1. The Lecture 9- 29 October 2013 Blood pressure-really it is elevated blood pressure or hypertension that is the focus of our discussion today

2. Outline of todays talk I.Pathology II.Socioeconomic factors contributing to the disease III. Elementary nutritional approaches to be taken to avoid and treat these diseases including foods available to those at risk IV.First Nations and other Cape Breton individuals at risk V.How is nutritional assessment made for blood pressure? VI. How would one assess from a nutritional perspective the socioeconomics, pathology and success of nutritional interventions relative to blood pressure?

3. Blood pressure I. Pathology Volume and viscosity of blood in a given volume of arterial lumen plus arterial pressure inwards gives blood pressure Blood pressure-systolic -diastolic >140 mm Hg systolic or > 90 mm Hg diastolic represents hypertension in otherwise healthy persons

4. Blood pressure I. Pathology So there are really two main factors in blood pressure volume and viscosity of water pushing outward pressure of artery pushing inward

5. Blood pressure I. Pathology Decrease blood pressure: If one can reduce water volume by reducing blood sodium, heart rate, stroke volume and hence cardiac output OR Decrease blood viscosity by reducing salt in blood serum and cholesterol, trans- and saturated fats in the blood cells

6. Blood pressure I. Pathology or decrease blood pressure via: reduction in pressure of artery by relaxing the artery (vasodilation) and hence reduce vasoconstriction

7. Socioeconomic factors Food and hence nutritional choices depend on: Personal preference what foods should be avoided what foods should be encouraged Habit fattening foods bring on obesity which increases blood pressure

8. Food and hence nutritional choices depend on: Ethnic heritage or tradition which groups would avoid the offending foods? Social interaction teenagers and younger children gathering at fast food establishments eat fattening and atherosclerosis producing foods and eat these foods in greater quantities due to repeated gatherings at these establishments

9. Food and hence nutritional choices depend on: Availability of food if only offending foods available this can be concern food borne pathogens(H. pylori and cytomegalovirus) may be an issue here- how? Convenience of food convenience foods are frequently cholesterol, trans fat, saturated fat and salt laden- what is the issue here?

10. Food and hence nutritional choices depend on: Economy of food bag of potato chips, bag of frozen fries Positive and negative association -child may have associations of fast foods with pleasant experiences -negative- examples?

11. Food and hence nutritional choices depend on: Emotional conflict elevates blood pressure on its own- this may be coupled with lack of judgment and eating blood pressure elevating foods Values -restrictions on prepared beef, pork may lower incidence of hypertension -contrast this point to values that allow prepared beef, pork

12. Food and hence nutritional choices depend on: Body image if blood pressure elevating foods are believed to be fattening such foods may be avoided Advertising fast food companies selling blood pressure elevating foods spend lots of money to promote via ease and price, the use of such foods

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15. More on socioeconomic factors Prestige -occupational-not necessarily an impact on risk or presence of hypertension in terms of diet but there is a relation between the lower the occupation of one’s father and oneself and both elevated diastolic and systolic blood pressure

17. More on socioeconomic factors Prestige -societal perceptions- may have an impact on risk or presence of hypertension -education- not necessarily an impact on risk or presence of hypertension

18. More on socioeconomic factors Power-may have an impact on risk or presence of hypertension Income-may have an impact on risk or presence of hypertension

19. More on socioeconomic factors Wealth-may have an impact on risk or presence of hypertension Education-may have an impact on risk or presence of hypertension

20. More on socioeconomic factors Social stratification -ancestry-groups with certain dietary habits -gender-males -race-blacks -ethnicity-see ancestry -mobility-see convenience of foods -mental and physical activity- mental-comfort foods physical activity-blood pressure lowered by chronic aerobic activity

21. More on socioeconomic factors Class -uppers -lower uppers -upper middles -average middles -working class -lower class How might each of these classes have an impact risk or presence of hypertension ?

22. More on socioeconomic factors Global economy- -bringing fast foods to the world -obesity is becoming an issue even in the third world Government -government can both help and hurt in the fight against hypertension-how?

23. More on socioeconomic factors Business-advertising, development of fast, convenient foods and marketing them to individuals facing the fast life profile Psychology-comfort foods -business uses behaviour modification techniques to obtain business today “you deserve a break today” History-movement toward fast paced society and the historical factors that have lead to that fast pace-such factors would be?

24. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Planning a healthy diet To do this bear in mind Adequacy Balance Energy control Nutrient density Moderation Variety

25. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Prevention-eat foods in accordance with low salt (if salt-sensitive) and eat in accordance with keeping blood plasma lipids and lipoproteins to target levels specified in the lectures on atherosclerosis

26. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk? prevention-increase fruits and vegetables and low fat foods(DASH diet) DASH-Dietary approaches to stop hypertension

27. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Post-onset-eat foods in accordance with low salt (if salt-sensitive) and eat in accordance with modifying blood plasma lipids and lipoproteins to target levels specified in the lectures on atherosclerosis antioxidant vitamins and minerals

28. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk? post onset-increase fruits and vegetables and low fat foods(DASH diet) DASH-Dietary approaches to stop hypertension

29. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Prevention-obesity, salt, dietary components detailed in the lectures on atherosclerosis to achieve a healthy blood lipid and lipoprotein profile Post-onset-obesity, salt, dietary components detailed in the lectures on atherosclerosis to achieve a healthy blood lipid and lipoprotein profile

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31. IV. First nations and other Cape Breton individuals at risk. Aboriginals Retired Unemployed Genetics Others?

32. How is nutritional assessment made for blood pressure-prevention and cure? Nutrient intake analysis salt intake dietary lipids -saturated fat -trans-fatty acids -cholesterol -other dietary components adjusted in accordance with recommendations made in lecture on atherosclerosis

33. How is nutritional assessment made for hypertension- prevention and cure? Daily food record/Diary what are potential problems with this approach?

34. How is nutritional assessment made for hypertension-prevention and cure? Retrospective data -24 hour recall -food frequency questionnaire both 24 hour recall and are used to cross check one another-how?

35. How is nutritional assessment made for hypertension--prevention and cure? Anthropometry-focus on overweight and obesity skin folds underwater weighing bioimpedance waist circumference weight, height BMI

36. How is nutritional assessment made for hypertension--prevention and cure? Nutrition focussed physical exam: body weight and height, waist circumference direct blood pressure determination headaches dizziness palpitations easy fatigability blurred vision

37. How is nutritional assessment made for hypertension--prevention and cure? Skin testing-not applicable

38. How is nutritional assessment made for hypertension--prevention and cure? Biochemical analysis blood lipids-which raise bp blood lipoproteins-which raise bp blood sodium-raises bp blood potassium-lowers bp blood calcium-lowers bp blood magnesium-lowers bp

39. How is nutritional assessment made for hypertension--prevention and cure? CLASSIFYING MALNUTRITION obesity is the main issue here thin individuals are much less at risk than obese persons

40. VI. GROUP DISCUSSION-HOW WOULD ONE ASSESS FROM NUTRITIONAL PERSPECTIVE THE SOCIOECONOMICS, PATHOLOGY AND SUCCESS OF NUTRITIONAL INTERVENTIONS RELATIVE TO HYPERTENSION ?