HYPERTENSION Shelby Bublitz Winter Quarter 2015 Cory Ruth NTRS 415A-03 Shelly Truong Professor Owen
What exactly is HYPERTENSION? Blood pressure is affected either by peripheral resistance or cardiac output. A decrease in in the diameter of the arterioles or an increase in blood viscosity is what contributes to resistance.
What are the normal range? Systolic: The pressure in the arteries when the heart beats (during systole) Diastolic: The pressure in the arteries between heart beats (during diastole) Why in mmhg? o Millimeters of mercury. The pressure generated by one column of mercury one millimeter high Blood Pressure Systolic Diastolic Desirable Range <120 <80 Prehypertension 120-139 80-89 Hypertension 140 90 Why are these ranges important to know? o There are typically no symptoms associated with hypertension The Silent Killer 20% of people living with Hypertension are unaware they have it.
What causes hypertension? WE DONT KNOW! 90 to 95 percent of the cases of hypertension are idiopathic. This is classified as primary or essential hypertension.
The Other 5 to 10 Percent..... Secondary hypertension: Occurs as a result from other complications. Can be caused by kidney disease, cardiovascular diseases, endocrine disorders, or neurologic disorders. Glucose/endocrine profile/hgba1c: We want to know their blood glucose levels. Insulin resistance interferes with normal relaxation and dilation of blood vessels. Hyperinsulinemia promotes reabsorption of salt in the kidneys. Both of these conditions raise blood pressure. Electrolytes: In renal disease blood flow is reduced, in response angiotensin II is released which causes vasoconstriction enhancing sodium, and chloride retention. A large increase or lack of electrolytes can lead to irregular heartbeats which in turn would affect blood pressure. Potassium is an important electrolyte because it counteracts the effects of sodium (Na + Cl - ) helping to regulate blood pressure. The ratio of these electrolytes is what is important to focus on. Blood Pressure: Hypertension refers to a chronic elevation of blood pressure. Lipid Profile: Lab tests for lipid status would include testing of LDL and HDL levels. Dyslipidemia is a disorder in which you have a high levels of LDL and low levels of HDL. This ratio increases your risk of atherosclerosis, which decreases arteriole elasticity as well as a thickening of the the vessels. Both of which increases arteriole resistance BP. Prealbumin: Prealbumin is a transport protein that has a short half-life which makes it a better indicator of protein status than albumin. In addition,... Increased levels would be a good indicator of renal disease.
Risk Factors Associated with Lifestyle Choice Excessive sodium intake Excessive alcohol intake Smoking Stress Obesity Poor diet Though aging is not a lifestyle choice it is a contributing risk factor of developing hypertension. People who have normal blood pressure at 55 still have a 90 percent chance of developing high blood pressure in their lifetime.
Bicep Cuff Monitor (Sphygmomanometer) Other testing: screening for any organ damage lab testing (urinalysis, blood glucose) Diagnostic Test or Procedures
Treatment Medical Treatments: Lifestyle modification o A.K.A. lifestyle prescription Medication Surgical Treatment: Banding Sclerotherapy Transjugular Intrahepatic Portosystematic Shunt (TIPS) Distal Splenorenal Shunt (DSRS) Transplant
Medical Treatment lifestyle modification: o o o o o o Change your diet DASH Diet Physical activity Avoid or quit smoking Limit alcohol consumption Maintain a healthy weight Manage to cope with stress Medication
Surgical Treatment Banding o tying off blood vessels feeding the portal vein Sclerotherapy o injecting to cause inflammation, coagulation, and compression of the blood vessel wall DSRS/TIPS o rerouting the blood flow through connecting two veins with a shent (tubular device) Transplant o liver, heart, lungs
Classes of Drugs Diuretics ACE Inhibitors Angiotensin II receptor blockers (ARB) Calcium channel blockers
First Course of Action Diuretic: Thiazide Work on the kidneys to flush excess water and sodium from the body *Water pills Hydrochlorothiazide (HydroDIURIL) Chlorothalidone (Thalitone) Indapamide (Lozol)
Second Course of Action ACE (Angiotensin Converting Enzyme) Inhibitor Vasodilators that reduce peripheral vascular resistance *Angiotensin: a protein in the blood that stimulates aldosterone secretion and raises blood pressure *Aldosterone: a corticosteroid hormone that stimulates the absorption of sodium by the kidneys and thus regulates salt and water balance Enalapril (Vasotec) Lisinopril (Prinivil/Zestril) Ramipril (Altace) ARB (Angiotensin II Receptor Blocker) Block action of angiotensin to relax blood vessels Losartan (Cozaar) Candesartan (Atacand) Valsartan (Diovan) CCB (Calcium Channel Blocker) Prevents calcium from going to heart and blood vessel muscle cells to relax
Making Changes DASH Diet o low sodium o high fiber o Increase in potassium, calcium, magnesium o ~2000 kcals per day o ~90 g protein per day o ~2400 mg sodium per day, ~1400 mg ideal
Counseling the Patient Assess: collect data Advise: behavioral advice Agree: collaborate Assist: more information Arrange: plan out schedule
PES Statements Excessive sodium intake related to food and nutrition knowledge deficit as evidenced by sodium intake of 6000 mg/day and BP 143/93. Inadequate intake of calcium and potassium related to less than two serving per day of fruits and vegetables as evidenced by Blood Pressure 143/93. Altered nutrition related laboratory values related to undesirable food choices as evidenced by dyslipidemia.
Question #1 What causes PRIMARY hypertension? A) Cardiovascular Diseases B) We don t know! C) Neurological Disorders
Answer B) We don t know! No causes have been discovered yet. However, there are risk factors such as family history, age, gender, race, unhealthy dieting, and much more.
Question #2 Which of the following is not part of the DASH diet? A) Increase fiber intake B) Cut down on saturated and trans fat C) Increase in red meat intake
Answer C) Increase in red meat intake The DASH diet is based on a daily 2000 calorie intake rich in fruits and vegetables, whole grains, lean proteins and low-fat dairy products
Question #3 How do diuretics prevent hypertension? A) Flush excess water and sodium from the body B) Expand the blood vessels for easy blood flow C) Limits the blood vessels ability to expand
Answer A) Diuretic- Flush excess water and sodium from the body.
References About Pulmonary Hypertension: Treatments. (2012). Retrieved from http://www.phassociation.org/treatments Cardiovascular Disease Risk Factors. (2015) Retrieved from http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/diabetes/ Electrolyte disturbances. (2014) Retrieved from http://mydoctor.kaiserpermanente.org/ncal/mdo/presentation/conditions/condition_viewall_page.jsp?condition=condition_electrolyte_disturbances_- _Nephrology.xml disease-risk-factors/diabetes/ High blood pressure (hypertension). (2015). Retrieved from http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-bloodpressure-medication/art-20046280 How do Thiazide Diuretics Work? (n.d.). Retrieved from http://soyeonk.weebly.com/how-thiazides-work.html Know the Facts About High Blood Pressure. (2014). Retrieved from http://www.cdc.gov/bloodpressure/docs/consumered_hbp.pdf Medication for High Blood Pressure. (2014). Retrieved from http://www.fda.gov/forconsumers/consumerupdates/ucm048534.htm
References (cont). Nelms, M., Sucher, K. P., & Lacey, K. (2016). Nutrition Therapy and Pathophysiology (3rd ed.). Boston, Massachusetts: Cengage Learning. Oral Hypertensive Drugs. (2015). Retrieved from http://www.drugoffice.gov.hk/eps/do/en/consumer/news_informations/dm_04.html#sthash.sbkszxex.dpbs. Portal Hypertension. (2012a) Retrieved from http://www.hopkinsmedicine.org/gastroenterology_hepatology/_pdfs/liver/portal_hypertension.pdf Portal Hypertension. (2012b). Retrieved from http://www.nyp.org/services/digestive/portal-hypertension.html Renovascular Hypertension. (2015, January 12). Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000204.htm Rolfes, S., Pinna, K., Whitney, E. (2012). Understanding Normal and Clinical Nutrition. Belmount, California: Cengage Learning. Understanding Your Risk for Blood Pressure. (2014). Retrieved from http://www.heart.org/heartorg/conditions/highbloodpressure/understandyourriskforhighbloodpressure/understand-your-risk-for-high-blood- Pressure_UCM_002052_Article.jsp