegetables
—4-5 fruits —2-3 low-fat or fat-free dairy products —6 oz or less meat/poultry/fish —4-5 servings nuts, beans, or legumes/week —2-3 servings fat (total kcal = 27% fat)

26 DASH Diet Website p/dash/new_dash.pdf

27 Food Label Terms Sodium free, no sodium = <5 mg/serving
Very low sodium = <35 mg/serving and per 100 g food Low sodium = <140 mg/serving and per 100 g food Reduced sodium = 50% less than comparison food 1

28 Salt Substitutes Composition: KCl, CaCl, Al-Cl
KCl can provide extra potassium for those taking diuretics KCl can be harmful if patient has renal insufficiency “Lite” salt contains sodium Some spices and herbs are low in sodium Others are high in sodium 2

29 Classification of Antihypertensive Drugs
Diuretics —Thiazides —Loop diuretics —Potassium-sparing diuretics Beta blockers Alpha-beta blockers Alpha1 receptor blockers ACE inhibitors Calcium antagonists Direct vasodilators

30 Antihypertensive Drugs
Volume Depletors Sympathetic Blockers Diuretics Peripheral Thiazides Reserpine Chlorthalidone Guanethidine Metolazone Loop diuretics Central: methyldopa Furosemide Clonidine K+ sparing ß-receptor: propranolol Spironolactone Atenolol Triamterene Metoprolol Amiloride Nadolol Timolol α-receptor: phentolamine Phenoxybenzamine Prazosin 4

31 Lifestyle Modifications for Prevention of Hypertension
Lose weight if overweight Limit alcohol Increase physical activity Decrease sodium intake Keep potassium intake at adequate levels Take in adequate amounts of calcium and magnesium Decrease intake of saturated fat and cholesterol Stop smoking

32 Summary Lifestyle modifications for prevention of hypertension—quite effective! Management of hypertension—very important to reduce risk of heart attack or stroke!

Download ppt "Medical Nutrition Therapy in Hypertension"

Similar presentations

Ads by Google