HYPERTENSION AND

CARDIOVASCULAR
DISEASE
A Case Study In

NCM 105: Nutrition and Diet Therapy

Prepared by:
Batulan, Aaron Jasper

Cosico, J

De Castro, Princess Yesha

Go, Quennie Rose

Maravilla, Francheska

Rivera, Ghenyzah Ahn

Rivera, Gherleth Ahn

Sudario, Nathalie Louisse

Group 3

Presented to:
(makikilagyan)
January 2024
 II. DISCUSSION ABOUT THE DISEASE CONDITION
Blood pressure or arterial blood pressure is a fundamental physiological parameter that
maintains the health and functionality of the human body. It is the pressure that blood produces on
the artery walls during heart contraction (systole) and relaxation (diastole). It can be measured by
the use of a sphygmomanometer (Nelms et al., 2016).
Renin-angiotensin-aldosterone system (RAAS), sympathetic nervous system, and renal
function all play a role in controlling arterial blood pressure. The sympathetic nervous system is in
charge of raising heart rate. The heart rate rises during sympathetic activation. The cardiac
accelerator nerves, which include sympathetic fibers, stimulate the ventricles and SA nodes. These
fibers release norepinephrine in response to stimulation, which raises heart rate (Nelms et al., 2016).
Renin-angiotensin-aldosterone system (RAAS) controls fluid and electrolyte balance; this
affects blood volume, which in turn affects cardiac output, venous return, and stroke volume. This
is a vital component that contributes to arterial blood pressure. Renin is a hormone released from
the kidney that stimulates conversion to Angiotensin I, which eventually gets converted to
Angiotensin II. Increased levels of this will stimulate the production of aldosterone, which causes
the kidneys to retain sodium and increase blood volume, which in turn raises blood pressure.
Additionally stimulating vasoconstriction, angiotensin II raises blood pressure (Nelms et al., 2016).
The body's fluid and electrolyte balance are regulated by the kidney. A decrease in renal function
will impact blood volume, which will then alter cardiac output and cause blood pressure to either
increase or drop.
 Maintaining a healthy blood pressure is essential for the well-being of a person, however,
certain health conditions are inevitable. One of the biggest risk factors for nearly all cardiovascular
diseases that develop during a person's lifetime is hypertension. Hypertension happens when the
body's smallest blood vessels, known as arterioles, narrow and the blood presses too hard against
the artery walls, making the heart work harder to keep the pressure constant. According to WHO,
people who have increased risk of hypertension include older age, have a family history of
hypertension, overweight or obese, not physically active, drinking too much alcohol, and those who
have a high-salt diet.
Primary hypertension is another name for essential hypertension. Unknown in its origin,
essential hypertension is a result of a complex relationship between gene expression and lifestyle
decisions. 90-95% of those with hypertension have essential hypertension (Mahan et al., 2012).
Patients with hypertension are frequently asymptomatic. On the other hand, chronic
hypertension can cause certain symptoms related to the heart, brain, and kidneys. For instance,
microalbuminuria, stroke, left ventricular hypertrophy, and the absence of a pulse in the extremities
are all indicators of chronic essential hypertension (Mahan et al., 2012). Severe headaches, chest
pain, dizziness, difficulty breathing, nausea, vomiting, blurred vision, buzzing in the ears,
nosebleeds, and abnormal heart rhythm are all included in the common symptoms of essential
hypertension.
According to JNC 8 guidelines, people with normal blood pressure when the systolic blood
pressure is 120 mmHg or equal and when the diastolic blood pressure is 80 mmHg or equal. For the
diagnosis of stage 1 hypertension, it is considered as stage 1 hypertension when a person's diastolic
blood pressure falls between 90 and 99 mm Hg for all ages, or when their systolic blood pressure is
greater than or equal to 150 mm Hg for those over 60 years old. For the diagnosis of stage 2
hypertension, it is considered as stage 2 hypertension when a person of any age has a systolic blood
pressure of more than 160 mmHg or a diastolic blood pressure of more than 100 mmHg (Nelms et
al., 2016).
A group of metabolic risk factors known as metabolic syndrome include insulin resistance,
abdominal obesity, and dyslipidemia, hypertension, and prothrombotic state (a condition that
 facilitates the formation of blood clots); it should be noted that this syndrome lacks a generally
established definition (Nelms et al., 2016).
In the case of Mrs. Moore there are three risk factors: she is African American, her diastolic
blood pressure is 160 mm Hg, and she has smoked in the past (Nelms, 2016). Mrs. Moore's family
medical history, which includes her mother's chronic hypertension, is a significant factor in
determining her CHD risk category. In addition, her age puts her in the risk category for those over
55. Her BMI and her sexual orientation should both be taken into consideration, but isn't necessarily
a risk factor because she is considered "overweight" rather than obese (Nelms et al., 2016). It is
important to take into account her lipid profile. There is an additional risk because of her low HDL
(38, 9 mos. later) and elevated LDL (147, 9 mos. later) levels. Her history of smoking cigarettes and
hypertension should also be considered as well as risk factors.
Among cardiovascular diseases and deaths, hypertension is the most common contributing
factor. A number of severe diseases can develop from uncontrolled hypertension, such as heart
attacks, myocardial infarction, cerebrovascular accident, aneurysm, reduced renal function, retinal
exudates and hemorrhages, papilledema, and left ventricular hypertrophy (Mahan et al., 2012).
Hypertension is often silent but immensely influential, serving as a reminder of the importance of a
proactive health lifestyle. Weight reduction, physical activity, nutrition therapy, and
pharmacological interventions are the four major modes of treatment for hypertension and must be
achieved with the help of a comprehensive plan (Nelms et al., 2016).

III. MAKIKILAGYAN NG PATIENT INFO

IV. NUTRITION ASSESSMENT
The energy and protein requirements are calculated, taking into account important factors
such as height, weight and physical activity level to improve the patient’s nutritional status. Mrs.
Moore is overweight, with a BMI of 25.8. The following tables present the detailed calculations of
Mrs. Moore’s energy and protein requirements.
TABLE I. COMPUTATION FOR BODY MASS INDEX (BMI)

BMI
Given: Weight: 160 lbs or 72.7 kgs
Height: 5’6’’ or 167.64 cm or 1.6764m

Formula:
BMI= ( 𝑊𝑒𝑖𝑔ℎ𝑡 (𝑖𝑛 𝑘𝑖𝑙𝑜𝑔𝑟𝑎𝑚𝑠)

𝐻𝑒𝑖𝑔ℎ𝑡 (𝑖𝑛 𝑚𝑒𝑡𝑒𝑟𝑠)

2
)
Solution: 2
72.7 / (1.6764)

Answer: = 2
25.9 kg/m

TABLE II. COMPUTATION FOR DESIRABLE BODY WEIGHT (DBW)

DBW

Given: Height: 5’6’’ or 167.64 cm

Formula: DBW = (Height - 100)

Solution: = (167.64 - 100)

Answer: = 67.64 = 68kg

TABLE III. COMPUTATION FOR TOTAL ENERGY REQUIREMENT (TER)

TER

Given: DBW: 68kg

PAL: 35 kcal/kg (Light;female, retired nurse)

Formula: TER = DBW x PAL

Solution: = 68 kg x 35

Answer: = 2380 = 2400 kcal

 TABLE IV. COMPUTATION FOR THE AMOUNT OF MACRONUTRIENTS

AMOUNT OF MACRONUTRIENTS FOR DIET PRESCRIPTION

a. Given: TER: 2400 kcal - 500 kcal(for calorie deficit diet) = 1900 kcal

Formula: CARBOHYDRATE: TER x 0.65

PROTEIN: TER x 0.15
FAT: TER x 0.20

Solution: CARBOHYDRATE: 1900 x 0.65

PROTEIN: 1900 x 0.15
FAT: 1900 x 0.20

Answer: CARBOHYDRATE: 1235 kcal

PROTEIN: 285 kcal
FAT: 380 kcal
b. Given: CARBOHYDRATE: 1235 kcal
PROTEIN: 285 kcal
FAT: 380 kcal
Formula: CARBOHYDRATE: CHO kcal / 4
PROTEIN: CHON kcal / 4
FAT: fat kcal / 9
Solution: CARBOHYDRATE: 1235 kcal / 4
PROTEIN: 285 kcal / 4
FAT: 380 kcal / 9
Answer: CARBOHYDRATE: 308.75 ~ 310 g
PROTEIN: 71.25 ~ 70 g
FAT: 42.22 ~ 40 g
 TABLE V. FOOD EXCHANGE

ENERGY AND MACRONUTRIENTS COMPOSITION OF FOOD EXCHANGES

Food No. of CHO CHON Fat Energy

Exchange Exchange (310g) (70g) (40g) (1900 kcal)
Group

Vegetable B 5 15 5 - 80

Fruit 5 50 - - 200
Milk 3 36 24 15 375

Rice 9 207 18 - 900

Meat 3 - 24 18 258

Fat 1 - - 5 45

Sugar 1 5 - - 20

TOTAL - 313 71 38 1878

 When compared to the Dash diet, Mrs. Moore’s diet is high in sodium, saturated fats and
added sugar which contradicts the focus of the DASH diet. Mrs. Moore’s diet includes tomato
bisque soup, saltine crackers, popcorn, ranch dressing and added salt on her chicken and baked
potato which are major sources of sodium. Glazed donut, ranch dressing, buttered popcorn, and
added butter to her carrots and baked potato are the major sources of saturated fat in her diet. She
also mentioned that she usually has either pizza or steak whenever she eats out which could be high
in sodium and saturated fat. Her diet includes inadequate fruits, vegetables and whole grains which
are major components of the DASH diet. She also lacks having fat-free or low-fat dairy products,
fish, poultry, beans and nuts in her diet.
The biochemical and medical tests like lipid profiles, albumin levels, electrolytes, and
glucose or HgbA1c values are the dietary assessment tools that could be useful in assessing Mrs.
Moore’s diet. It would be helpful to know the amounts of triglycerides, HDL, LDL, and glucose
cholesterol in Mrs. Moore’s diet through laboratory tests. Information that could be obtained such
as her diet and nutrition-related history might also be relevant. The pattern and frequency of Mrs.
Moore’s meal would be helpful in the assessment. In line with this, the proportion sizes, total fat
and cholesterol, saturated fat, type of carbohydrates such as monosaccharides, glucose or starch,
alcohol intake, and sources of sodium. Assessing also the frequency of restaurant meals and what
are the foods eaten would be very helpful. Lastly, assessing Mrs. Moore’s physical activity can be
beneficial for the assessment.
The following laboratory results summarize Mrs. Moore’s values from 6/25 and the
potential cause of any abnormalities:

Parameter Normal Value Pt’s Value Reason for Abnormality

Glucose 70-99 mg/dL 101↑ High sugar intake

BUN 6-20 mg/dL 20 No abnormality - within normal range

Creatinine 0.6-1.1 mg/dL 0.9 No abnormality - within normal range

Total cholesterol <200 mg/dL 270↑ High intake of SFA

HDL-cholesterol >59 mg/dL 30↓ Low intake of MUFA/PUFA, high intake of

 SFA

LDL-cholesterol <130 mg/dL 210↑ Low intake of MUFA/PUFA, high intake of

SFA

Apo A 80-175 mg/dL 75↓ Low HDL levels due to low MUFA/PUFA
intake, and high SFA intake

Apo B 45-120 mg/dL 140↑ High LDL levels, due to low MUFA/PUFA
intake, and high SFA intake

Triglycerides 35-135 mg/dL 150↑ Excess fat intake

Table 6. Mrs. Moore’s values from 6/25 and the potential cause of any abnormalities

Mrs. Moore’s 10-year risk of CVD based on her lipid profile is 15.6% compared to a 2.2%
risk for those who are with optimal risk factors. Her lifetime risk of CVD is 50%. Some factors
that can contribute to her CVD risk are her diet and physical activity, medical history and her
history of smoking. Some of the laboratory results of Mrs. Moore’s improved between 6/25 and
3/15. Her glucose level went from 101 mg/dL to 96 mg/dL which is in the normal range. The total
cholesterol and LDL-cholesterol are still high in levels and have not reached the normal range, but
it maintains the decreasing pattern. Her HDL-cholesterol increases but it does not reach the normal
range yet. Lastly, her Apo A, Apo B and triglycerides level are within the normal range comparing
the results between 6/25 and 3/15. Based on Mrs. Moore’s health history, her physical activity that
caused her to lose weight had an impact on improving the results of her laboratory tests. Another
factor that made an impact is quitting smoking. From the information gathered within the clinical
domain: obesity or overweight, insufficient adherence to dietary recommendations and unhealthy
food selections are the possible nutritional problems.
Blood pressure medications or antihypertensive agents work by bringing the blood pressure
down in various ways. Apart from factors such as age, ethnicity and gender, the healthcare provider
will also consider the patient’s existing health problems and the severity of the high blood pressure
when determining the most suitable medication. The following table shows the pharmacological
differences among antihypertensive agents:
Medications Mechanism of Action
Diuretics Decreases blood volume by
increasing urinary output,
inhibiting renal sodium/water
reabsorption
Beta-blockers Block beta or alpha receptors in
heart to decrease heart rate and
cardiac output and increase
peripheral vasodilation
Calcium-channel Affect movement of calcium,
blockers causing blood vessels to relax,
reducing vasoconstriction
ACE inhibitors Interferes with the production of
angiotensin II and inhibiting
degradation of bradykinin
Angiotensin II Interfere with renin-angiotensin
receptor blockers system without inhibiting
degradation of bradykinin
Nutritional Side Effects and
Contraindications
Loss of essential nutrients such as
Vitamin B1, Folic Acid, Calcium,
Potassium, Magnesium and Zinc,
N/V, diarrhea, constipation
Contraindication: hypokalemia
(only to be administered after
correction), severe hyponatremia,
hypotension, azotemia,
oliguria/anuria, and hepatic coma.
Decreases whole-body metabolic
rate and increases protein oxidation,
N/V, diarrhea, increases weight, dry
mouth, gas, bloating, calcium may
interfere with absorption
Contraindications: Peripheral
vascular diseases, diabetes mellitus,
chronic obstructive pulmonary
disease (COPD) and asthma.
Nausea, bradycardia.
Heartburn, hyperplasia,
Headaches, Swelling in limbs,
constipation Contraindications: sick
sinus syndrome,
severe hypotension,
acute myocardial infarction, and
pulmonary congestion
Increases potassium levels, dry
cough, headaches, loss of taste,
extreme tiredness or dizziness
Contraindications: pregnancy,
hypersensitivity reactions
Increase potassium levels, Nausea,
fatigue, dry cough
Contraindications: pregnancy
Hypotension Hypovolemia
Hyperkalemia Renal or hepatic
disease
 Alpha-adrenergic Block peripheral a1-adrenergic Dizziness, palpitations, edema, dry
blockers receptors, dilates peripheral blood mouth, constipation
vessels, lowers peripheral Contraindications: pregnancy and
resistance breastfeeding, children and elderly,
prostate cancer, hepatic disease
Table 7. Pharmacological differences among antihypertensive agents

Hydrochlorothiazide can also be used to treat hypertension and fluid retention. It also helps
to reduce the amount of water in the body by increasing urine flow. The nutritional implication of
this drug is to avoid alcohol when taking this medication because it may cause orthostatic
hypotension. Also, avoid multivalent ions because it may decrease the absorption of
hydrochlorothiazide. Consumption of potassium-rich foods should be increased because the drug
can cause potassium depletion, and lastly limit the salt intake.
Mrs. Moore’s physician has decided to prescribe an ace inhibitor and an HMG-CoA
reductase inhibitor (Zocor). ACE inhibitors could possibly affect the laboratory test of Mrs. Moore
since her laboratory results show an increase in the BUN and creatinine. Also, an increase in her
potassium could be caused by the ACE inhibitor. Zocor does not have any effect on her laboratory
results because it does not reduce the cholesterol and triglycerides that come from fat in food.

V. NUTRITION DIAGNOSIS
● Excessive sodium intake related to limited adherence to nutrition-related recommendation of
low-sodium diet as evidenced by 24-hour diet recall and statement of non-compliance with
diet guidelines.
● Overweight related to undesirable food choices and patterns, including high saturated fat
intake as evidenced by 24-hour diet recall, and HDL level of 38 mg/dL, LDL level of 147
mg/dL , and BMI of 25.8.
VI. NUTRITION INTERVENTION
A. Dietary Recommendation
PES # 1

Ideal Goal: To reduce sodium intake to meet recommended dietary guidelines and improve
adherence to a low-sodium diet.
Appropriate Intervention: Provide the patient with comprehensive education on the health risks
associated with excessive sodium intake, the importance of following a low-sodium diet, and the
sources of hidden sodium in various foods. Collaborating with Mrs. Moore by giving her a
personalized low-sodium meal plan that considers her dietary preferences and cultural
considerations while staying within the recommended daily sodium intake (e.g., 2,300 mg or less
per day). Also, teach the patient how to read food labels effectively to identify high-sodium
products and make much more healthy food choices when it comes to the food she eats.
PES # 2
Ideal Goal: To achieve a healthy weight within the recommended BMI range (e.g., 18.5-24.9) and
improve lipid profile by increasing HDL levels and reducing LDL levels.
Appropriate Intervention: Modify the dietary intake of Mrs. Moore by developing a personalized
diet plan that focuses on reducing saturated fat intake and increasing consumption of fruits,
vegetables, whole grains, and lean proteins. Also, encourage the patient to engage in regular
physical activity to support weight loss and improve cardiovascular health and assess the patient's
BMI, HDL, and LDL levels periodically to track progress and adjust interventions as needed.
Based on the given data, Mrs. Moore’s height is 5 '6 " and currently weighs 160 lbs, 25.8
which falls under the overweight category. If Mrs. Moore would like to weigh 125 lbs, this would
be good for her since her BMI would be lowered to 20.2 which will fall under the healthy BMI
range but it is more ideal for her to weigh 143 lbs because that is her desirable body weight.
According to Mayo Clinic (2021), over the long term, it is smart to aim for losing 1 to 2
pounds (0.5 to 1 kilogram) a week as it is safe and sustainable. Rapid weight loss is not
recommended, as it can be unhealthy and difficult to maintain.. It is suggested that she must reduce
her calorie intake for at least 500 to 1000 calories per day, make much more healthy food choices,
and have light to moderate activities such as walking or jogging in the morning for her to be able to
achieve her desired weight.
 In order to help Mrs. Moore reach her medical nutrition therapy goals and be consistent with
the DASH diet and sodium intake guidelines, here are some major dietary recommendations and
changes to consider:
Reduce Sodium Intake
It is important to encourage Mrs. Moore to limit her consumption of processed, canned, and
restaurant foods, which tend to be high in sodium. As indicated by her 24-hour recall, she usually
consumes saltines which are high in sodium. By eliminating these from her diet and substituting
them with low-sodium or reduced-sodium crackers, this makes it a better choice for the DASH diet.
Limit Added Sugar
It is advisable for Mrs. Moore to limit foods and drinks high in added sugars, like sugary
beverages, sweets, and pastries. According to her 24-hour recall, she consumes glazed donuts and
cola. Glazed donuts are packed with added sugars, saturated fats, and low in nutrients. It is
recommended for Mrs. Moore to substitute her donut with fruits, yogurt, or homemade snacks that
are lower in added sugars, saturated fats, and refined carbohydrates. It is best to choose healthier
beverages such as water, tea, or sparkling water. Also, instead of using sugar to glaze food, consider
sweetening them with a small amount of honey, maple syrup, or a sugar substitute.
Consume Heart-healthy Fats
It is recommended to replace saturated fats (butter, milk, cheese) with unsaturated fats, such
as olive oil, avocados, and low-fat or non-fat dairy products. Instead of using ranch dressing which
is a major source of saturated fat, it is recommended to substitute it with vinegar or lemon juice. It
is also important to consume lean meat like skinless poultry, fish, beans, and tofu, while minimizing
red and processed meats as it contains lesser fat content.
Practice Portion Control
It is recommended to educate Mrs. Moore about appropriate portion sizes in certain foods to
avoid overeating and support weight management. The DASH diet does not specifically prohibit
moderate alcohol consumption, but it does recommend limiting alcohol intake. It is suggested for
women to drink only one beer per day.
 Increase the Consumption of Fruits, Vegetables and Water

Mrs. Moore only includes a subtle amount of fruits and vegetables in her 24-hour recall. It is
recommended for her to include a variety of fruits and vegetables in her meals and snacks, at least
4-5 servings of each per day. It is best to use fresh versions as they are often lower in sodium than
canned products. It is also recommended for Mrs.Moore to consume regular water to help maintain
proper hydration levels.

VII. NUTRITION MONITORING AND EVALUATION

In the practice of dietetics and nutrition, observation and reviewing are our go-to tools for
guaranteeing that clients are eating appropriately and maintaining their weight, and determining
whether it is beneficial or detrimental to them and ensuring they receive the finest nutritional
guidance available. Understanding nutrition monitoring and evaluation relates to learning how to be
food detectives, assisting people in making better decisions that would enhance their health.
VIII. Meal Plan
Diet Prescription: 1900 kcal/day, Calorie Deficit, DASH diet plan, Low Sodium Diet, Low Fat
Diet

Food No. of Breakfast AM Snack Lunch PM Snack Dinner

Group Exchange

Vegetables 5 2 exchanges 2 exchanges 1 exchange

½ cup ½ cup ½ cup

blanched Blanched blanched
spinach — kangkong — kamote tops

1/2 boiled ½ cup

kale boiled
potatoes

Fruits 5 1 exchange 1 exchange 1 exchange 1 exchange 1

exchang
1 fist size 10 pcs 1 fist size 1 medium e
orange grapes apple size banana
(small) 1 fist size
avocado
1 cup of 2 slices of 1 cup of 1 slice of 1 cup of
Non Fat 3 1 exchangewheat bread
rice 1 exchangewheat bread
rice 1 exchange
rice
Milk
1 glass of — 1 glass of — 1 glass of
Meat 3 1 exchange
nonfat milk 1 exchange
nonfat milk 1 exchange
nonfat milk

1 matchbox 1 matchbox 1 matchbox

Rice 9 size2ofexchanges
fish 2—
exchangessize2grilled
exchanges 1—exchange 2size
exchanges
fried in bangus steamed
olive oil chicken
breast

Fat 1 1 exchange

1tsp Olive — — — —
Oil

Sugar 1 1 exchange
— — — —
1 tbsp of
berry jam
 Remarks:
● Sodium intake must not exceed 2000 mg/day
● Avoid saturated fats and consume heart healthy fats
● Check food labels for sodium content
● Do physical activities such as jogging, 30-minute walk, bicycling, etc.

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