Hypertension

Etiology:
*90% of hypertension cases the cause is unkown. This is called primary hypertension. Although the cause is unkown there are several factors that contribute to high blood pressure. Contributing factors that cannot be changed: age, gender, socioeconomic status, and heredity. Contributing factors that can be changed: obesity, alcohol use, lack of exercise, drugs, and sodium sensitivity. The other 10% of hypertension cases are caused by another disease. These cases are called secondary hypertension. Examples of these conditions: chronic kidney disease, tumors or other diseases of the adrenal gland, pregnancy, use of birth control pills, alcohol addiction, thyroid dysfunction, and sleep apnea.
Jai Stephenson

Signs/Symptoms:
Hypertension is usually asymptomatic until complications develop in target organs. Dizziness, flushed facies, headache, fatigue, epistaxis, and nervousness are not caused by uncomplicated hypertension. Severe hypertension (hypertensive emergencies—see Arterial Hypertension: Hypertensive Emergencies) can cause severe cardiovascular, neurologic, renal, and retinal symptoms (eg, symptomatic coronary atherosclerosis, HF, hypertensive encephalopathy, renal failure). Layne Adams

Method of Diagnosis:
• Multiple measurements of BP to confirm
• Urinalysis and urinary albumin:creatinine ratio; if abnormal, consider renal ultrasonography
• Blood tests: Fasting lipids, creatinine, K
• If creatinine increased, renal ultrasonography
• If K decreased, evaluate for aldosteronism
• ECG: If left ventricular hypertrophy, consider echocardiography
• Sometimes thyroid-stimulating hormone measurement
• If BP elevation sudden and labile or severe, evaluate for pheochromocytoma

Hypertension is diagnosed and classified by sphygmomanometry. History, physical examination, and other tests help identify etiology and determine whether target organs are damaged. BP must be measured twice—first with the patient supine or seated, then after the patient has been standing for ≥ 2 min—on 3 separate days. The average of these measurements is used for diagnosis. BP is classified as normal, prehypertension, or stage 1 (mild) or stage 2 hypertension. Layne Adams

Risk Factors:
*Modifiable:

*Obesity: as body weight increases. the blood pressure rises. Obese people are 6 times more likely to develop hypertension than those of a healthy weight.
*Alcohol use: drinking more than one or two drinks of alcohol per day tends to raise blood pressure in those who are sensitive to alcohol.
*Lack of exercise: a sedentary lifestyle contributes to the development of obesity and hypertension.
*Drugs: certain drugs such as amphtamines, diet pills, and some pills used for cold and allergy symptoms tend to raise blood pressure.
*Sodium sensitivity: some people have high sensitivity to salt, and their blood pressure rises when they consume it. Blood pressure rises due to increasing salt intake, kidneys will retain more water, resulting in increased blood pressure.
*Non-Modifiable:
*Age: the older you get the greater the chance you will develop high blood pressure. This is largely due to arteriosclerosis, or "hardending of the arteries"
*Socioeconomic status: is more common amoung the less educated and lower socioeconomic groups
*Gender: generally men have a greater possibility of developing high blood pressure then women.
*Heredity
Jai Stephenson

Prevention:
*Unless the patient has very severe hypertension there should be a relatively prolonged assessment period. During this assessment period there should be repeated blood pressure measurements. After these measurements are taken lifestyle advice and non-pharmacological options should be offered to the patient, before any initiation of drug therapy.
*Non-Pharmacological options: weight reduction and regular aerobic exercise (regular exercise improves blood flow and helps to reduce resting heart rate and blood pressure), reducing dietary sugar intake, reducing sodium in the diet (it decreases blood pressure in about 33% of people), discontinuing tobacco use and alcohol consumption, reducing stress, and use of the DASH (Dietary Approach to Stop Hypertension)diet.
Jai Stephenson

Supplements Commonly Used:
Fish Oils are useful for thinning the blood and improving circulation and it is now known that those whose diets are high in fish oils have a lower risk for hypertension.
Grape seed extract has been shown to reduce hypertension.
Quercetin is known as a very strong blood vessel dilator.
B vitamin and coenzyme complex— B6, folate, and B12 are crucial for the health of arteries and to lower homocysteine, an amino acid-like compound in the blood stream that can be toxic in high doses.
Lycopene supplements lowered blood pressure in one study, but if you eat plenty of tomatoes and other foods with lycopene, a supplement is not necessary.
Calcium and Magnesium are important minerals helpful in supporting healthy blood pressure.
Potassium - Potassium citrate has similar hypertension lowering effects as the best-studied potassium compound, potassium chloride. Layne Adams

Labs Appropriate to Disease:
*Normal Values Range:
*Values in the Disease:
*Nutritional Significance:

Values that would be affected significantly would be cholesterol. Normal values range from 140-199 but they would most likely be very high. Triglyceride levels would also be higher than normal. Normal ranges are from 40-160. Other lab values would depend on the individual and other health factors would have to be considered. Layne Adams

General Dietary Prescription:
*Increase their fruit, vegetable, whole grains and fiber intake. Lower dietary intake of saturated fat and cholesterol. Use low-fat products. Take antioxidants, folic acid, potassium, magnesium, and vegetable protein.
Jai Stephenson

Specific Foods to Include:
*DASH diet is recommended: diet rich in fruits and vegetables, diet using low-fat or fat -free dairy foods. Foods rich in calcium.
Jai Stephenson

Specific Foods to Avoid:
Excessive salt/sodium intake: salt ingestion is thought to cause Na and water retention. Salt sensitive individuals experience a rise in both systolic and diastolic pressure after ingesting salt.

High fat and cholesterol foods such as: fatty meats, cakes, ice cream, and processed foods.

Alcohol intake: blood pressure increases progressively when reported alcohol intake exceeds 3 drinks per day.

Smoking: nicotine is associated with increased blood pressure levels.
Layne Adams

Reccomended Prescription Drug Therapy:
*Medications used to treat hypertension are called antihypertensives, meaning lowering blood pressure. Several of theses agents may be given simultaneously.
*Commonly used drugs: ACE inhibitors (Enalapril, Captopril, Quinapril), Angiotension II receptor antagonists (Valsartan), Calcium channel blockers (Diltiazem & Verapamil), Diuretics (Bendroflumethiazide, Chlortalidone, Furosemide, Hydrochlorothiazide), Alpha blockers (Prazosin & Terazosin), Beta blockers (Atenolol, Labetalol, Propranolol), and Direct renin inhibitors (Aliskiren).
Jai Stephenson

Potential Food and Drug Interactions:

Beta Blockers: decrease Na and decrease calcium may be recommended.

Angiotension II receptor blocker: caution salt substitutes, decrease Na, decrease calcium may be recommended

Vasodilators: decrease Na, decrease sodium may be recommended
Layne Adams

General Nutrition Education Objectives or Goals:
Follow a low fat, especially saturated fat diet to 10% of kcals and also a low cholesterol diet as well to <200 mg/day. Limit animal products. Limit sodium as well to <2500 mg/day. Fiber should be around 20-35mg/day. Limit caffeine. Magnesium 280-350mg/day. Calcium 800-1200mg/day. Potassium 90MEq/day. Should stop smoking and limit alcohol to <2 drinks per day. Should strive for a BMI <27, waist circumference <34 for females and <39 for males.
Layne Adams

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