What is it?
High blood pressure. It is a condition where the force of blood against the walls of the arteries is consistently too high. If left untreated, hypertension can lead to complications like a heart attack or failure, stroke, vision loss and kidney damage – all due to damage to the blood vessels. |
Blood pressure RR = 120-129/80-89
Grade |
SBP (mmHg) |
DBP (mmHg) |
High-normal |
130-139 |
85-89 |
Grade 1 (mild) |
140-159 |
90-99 |
Grade 2 (moderate) |
160-179 |
100-109 |
Grade 3 (severe) |
180-209 |
110-119 |
Risk factors
Modifiable |
Non-Modifiable |
↑ weight |
Age >55 (M), >65 (F) |
↑ blood lipids |
CKD |
↑ alcohol & smoking |
Low socio-ec |
Metablic syndrome/diabetes |
Psycosocial stress |
↑ Na consumption |
Low PA |
Consider stress & any recent crisis |
Complications
Heart |
Enlarged heart w/ thickened L.ventricle |
Cardiac failure |
Vessels |
↑ pressure, turbulent blood flow, plaque |
Stroke, dementia, TIA |
Kidney |
Poor regulation of salt-retaining hormones |
CKD, microalbuminuria, proteinuria |
Eyes |
Papilledema = ↑ pressure in eye causing swelling of optic discs |
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Medications that affect BP
HRT (hormone replacement therapy) |
OCP (oral contraception pill) |
Corticosteroids |
MAOIs (Monoamine Oxidase Inhibitors – antidepressant): can cause both hypertension and hypotension |
NSAIDS (anti-inflammatory drugs) Eg.ibuprofen, Naproxen (Aleve), Diclofenac (Voltaren), Celecoxib (Celebrex) |
Biochem
renal and electrolytes (microalbuminuria), glucose, lipid profiles, urine profile, TSH – use these to prioritise nutrition strategies |
Intervention
DASH/similar - wholefoods, plants, reduced sat fat etc |
Overweight/obese = gradual weight loss |
Reduced Na (max 2000-2300mg) |
<120mg/100g for low salt |
PA: 150min/week |
<10 standard drinks/week & <4/day |
Strategies
Lower Na swaps & recipes |
Flavour enhancers: herbs, citrus, spices etc |
Educate: label reading (Na) |
No added salt or salt reduced products |
↓ deli meats, sausages, olives, gravy, sauces, chips, salted nuts/pretzels |
Educate: Taste buds 4-6 weeks to adapt to a lower salt diet |
Nut Reqs
Fibre F: 25, M: 30g |
K: 4,700mg/day (consider renal function) |
Na: 1500-2300mg/day |
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DASH (Dietary approach to stop hypertension)
↑ plant foods, wholegrains, ↓ red meat and sat fat |
Na 2300mg/100mmol/day |
Na 1500mg/65mmol/day - diabetes, CKD, >51 years or African descent |
p141 handbook |
Example PESS
P |
E |
Excessive mineral intake (sodium) |
Strong preference for salty foods |
Excessive energy intake |
Lack of knowledge on healthy/low Na food choices |
Inadequate potassium intake |
Lack of motivation |
Food and nutrition related knowledge deficit |
No previous nutrition education |
Consider
Renal function & urine profile |
Daily stress level |
Any recent crisis? |
Social support - alcohol & smoking |
Guidelines & References
Handbook p140 |
2014 evidence-based guideline for the management of high blood pressure in adults |
2018 ESC/ESH Guidelines for the management of arterial hypertension |
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