Transcript File - Medical Nutrition Therapy Portfolio

HYPERTENSION & CARDIOVASCULAR
DISEASE
Case Study #4: Cookie Sanders
Katie Arlinghaus
9/10/2013
COOKIE SANDERS
54-year old African American female
 Diagnosed with Stage 2 HTN 1 year ago
 Quit smoking upon diagnosis a year ago
 Lost 10 lbs within the year from walking 30
minutes 4-5 times a week
 Abandoned efforts to comply with suggested low
sodium guidelines because she found foods to be
bland and tasteless
 Mother died from MI as a result of uncontrolled
HTN

VITALS AND LAB RESULTS
Blood Pressure: 160/100mmHg
 Height: 5’ 6”
 Weight: 160 lbs
 BMI: 25.8
 Laboratory Results

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
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Cholesterol 270mg/dL
HDL-C: 30mg/dL
LDL: 210mg/dL
Apo A: 75mg/dL
Apo B: 140mg/dL
Triglycerides: 150mg/dL
HYPERTENSION ETIOLOGY

Chronic elevation of blood pressure
Higher than 120/80mmHg
 To have high blood pressure systolic pressure and/or
diastolic pressure can be too high
 At 160/100mmHg, Mrs. Sanders has Stage 2 Hypertension

Category
Systolic BP
(mm Hg)
Diastolic BP
(mm Hg)
Normal
<120
an
d
<80
Prehypertension
120-139
or
80-89
Hypertension: Stage 1 140-159
or
90-99
Hypertension: Stage 2 ≥ 160
or
≥ 100
TYPES OF HYPERTENSION

Primary (or Essential) HTN has no known cause
but is thought to be the result of a variety of
factors including:






Diet (high sodium, alcohol intake; low potassium)
Smoking
Lack of Exercise
Stress
Obesity
Genetic component contributing to the management
of sodium balance
Primary HTN accounts for 90% HTN diagnosis
 Secondary HTN is the result of another primary
problem like CVD, Renal disease, etc

TABLE 13.2: EFFECTS OF DIETARY FACTORS & DIETARY
PATTERNS ON BP: A SUMMARY OF THE EVIDENCE
Evidence Key:
+/- indicates limited
or equivocal evidence
+ indicates suggestive
evidence from
observational and
clinical trials
++ indicates
persuasive evidence
from clinical trials
HOW IS HYPERTENSION DIAGNOSED?



Nicknamed “the silent killer” because there are
typically no symptoms of HTP
If untreated, can cause congestive heart failure,
kidney failure, myocardial infarction, stroke, and
aneurysms
Common Nutrition diagnoses include:







Excessive energy intake
Inappropriate intake of fats
Excessive sodium intake
Inadequate calcium, fiber, potassium, or magnesium intake
Overweight/obesity
Food and nutrition-related knowledge deficit
Physical inactivity
TREATMENT

Goals
Reduce risk of cardiovascular disease
 Reduce blood pressure to <140/80 mmHg


Methods
Weight reduction
 Physical activity
 Pharmacological interventions
 Nutrition therapy

PHARMACOLOGICAL INTERVENTION
Medication
Photo: Wall Street Journal
Mechanism of Action
Nutritional Side
Effects
Diuretics
Decreases blood volume by
increasing urinary output
and inhibits renal Na and
H20 reabsorption
Potassium
supplements may be
necessary, avoid
natural licorice
Betablockers
Blocks B-receptors in the
heart to decrease heart rate
and cardiac output
Calcium may
interfere with
absorption
Calciumchannel
blockers
Affect the movement of
calcium and cause blood
vessels to relax and reduce
vasoconstriction
Avoid natural
licorice, limit
caffeine, and avoid
or limit alcohol
ACE
inhibitors
Vasodilators that reduce
blood pressure by decreasing
peripheral vascular
resistance by interfering with
the production of angiotensin
II from angiotensin I and
inhibiting degradation of
bradykinin
Avoid natural
licorice, and avoid
salt substitutes
Alphaadrenergic
blockers
Blocks the vascular muscle
response to sympathetic
stimulation and reduces
stroke volume.
Avoid natural
licorice
NUTRITION THERAPY

DASH Diet
Dietary Approaches to Stop Hypertension
 The plan emphasizes whole-grain products, fish,
poultry, nuts, low-fat dairy, vegetables, and fruits. It
limits red meat, sweets, and sugary beverages


Sodium reduction
No more than 2300mg/day, <1500mg/day is best
 Avoid processed foods


Increase potassium, calcium, and magnesium
MRS. SANDERS’S HTN RISK FACTORS
African American
 Family history
 Smoked
 Overweight
 High cholesterol
 Diet

High sodium intake
 High saturated fat intake
 Excessive energy intake

NUTRITION THERAPY FOR MRS. SANDERS
Excessive sodium intake related to frequent
consumption of high sodium foods as evidenced
by patient’s 24-hour diet recall and high blood
pressure of 160/100mmHg.
 High cholesterol related to inappropriate intake
of fats as evidenced by patient’s 24-hour diet
recall and lipid profile lab results of total
cholesterol of 270mg/dL with high LDL levels of
210mg/dL, and low HDL levels of 30 mg/dL.

NUTRITION THERAPY GOALS
Lower blood pressure to <120/80mmHg by
educating Mrs. Sanders on ways to add flavor to
foods without adding salt and implementing the
DASH diet with less than 2300mg salt a day.
 Reduce total cholesterol to <200mg/dL, lower
LDL level to <130 mg/dL, and raise HDL level to
>55 mg/dL by educating Mrs. Sanders on the
importance of and how to implement the DASH
diet plan into her daily life.

HOW MUCH SODIUM IS IN THAT?
ORDER THE FOLLOWING FROM HIGHEST TO LOWEST SODIUM CONTENT:
5-ounce frozen turkey & gravy dinner
 1 cup raisin bran cereal
 1 cup vegetable juice cocktail
 1 tablespoon Teriyaki sauce
 1 tablespoon soy sauce
 1 ounce potato chips
 1 ounce cheese puffs
 1 ounce pretzels
 1 (4g) dill pickle spear

…I’LL GIVE YOU A HINT: THERE’S A LOT!
1.
2.
3.
4.
5.
6.
7.
8.
9.
1 tablespoon soy sauce 1,024mg
5-ounce frozen turkey & gravy dinner 787mg
1 tablespoon Teriyaki sauce 690mg
1 cup vegetable juice cocktail 479mg
1 ounce pretzels 385mg
1 (4g) dill pickle spear 306mg
1 cup raisin bran cereal 250mg
1 ounce cheese puffs 240mg
1 ounce potato chips 136mg
PROGNOSIS
There is no “cure” for hypertension but can be
controlled through medical nutrition therapy
and/or medication.
 Sodium modifications may reduce incidence of
hypertension as much as 17%
 Weight loss greater than 5kg reduced both
diastolic and systolic BP
 ~20lb weight loss results in lowered systolic BP
 <10% weight loss has sustained effect on BP

REFERENCES
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Academy of Nutrition and Dietetics. (2005). Evidence Analysis Library: What
evidence suggests a relationship between sodium intake and blood pressure in
healthy and hypertensive adults? Retrieved from
http://andevidencelibrary.com/conclusion.cfm?conclusion_statement_id=250636
&highlight=sodium&home=1
Group Health Cooperative. (2011). Statins & ACE Inhibitors. Retrieved from
https://provider.ghc.org/open/caringForOurMembers/patientHealthEducation/c
onditionsDiseases/statins.pdf.
Nelms M, Sucher K, Lacey, K., Habash, D., Roth S. Nutrition Therapy and
Pathophysiology. 2nd ed.Belmonte, CA: Thomson Brooks/Cole, 2010.
Net Industries Science Encyclopedia. (2013). Hypertension-Prognosis.
Retrieved from http://science.jrank.org/pages/3488/HypertensionPrognosis.html.
Smith MEB, Lee NJ, Haney E, et al. Drug Class Review: HMG-CoA Reductase
Inhibitors (Statins) and Fixed-dose Combination Products Containing a Statin:
Final Report Update 5 [Internet]. Portland (OR): Oregon Health & Science
University; 2009 Nov. Retrieved from:
http://www.ncbi.nlm.nih.gov/books/NBK47273
Zelman K. (2012). Salt Shockers. Retrieved from
http://www.webmd.com/diet/ss/slideshow-salt-shockers.