Clinical Nutrition

Workshop
“Let food be thy medicine” - Hippocrates
Content curated by - Presenting –
Dr Akshay Alawani ANutr, Faculty Dr Poonam Vichare
Head, INFS
Assistant faculty, INFS
BDS (In), MSc Human Nutrition (UK)
BHMS, MD (Hom)
&
P.G.D.E.M.S
Dr Poonam Vichare
BHMS, MD (Hom)
P.G.D.E.M.S
Introduction to dyslipidemia and
hypertension
Hypertension
 Why know about hypertension?

Hypertension - “Silent killer”

• Raised BP remains the leading cause of death globally.

• It accounts for 10.4 million deaths per year.
• Globally, 3.5 billion adults now have non-optimal systolic BP levels (that is, >110–
115 mmHg) and 874 million adults have systolic BP ≥140 mmHg.
• Approximately one in four adults has hypertension.
 Blood Pressure

• The lateral pressure exerted by blood on the walls of arteries

• It is divided into systolic (SBP) (when the heart contracts) and
diastolic (DBP) (when the heart is filling) pressures.
• Blood is full of nutrients and gases. It is a fluid that transports
these, and even many other molecules and chemicals throughout
the body.
• Arteries (heart to organs), veins (organs to heart) and smaller
vessels are spread throughout body and organs are innervated by
them
• Without blood pressure, there is no transport. Everything will come
to stand still.
Systolic Vs Diastolic
 Factors Affecting Arterial Pressure

wiki
 What is Hypertension?

• Raised blood pressure

Reading the new blood pressure guidelines - Harvard Health

 Interventions in each stage of HTN

▪ Normal BP – Maintain it with heart healthy habits like balanced diet & regular exercise.

▪ Elevated BP – Will progress to HTN unless interventions taken (usually lifestyle change)

▪ Stage 1 – May present with features of stroke or myocardial infarction.

Physicians prescribe lifestyle changes with medication to regulate BP.

▪ Stage 2 – Lifestyle changes with Medications required.

▪ Stage 3 / Hypertensive crisis – Medical emergency

 White Coat Hypertension

• Related to patient anxiety

HarvardHealth
 ACSM Guidelines

https://www.acsm.org/blog-detail/acsm-certified-blog/2019/02/27/exercise-hypertension-
prevention-treatment
 Types

• Primary/ essential HTN:

No underlying cause.
Increases with time.
Can be managed.
Accounts for total of 95% of cases.

• Secondary HTN:
Influenced by other causes (kidney disease).
As the root is fixed the hypertension gets fixed.
 Why does it occur (essential)?

Mechanism so far,
not completely
understood.
However, there are
some theories.

Image: Craft, J. et al. (2011) ‘ALTERATIONS OF CARDIOVASCULAR FUNCTION ACROSS THE LIFE SPAN’, in Understanding
Pathophysiology. doi: 10.1097/01376517-199702000-00013.
 What does it lead to?

• Risk factor for following conditions:

➢ Cardiovascular disorders: stroke, heart
failure, renal disease
➢ Organ damage
• In 40-69 year of age individuals, 20 point
rise in SBP and 10 point rise in DBP
regardless of baseline numbers is
associated with >200% risk for stroke
and ischemic* heart disease mortality
(secondary ref from Oparil et al.)

*Ischemia- lack of blood flow

Oparil, S. et al. (2018) ‘Hypertension’, Nature Reviews Disease Primers. Nature

Publishing Group, p. 18014. doi: 10.1038/nrdp.2018.14.
 Positive Associations/ Risk Factors

• Visceral adiposity and obesity (7.2 times more risk for those with BMI above 30
kg/mm2)
• Insulin resistance
• Age
• Sedentary lifestyle
• High Sodium (Salt) intake
• Male gender
• Smoking
• Insulin resistance is predominant mechanism in pathophysiology of hypertension
(mechanism such as renal sodium retention)

Beilin, L. J., Puddey, I. B. and Burke, V. (1999) ‘Lifestyle and Hypertension’, American Journal of Hypertension, 12(9), pp. 934–945. doi: 10.1097/01376517-199702000-00013.
Elia, M. et al. (2013) Clinical Nutrition.
Mouhtadi, B. B. et al. (2018) ‘Prevalence, awareness, treatment, control and risk factors associated with hypertension in Lebanese adults: A cross sectional study’, Global
Cardiology Science and Practice. Global Cardiology Science and Practice, 2018(1). doi: 10.21542/gcsp.2018.6.
Tarray, R. et al. (2014) ‘Role of insulin resistance in essential hypertension’, Cardiovascular Endocrinology, 3(4), pp. 129–133. doi: 10.1097/XCE.0000000000000032.
 Common myths about HTN

▪ It is hereditary & nothing can be done about it.

▪ Avoiding table salt is sufficient to control HTN.
▪ Using Kosher salt instead of table salt is safe.
▪ If one doesn’t have any symptoms means the BP would be normal.
▪ Red wine is healthy for heart & can be consumed daily.
▪ There is no need to track BP at home.
▪ One can stop medication once the BP.
THANK YOU