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Loan Vi

on 26 September 2014

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Transcript of Hypertension

Complex Concept

Pathophysiology & More
NCP Case Study
Loan V.
Jason W.
Winnie G.
The D.A.S.H.
34 yrs old Mrs. B came to her doctor appointment, BP was 140/92, wt 160#, ht 5’6”, HDL 30, LDL 210, glucose 92, BUN 20. Dietary habit include meals not prepare at home, eat 2 meals a day and skipped breakfast. Pt does not know how to cook, therefore she eat most of her meals outside of home. Pt is unemployed and has been off blood pressure meds for 30 days. Pt has stress due to unemployment. Medications include Linsinopril (for bp), Hydrochlorothiazide (HCTZ/diuretic). Diet is NAS/2000mg

Let's Study
Presenting by:
Rich in fruits and vegetables
Low in fat
Low in Na+


Nutrient absorption
Muscle contraction
Nerve transmission
Fluid blance.

Na+ (Sodium)
Foods High in Na+
Case Study
Wt: 160#
Ht: 5'6"
BMI: 25.82
Bp: 140/92

Image credited to http://mactayrenjupiter.blogspot.com
What is blood pressure?
Image credited to CDC.gov
"Persistently high arterial blood pressure"
BP Regulatory Mechanisms
: (Cardiovascular reflexes)
Baroreceptors reflexes
Chemoreceptors reflexes
Brain (CNS) ischaemic response

RAA system

Renal-body fluid control system
Short term: Rapid
Short term: Intermediate
Long term
BP is defined by two measurements:
Systolic BP
is measured when the heart contracts

Diastolic BP
is measured when the heart relaxes between contractions
BP is written as
Image credited to ahrq.gov
Stages of HTN
Image credited to ahrq.gov
Usually no symptoms until diagnosed with HTN. (Some may experience a dull headache or dizziness)

Untreated HTN contributes to stroke, kidney failure, dementia, etc
Symptoms & Complications?
Risk Factors
African Americans
Persistent DP > 115 mm Hg
Excessive alcohol intake
End damage organ
Family history
HDL: 30
LDL: 210
Glucose: 92
Eats 2x/d
NAS/2000 mg
Not on bp med
for 30 days

Diagnosis: PES Statements
1. Excessive energy intake (NI-1.3) (P), limit access to healthy food choices (E), as evidence by BMI being 25.82 and intake of high caloric density (S)
2. Food and nutrition related knowledge deficient (NB-1.1)(P), related to uncertain how to apply nutrition information (E), as evidence by patient report that she does not know how to cook.(S)
3. Limit access to nutrition related supply (NB-3.3)(P), related to lack of access to financial resource (E), as evidence by b.p. 140/92 and patient reporting for unemployment (S)
Skill development E-2.2
Lowering Mrs. B’s BMI to 24, by incorporate physical activity at least 30 minutes for 3-4x weekly and intake of more healthy foods.
Monitoring & Evaluation
In 4 weeks, re-evaluate Mrs. B’s BMI, B/P and lipid profile to see if there are any changes in reductions. Compare the lab values with another 24-hrr recall. Test her blood glucose to see if she is at risk for diabetes.
Cognitive-behavioral theory C-1.1
Increase Mrs. B’s nutrition knowledge by offering nutrition counseling for 15-20 minutes/ 2x weekly, until Mrs. B know how to choose the foods that can her help to decrease of her LDL.
Referral to community agency/program RC-1.6
Increase Mrs. B’s healthy food consumption at least 3-4x weekly, through referral to DHS-SNAP program and unemployment program.

At 3 months, follow up with Mrs. B lab results, BMI and B/P, if these measurements with significant change, then it reveal Mrs. B in compliance with the recommended diet and exercise plan. If Mrs. B’s lab and other measurement remains the same with slightly change, then this mean she is not following her recommendations.
1. Mahan LK, Escott Stump S, Raymond JL. Krause's Food and the Nutrition Care Process. 13th edition. St Louis, MO: Elsevier/Saunders; 2012:758-769
2. What Is High Blood Pressure? National Heart, Blood, and Lung Institute Web site, http://www.nhlbi.nih.gov/health/health-topics/topics/hbp. Published August 2, 2012. Accessed Sept 8, 2014
3. National Center for Health Statistics. (2007–2010). National Health and Nutrition Examination Survey. Retrieved September 11, 2014, from http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=21#513961
4. Centers for Disease Control and Prevention. (2011). Vital signs: prevalence, treatment, and control of hypertension, 1999–2002 and 2005–2008. MMWR: Morbidity & Mortality Weekly Report, 60(4), 103–108
5. National Heart, Lung, and Blood Institute, National High Blood Pressure Education Program. (2004). The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Retrieved Sept 8, 2014, from http://www.nhlbi.nih.gov/files/docs/guidelines/jnc7full.pdf
6. Blumenthal JA, Babyak MA, Hinderliter A, et al. Effects of the DASH Diet Alone and in Combination With Exercise and Weight Loss on Blood Pressure and Cardiovascular Biomarkers in Men and Women With High Blood Pressure: The ENCORE Study. Arch Intern Med. 2010;170(2):126-135. doi:10.1001/archinternmed.2009.470.
7.O’Connor D, Downes D. You and Your Blood Pressure: Beating out Hypertension. Academy of Nutrition and Dietetics Evidence Analysis Library. 2012.
8.U.S. Food and Drug Administration. Sodium in Your Diet: Using the Nutrition Facts Label to Reduce Your Intake. U.S. Department of Health & Human Services. http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm315393.htm. Published June 20, 2014. Accessed September 21, 2014.
National Heart, Lung and Blood Institute. Following the DASH Eating Plan. U.S. Department of Health & Human Services. http://www.nhlbi.nih.gov/health/health-topics/topics/dash/followdash.html. Published June 6, 2014. Accessed September 21, 2014.
9. HTN: Minerals (2007). Evidence Analysis Library. Web site, http://www.andeal.org/topic.cfm?cat=2777&conclusion_statement_id=250636. Assessed Sept 11, 2014
10. HTN: Caffeine (2007). Evidence Analysis Library. Web site,http://www.andeal.org/topic.cfm?menu=2777&cat=2781. Assessed Sept 11, 2014
11. Escott-stump, S. Nutrition and Diagnosis-Related Care. 4th ed. Philadelphia, Lippincott Williams & Wilkins, 2002
12. Mark Hamer, G. David Batty, Emmanuel Stamatakis, Mika Kivimaki, Hypertension Awareness and Psychological stress. Psychological Stress. http://hyper.ahajournals.org. Published June 12, 2010
13. Susan A Lanham-New, Helen Lambert, Lynda Frassetto. Potassium. 2012;3:820-821. http://m.advances.nutriton.org. Published November, 2012.
Connie M. Weaver. Potassium and Health. 2013;4:368S-377S.http://m.advances.nutrition.org. Published May 2013.
14. Janet C. King, Kristin J Reimers. Beyond Blood Pressure: New Paradigms in Sodium Intake Reduction and health outcomes. 2014;5:550-552. http://m.advance.nutrition.org. Published September 2014.
15. Nutrition Diagnosis Snapshot (2013). In Pocket guide for International dietetics & nutrition terminology (IDNT) reference manual, ed. 4rd. (pp. 9- 17). Chicago, IL: ADA
Perform any moderate- to vigorous-intensity aerobic activity using the following guidelines:

For most healthy people, get the equivalent of at least 150 minutes (2 hours and 30 minutes) per week of moderate-intensity physical activity, such as brisk walking.
If you need to lower your blood pressure or cholesterol, aim for 40 minutes of moderate to vigorous physical activity 3 to 4 times per week.
You can incorporate your weekly physical activity with 30 minutes a day on at least 5 days a week.
Physical activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the week.
Include flexibility and stretching exercises.
Include muscle strengthening activity at least 2 days each week.
There are eight main ways you can control your blood pressure.

Eat a better diet; the DASH diet
Enjoy regular physical activity
Maintain a healthy weight
Manage stress
Avoid tobacco smoke
Comply with medication prescriptions
If you drink, limit alcohol
Understand hot tub safety
Prevention & Treatment
AHA Recommendation
Daily Value (DV):
Salt is 40% Na+
1 tsp = 2,300 mg Na+
Increases Ca losses in urine

Processed Foods
Potato Chips
Salted crackers
Canned soups
Many cheeses
Soy sauce
Frozen dinners
Canned vegetables

K+ (Potassium)
Adequate Intake (AI)
Helps regulate
Food sources:

Mg2+ (Magnesium)
400mg/d for men 19 - 30
420mg/d for men ages 31 - 70
310mg/d for women 19 -30
320mg/d for women 31 - 70

Helps maintain normal heart rhythm

Relaxes muscles lining of vessels

Ca2+ (Calcium)
Regulates BP

Adequate Intake (AI):
1,000mg/d ages 19-50
1,200mg/d ages >51

Food sources:
Brussel Sprouts
Dairy products Fortified juices

Evidence Analysis Library
HTN & Sodium
Sodium Health Claims
17 studies demonstrate the benefit of reducing dietary sodium intake for lowering blood pressure.
A sodium intake of less than 2,300mg per day and further reduction of sodium intake to 1,600mg may have additional blood pressure-lowering effects, especially when combined with the DASH dietary pattern.
Duration: 18mo to 30 mo
Population: 40 to 23,104 subjects

USDA Food Survey: Sodium Intake for 2007-2008

Six studies report that a one-time dose of caffeine (200-300 mg) raises blood pressure, by 3 to 12 mmHg in systolic blood pressure and 3 to 4 mmHg in diastolic blood pressure.
Two studies report that the effect of habitual consumption of caffeine on blood pressure is unclear.
Limitation: small sample size, unknown diet & smoking status, difference products

Evidence Analysis Library
HTN & Caffeine
Full transcript