Hypertension & Cardiovascular Disease

1. Hypertension & Cardiovascular Disease Case Study #4: Cookie Sanders Katie Arlinghaus 9/10/2013

2. 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

3. Vitals and Lab Results • Blood Pressure: 160/100mmHg • Height: 5’ 6” • Weight: 160 lbs • BMI: 25.8 • Laboratory Results • Cholesterol 270mg/dL • HDL-C: 30mg/dL • LDL: 210mg/dL • Apo A: 75mg/dL • ApoB: 140mg/dL • Triglycerides: 150mg/dL

4. 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

5. 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

6. Evidence Key: +/- indicates limited or equivocal evidence + indicates suggestive evidence from observational and clinical trials ++ indicates persuasive evidence from clinical trials Table 13.2: Effects of Dietary Factors & Dietary Patterns on BP: A summary of the Evidence

7. 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

8. Treatment • Goals • Reduce risk of cardiovascular disease • Reduce blood pressure to <140/80 mmHg • Methods • Weight reduction • Physical activity • Pharmacological interventions • Nutrition therapy

9. Pharmacological intervention Photo: Wall Street Journal

10. 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

11. 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

12. 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.

13. 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.

14. 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

15. …I’ll give you a hint: There’s A LOT! • 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 cereal250mg • 1 ounce cheese puffs 240mg • 1 ounce potato chips 136mg

16. 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

17. References • 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/conditionsDiseases/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/Hypertension-Prognosis.html. • Smith MEB, Lee NJ, Haney E, et al. Drug Class Review: HMG-CoAReductase 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.