1. Nutrition Therapy for Cardiovascular Disorders
Case Study 6

2. Patient Profile Client Name: Corey Anderson Age: 54 years old
Gender: Female
Education: High School
Occupation: Housewife
Ethnicity: African American
Religious Affiliation: Catholic

3. Medical Diagnosis Current Medical diagnosis: BP 160/100 mm Hg
Stage 1 Hypertension (HTN)
Hypertensive Heart Disease
Early Chronic Obstructive Pulmonary Disease (COPD)
Abnormal complete fasting lipid profile

4. Pathophysiology
Although the exact cause of Hypertension is not known, there are several conditions and factors that contribute to the development of this disease (nutritioncaremanual.org 2012).
Risk factors: Age, ethnicity, Family history, overweight and/or obesity, low or no physical activity, dietary intake, and socioeconomic status (nutritioncaremanual.org 2012).

5. Pathophysiology
Increased blood pressure and heart rate due to hypertension can cause damage to the endothelial lining of blood vessels (nutritioncaremanual.org 2012).
This leads to the development of Left ventricular hypertrophy, atherosclerosis, myocardial infraction, stroke, heart failure, and kidney failure (nutritioncaremanual.org 2012).

6. Relevant Medical History
Diagnosed 1 year ago with Stage 2 (essential) HTN
Was a smoker, smoked 2 packs a day for 30 years. Quit “cold turkey” when she was diagnosed with Stage 2 HTN a year ago.
Treatment over the past year focused on lifestyle changes and non-pharmacological measures.

7. Relevant Medical History
Mrs. Anderson’s mother died of a Myocardial infarction due in part to uncontrolled HTN.
Diet Therapy: Was instructed by her Medical Doctor to follow a 4g Na (no salt added) diet and given a handout outlining this dietary pattern.

8. Nutritionally Relevant Labs
Total Cholesterol: mg/dL high, normal < 200 mg/dL
LDL-C: mg/dL high, normal: < 130 mg/dL
HDL-C: 30-38mg/dL low, normal: > 55 mg/dL
Apo A: 75mg/dL low (normal range mg/dL)

9. Nutritionally Relevant Labs
Apo B: 140mg/dL high (normal range mg/dL)
TG: 150mg/dL high (normal range mg/dL)
Ferritin: mg/mL high (normal range mg/mL)

10. Nutritionally Relevant Medications
Hydrochlorothiazide- 25mg daily
Antihypertensive, Diuretic, Thiazide (K-depleting)
Take in the AM with food or milk
May need to decrease Na and calcium; increase K and Mg (or supplement). Discontinue Na restriction if hyponatremia occurs. Avoid natural licorice. Caution with Ca &/or Vit D supplements-risk of hypercalcemia. Monitor electrolytes, Mg, and Ca.
May cause anorexia and increase thirst. (Pronsky Z & Crowe J 2010)

11. Nutritionally Relevant Medications
Multivitamin and mineral supplement daily
Mrs. Anderson’s MD prescribed the following medications to treat her high blood pressure:
Angiotensin Converting Enzyme (ACE) Inhibitor (Captopril) Antihypertensive, CHF Treatment (adjunct)

12. ACE Inhibitor Side Effects
Take on empty stomach 1 hr before meals (food decreases absorption by 30-50%).
Insure adequate fluid intake/hydration.
Decrease Na & cal may be recommended. Avoid salt substitutes.
Caution with K supplements. Caution with IV iron- severe systemic reactions reported.
Fe, Mg, or Al decrease absorption-take oral Fe or Mg supplements & captopril seperately by at least 2hr.

13. ACE Inhibitor Side Effects
Al-Mg antacids/supplements decrease captopril absorption-take seperately. Avoid natural licorice.
May cause Anorexia, decrease weight. Rare- dysgeusia, metallic or salty taste.
Limit alcohol. Drug efficiency may decrease & side effects may increase in Black patients. (Pronsky Z & Crowe J 2010)

14. Nutritionally Relevant Medications
HMG CoA Reductase Inhibitors (statins)- (Zocor) Antihyperlipidemic (to decrease total & LDL-C or TG) To prevent or decrease risk of cardiovascular events to slow progression of atherosclerosis
Take without regard regard to food. Take single dose HS. Swallow SR form whole.
Decrease fat, cholesterol, (and calories if needed). Avoid grapefruit/related citrus fruit & avoid St. John’s Wart. Avoid substantial alcohol
Risk of fracture due to decrease bone resorption. (Pronsky Z & Crowe J 2010)

15. Height and Weight Interpretation
Weight: 160 lbs
BMI 25.9 kg/m2  Overwieght
Lost 10lbs over the last year since she was diagnosed with Stage 2 HTN.
Started a walking program 3-4 days a week.

16. Diet Prescription
Adopt Dietary Approaches to Stop Hypertension (DASH) dietary pattern
low sodium, fat, and saturated fat.
High in vegetables, fruits, nuts, and low-fat dairy.
“The DASH dietary pattern reduces systolic blood pressure by 8-14 mmHg”. Consensus, Imperative (Evidence Analysis Library 2012).

17. Diet Prescription
Dietary sodium intake should be limited to less than 2300mg Na per day. This can help lower systolic blood pressure 2- 8mmHg. Strong, Imperative (Evidence Analysis Library 2012).
These dietary changes and patterns are interventions that will help lower Mrs. Anderson’s blood pressure.
Decreasing her blood pressure may help reverse the development and onset of Hypertensive Heart Disease and COPD

18. Diet Prescription Decrease sodium, fat, saturated fat and kcal intake
Estimated kcal needs = 2100 kcal/day (EER equation for Overweight and Obese Adults)
Dr. Atkins diet—Effective diet for weight loss??
High protein, low carbohydrate diets may be a short term strategy for some individuals (by focusing on reducing carbohydrates rather than reducing fat and/or kcals).

19. Diet Prescription
Research indicates that focusing on reducing carbohydrate intake (< 35% of kcals form carbohydrate) results in reduced energy intake.
A low-carbohydrate diet is associated with a greater amount of fat and weight loss than traditional reduced calorie diets during the first 6 months. After 1 year though there is not a significant difference.
Therefore to maintain consistent long-term weight loss, this diet may not be better than reducing overall energy intake from fat and kcals (Evidence Analysis Library 2012).

20. PES Statements
PES 1: Excessive sodium intake related to patients opinion that low sodium foods are tasteless as evidenced by analysis of 24-hour recall revealing 6124mg Na in one day.
PES 2: Excessive energy intake related to large amounts of undesirable food choices such as ice cream, donuts, and added fats as evidenced by consumption of 2,863 kcals in 24-hour recall.