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Hypertension
among obese pt
Done by:
Lina al –freeh
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Table of content:
NO.
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2
3
4
5
6
7
Definition
Causes and symptom
Risk factor
Diagnosis
Treatment
Prognosis
obesity &HTN relation ship
Page
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3,4
4
5
7
10
11
8
9
10
Complication
prevention
Food/Diet Therapy for Hypertension
13,14
14
15..19
11
12
Table of calorie need
Table of sodium ,potassium in food
21
22..25
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Hypertension
among obese pt
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Definition:
Hypertension is the medical term for high blood pressure
pressure is the force of blood pushing against the walls of
arteries as it flows through them. Arteries are the blood vessels
that carry oxygenated blood from the heart to the body's tissues.
Causes & symptoms:
Many different actions or situations can normally raise blood
pressure. Physical activity can temporarily raise blood pressure.
Stressful situations can make blood pressure go up. When the
stress goes away, blood pressure usually returns to normal.
These temporary increases in blood pressure are not considered
hypertension. A diagnosis of hypertension is made only when a
person has multiple high blood pressure readings over a period
of time.
The cause of hypertension is not known in 90–95% of the
people who have it. Hypertension without a known cause is
called primary or essential hypertension. When a person has
hypertension caused by another medical condition, it is called
secondary hypertension. Secondary hypertension can be caused
by a number of different illnesses. Many people with kidney
disorders have secondary hypertension. The kidneys regulate the
balance of salt and water in the body. If the kidneys cannot rid
the body of excess salt and water, blood pressure goes up.
Kidney infections, a narrowing of the arteries that carry blood to
the kidneys, called renal artery stenosis, and other kidney
disorders can disturb the salt and water balance.
Cushing's syndrome and tumors of the pituitary and adrenal
glands often increase levels of the adrenal gland hormones
cortisol, adrenalin, and aldosterone, which can cause
hypertension. Other conditions that can cause hypertension are
blood vessel diseases, thyroid gland disorders, some prescribed
drugs, alcoholism, and pregnancy.
Even though the cause of most hypertension is not known, some
people have risk factors that give them a greater chance of
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getting hypertension. Many of these risk factors can be changed
to lower the chance of developing hypertension or as part of a
treatment program to lower blood pressure.
Symptoms…
Most people with high blood pressure have no signs or
symptoms, even if blood pressure readings reach dangerously
high levels.
Although a few people with early-stage high blood pressure may
have dull headaches, dizzy spells or a few more nosebleeds than
normal, these signs and symptoms typically don't occur until
high blood pressure has reached an advanced — even lifethreatening — stage
Risk factors for hypertension include:

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age over 60
male sex
race (The African-American community has a higher
incidence of hypertension.)
heredity
salt sensitivity
obesity
inactive lifestyle
heavy alcohol consumption
use of oral contraceptives
Some risk factors for hypertension can be changed, while others
cannot. Age, male sex, and race are risk factors that a person
cannot deteriorate. Some people inherit a tendency to get
hypertension. People with family members who have
hypertension are more likely to develop it than those whose
relatives are not hypertensive. People with these risk factors can
avoid or eliminate the other risk factors to lower their chance of
developing hypertension.
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Diagnosis:
Because hypertension doesn't cause symptoms, it is important to
have blood pressure checked regularly. Blood pressure is
measured with an instrument called a sphygmomanometer. A
cloth-covered rubber cuff is wrapped around the upper arm and
inflated. When the cuff is inflated, an artery in the arm is
squeezed to momentarily stop the flow of blood. Then, the air is
let out of the cuff while a stethoscope placed over the artery is
used to detect the sound of the blood spurting back through the
artery. This first sound is the systolic pressure, the pressure
when the heart beats. The last sound heard as the rest of the air
is released is the diastolic pressure, the pressure between heart
beats. Both sounds are recorded on the mercury gauge on the
sphygmomanometer.
Normal blood pressure is defined by a range of values. Blood
pressure lower than 140/90 mm Hg is considered normal. A
blood pressure around 120/80 mm Hg is considered the best
level to avoid heart disease. A number of factors such as pain,
stress or anxiety can cause a temporary increase in blood
pressure. For this reason, hypertension is not diagnosed on one
high blood pressure reading. If a blood pressure reading is
140/90 or higher for the first time, the physician will have the
person return for another blood pressure check. Diagnosis of
hypertension usually is made based on two or more readings
after the first visit.
Systolic hypertension of the elderly is common and is diagnosed
when the diastolic pressure is normal or low, but the systolic is
elevated, e.g.170/70 mm Hg. This condition usually co-exists
with hardening of the arteries (atherosclerosis).
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Blood pressure measurements are classified in stages,
according to severity:
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normal blood pressure: less than 130/85 mm Hg
high normal: 130–139/85–89 mm Hg
mild hypertension: 140–159/90–99 mm Hg
moderate hypertension: 160–179/100–109 mm Hg
severe hypertension: 180–209/110–119
very severe hypertension: 210/120 or higher
A typical physical examination to evaluate
hypertension includes:
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medical and family history
physical examination
ophthalmoscope: Examination of the blood vessels in the
eye
chest x ray
electrocardiograph (ECG)
blood and urine tests
The medical and family history help the physician determine if
the patient has any conditions or disorders that might contribute
to or cause the hypertension. A family history of hypertension
might suggest a genetic predisposition for hypertension.
The physical exam may include several blood pressure readings
at different times and in different positions. The physician uses a
stethoscope to listen to sounds made by the heart and blood
flowing through the arteries. The pulse, reflexes, and height and
weight are checked and recorded. Internal organs are palpated,
or felt, to determine if they are enlarged.
Because hypertension can cause damage to the blood vessels in
the eyes, the eyes may be checked with an instrument called an
ophthalmoscope. The physician will look for thickening,
narrowing, or hemorrhages in the blood vessels.
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A chest x ray can detect an enlarged heart, other vascular (heart)
abnormalities, or lung disease.
An electrocardiogram (ECG) measures the electrical activity of
the heart. It can detect if the heart muscle is enlarged and if there
is damage to the heart muscle from blocked arteries.
Urine and blood tests may be done to evaluate health and to
detect the presence of disorders that might cause hypertension.
Treatment:
There is no cure for primary hypertension, but blood pressure
can almost always be lowered with the correct treatment. The
goal of treatment is to lower blood pressure to levels that will
prevent heart disease and other complications of hypertension.
In secondary hypertension, the disease that is responsible for the
hypertension is treated in addition to the hypertension itself.
Successful treatment of the underlying disorder may cure the
secondary hypertension.
Treatment to lower blood pressure usually includes changes in
diet, getting regular exercise, and taking anti-hypertensive
medications. Patients with mild or moderate hypertension who
don't have damage to the heart or kidneys may first be treated
with lifestyle changes.
Lifestyle changes that may reduce blood pressure by
about 5 to 10 mm Hg include:
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reducing salt intake
reducing fat intake
losing weight
getting regular exercise
quitting smoking
reducing alcohol consumption
managing stress
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Patients whose blood pressure remains higher than 139/90 will
most likely be advised to take antihypertensive medication.
Numerous drugs have been developed to treat hypertension. The
choice of medication will depend on the stage of hypertension,
side effects, other medical conditions the patient may have, and
other medicines the patient is taking.
Patients with mild or moderate hypertension are initially treated
with monotherapy, a single antihypertensive medicine. If
treatment with a single medicine fails to lower blood pressure
enough, a different medicine may be tried or another medicine
may be added to the first. Patients with more severe
hypertension may initially be given a combination of medicines
to control their hypertension. Combining antihypertensive
medicines with different types of action often controls blood
pressure with smaller doses of each drug than would be needed
for monotherapy.
Antihypertensive medicines fall into several classes of
drugs:
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diuretics
beta-blockers
calcium channel blockers
angiotensin converting enzyme inhibitors (ACE inhibitors)
alpha-blockers
alpha-beta blockers
vasodilators
peripheral acting adrenergic antagonists
centrally acting agonists
Diuretics help the kidneys eliminate excess salt and water from
the body's tissues and the blood. This helps reduce the swelling
caused by fluid buildup in the tissues. The reduction of fluid
dilates the walls of arteries and lowers blood pressure.
Beta-blockers lower blood pressure by acting on the nervous
system to slow the heart rate and reduce the force of the heart's
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contraction. They are used with caution in patients with heart
failure, asthma, diabetes, or circulation problems in the hands
and feet.
Calcium channel blockers block the entry of calcium into
muscle cells in artery walls. Muscle cells need calcium to
constrict, so reducing their calcium keeps them more relaxed
and lowers blood pressure.
ACE inhibitors block the production of substances that constrict
blood vessels. They also help reduce the build-up of water and
salt in the tissues. They are often given to patients with heart
failure, kidney disease, or diabetes. ACE inhibitors may be used
together with diuretics.
Alpha-blockers act on the nervous system to dilate arteries and
reduce the force of the heart's contractions.
Alpha-beta blockers combine the actions of alpha and beta
blockers.
Vasodilators act directly on arteries to relax their walls so blood
can move more easily through them. They lower blood pressure
rapidly and are injected in hypertensive emergencies when
patients have dangerously high blood pressure.
Peripheral acting adrenergic antagonists act on the nervous
system to relax arteries and reduce the force of the heart's
contractions. They usually are prescribed together with a
diuretic. Peripheral acting adrenergic antagonists can cause
slowed mental function and lethargy.
Centrally acting agonists also act on the nervous system to relax
arteries and slow the heart rate. They are usually used with other
antihypertensive medicines.
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Non-pharmacological
treatments
for
obesity
hypertension. Recommendations for using a nonpharmacological
approach to treat obesity
hypertension include:
Weight loss: Weight loss is considered the most effective nonpharmacological therapy for lowering BP in obese hypertensive.
There is a dose-response relation between the degree of weight
loss and the reduction in BP that is independent of sodium
intake. Even modest weight loss of 5–10 percent of body weight
is associated with clinically significant reductions.
Regular physical activity: The incidence of hypertension is
highest in obese sedentary and lowest in lean physically active
individuals. Physically active individuals have a lower risk of
hypertension compared with their sedentary counterparts.
Importantly, the risk of hypertension associated with weight
gain also appears to be lower in physically active individuals.
As such, regular physical activity is recommended for
individuals with elevated BP.
Prognosis:
There is no cure for hypertension. However, it can be well
controlled with the proper treatment. Therapy with a
combination of lifestyle changes and antihypertensive medicines
usually can keep blood pressure at levels that will not cause
damage to the heart or other organs. The key to avoiding serious
complications of hypertension is to detect and treat it before
damage occurs. Because antihypertensive medicines control
blood pressure, but do not cure it, patients must continue taking
the medications to maintain reduced blood pressure levels and
avoid complications.
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Obesity and Hypertension
With the significant rise in obesity in this last decade comes a
corresponding increase in the prevalence of hypertension.
Almost 29 percent of the population is hypertensive (having a
blood pressure (BP) greater than 140/90 mmHg or using
hypertensive medications). The relationship between obesity
and BP appears to be linear and exists throughout the non-obese
range. But the strength of the association of obesity with
hypertension varies among different racial and ethnic groups.
Generally, risk estimates suggest that approximately 75 and 65
percent of the cases of hypertension in men and women,
respectively, are directly attributable to an overweight condition
and obesity.
It is important to recognize that long-duration obesity does not
appear necessary to elevate BP, as demonstrated by obesity in
children without a condition of hypertension. Therefore, rather
than a special case, obesity hypertension should be considered
the most common form of hypertension due to unknown
reasons.
Many but not all studies suggest that abdominal adiposity or
“beer gut” is more closely associated with high blood pressure
rather than overall obesity. Obese individuals with elevated
intra-abdominal (visceral) fat demonstrate a clustering of
coronary heart disease risk factors (i.e., the Metabolic
Syndrome). Heretofore, medical researchers believed the
accumulation of visceral fat is the central feature of this
syndrome. However, recent evidence favors a role for ectopic or
inappropriate fat storage as a cause of the metabolic syndrome.
In this regard, both the accumulation of visceral fat and ectopic
fat storage in a number of tissues and organs may be important
in the cause and consequences of obesity hypertension.
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A Comprehensive Review
Two researchers have provided an overview of cause, process,
and treatment of obesity hypertension. Their focus was on the
current state of knowledge of this condition in humans,
particularly with the potential role of abdominal obesity. This
Invited Review, entitled “Obesity and Hypertension: Two
Epidemics or One?,” was authored by Kevin P. Davy from
Department of Human Nutrition, Foods and Exercise, Virginia
Polytechnic Institute and State University, Blacksburg, VA; and
John E. Hall, with the Department of Physiology and
Biophysics, University of Mississippi Medical Center, Jackson,
MS. Their discussion appears in the May 2004 edition of the
American Journal of Physiology-Regulatory, Integrative, and
Comparative Physiology. The journal is one of 14 published
each month by the American Physiological Society (APS) .
Highlights of this comprehensive review of existing literature
and research regarding the association between hypertension
and obesity are:
1. Not all obese individuals are hypertensive by clinical
standards. Weight gain is almost invariably associated with an
increased BP. The increase in BP is closely related to the
magnitude of weight gain, and even moderate weight gain is
associated with an increased risk of developing hypertension.
However, there is considerable inter-individual variability in the
BP response to weight gain and not all obese individuals
become hypertensive, at least by the standard of 140/90 mmHg.
In addition, weight loss is associated with a reduction in BP in
many normotensive obese individuals. Therefore, BP is higher
in obese humans than would be achieved at a lower level of
excessive fat cells.
The reasons for the inter-individual variability in the BP
response to weight gain remain unclear, but genetic factors may
contribute. In addition, inter-individual variability in visceral fat
accumulation with weight gain may also play a role. It is
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important to emphasize that any elevation in BP above optimal
levels (approximately120/80 mmHg) will increase an
individual’s risk of developing cardiovascular diseases. In turn,
reductions in BP from above optimal levels should confer a
health benefit.
Complications:
The excessive pressure on your artery walls caused by high
blood pressure can damage your blood vessels, as well as organs
in your body. The higher your blood pressure and the longer it
goes uncontrolled, the greater the damage.
Uncontrolled high blood pressure can lead to:

Damage to your arteries. This can result in hardening
and thickening of the arteries (atherosclerosis), which can lead
to a heart attack, stroke or other complications.
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Aneurysm. Increased blood pressure can cause your blood
vessels to weaken and bulge, forming an aneurysm. If an
aneurysm ruptures, it can be life-threatening.
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Heart failure. To pump blood against the higher pressure
in your vessels, your heart muscle thickens. Eventually, the
thickened muscle may have a hard time pumping enough blood
to meet your body's needs, which can lead to heart failure.
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A blocked or ruptured blood vessel in your brain. High
blood pressure in the arteries leading to your brain can either
slow the blood flow to your brain or cause a blood vessel in
your brain to burst, causing a stroke.
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Weakened and narrowed blood vessels in your kidneys.
This can prevent these organs from functioning normally.
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Thickened, narrowed or torn blood vessels in the eyes.
This can result in vision loss.
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Metabolic syndrome. This syndrome is a cluster of
disorders of your body's metabolism — including increased
waist circumference, high triglycerides, low high-density
lipoprotein (HDL), or "good," cholesterol, high blood pressure,
and high insulin levels. If you have high blood pressure, you're
more likely to have other components of metabolic syndrome.
The more components you have, the greater your risk of
developing diabetes, heart disease or stroke.
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Trouble with memory or understanding. Uncontrolled
high blood pressure also may affect your ability to think,
remember and learn. Trouble with memory or understanding
concepts is more common in people who have high blood
pressure.
Prevention:
Prevention of hypertension centers on avoiding or eliminating
known risk factors. Even persons at risk because of age, race, or
sex or those who have an inherited risk can lower their chance
of developing hypertension.
The risk of developing hypertension can be reduced by
making the same changes recommended for treating
hypertension:
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reducing salt intake
reducing fat intake
losing weight
getting regular exercise
quitting smoking
managing stress
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Food/Diet Therapy for Hypertension
Research has shown that following a healthy eating plan can
both reduce the risk of developing high blood pressure and
lower an already elevated blood pressure.
Vegetarian Diet
Vegetarians, in general, have lower blood pressure levels and
a lower incidence of hypertension and other cardiovascular
diseases. Experts postulate that a typical vegetarian's diet
contains more potassium, complex carbohydrates,
polyunsaturated fat, fiber, calcium, magnesium, vitamin C
and vitamin A, all of which may have a favorable influence
on blood pressure.
Fiber
A high-fiber diet has been shown to be effective in preventing
and treating many forms of cardiovascular disease, including
hypertension.
The types of dietary fiber is important. Of the greatest benefit
to hypertension are the water soluble gel-forming fibers such
as oat bran, apple pectin, psyllium seeds, and guar gum.
These fibers, in addition to be of benefit against hypertension,
are also useful to reduce cholesterol levels, promote weight
loss, chelate out heavy metals, etc.
Take one to three tablespoons of herbal bulking formula
containing such things as oat fiber, guar gum, apple pectin,
gum karaya, psyllium seed, dandelion root powder, ginger
root powder, fenugreek seed powder and fennel seed powder.
Sugar
Sucrose, common table sugar, elevates blood pressure.
Underlying mechanism is not clearly understood. It is
possible that sugar increases the production of adrenaline,
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which in turn, increases blood vessel constriction and sodium
retention.
Take a diet that is rich in high potassium foods (vegetables
and fruits) and essential fatty acids. Daily intake of potassium
should total 7 grams per day. The diet should be low in
saturated fat, sugar and salt. In general, a whole food diet
emphasizing vegetables and members of the garlic/onion
family should be consumed.
In an NIH sponsored research called "Dietary Approaches to
Stop Hypertension (DASH)," researchers tested the effects of
nutrients in food on blood pressure. The results showed that
elevated blood pressures were reduced by an eating plan that
emphasized fruits, vegetables, and low-fat dairy foods and
was low in saturated fat, total fat, and cholesterol. The DASH
diet included whole grains, poultry, fish, and nuts. It
employed reduced amounts of fats, red meats, sweets, and
sugared beverages.
Reduce Salt and Sodium in Your Diet
A key to healthy eating is choosing foods lower in salt and
sodium. Before the widespread availability of medication to
control high blood pressure, people with serious hypertension
had only one treatment option, a drastically salt-reduced, lowcalorie "rice diet." Some people can significantly lower their
blood pressure by avoiding salt.
Studies show that people in countries that use a great deal of
salt in their cooking tend to have higher blood pressures than
people in countries that use little salt. For example, the
Japanese, whose cuisine is among the saltiest in the world,
also have the highest blood pressure; and so do Americans.
Americans take it for granted that blood pressure will rise as
we age. But in countries with low per-capita salt intake, blood
pressure does not rise significantly after puberty. For
example, blacks in Africa, who typically eat a low-salt, high-
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fiber diet, have relatively low blood pressure, but for AfricanAmericans, just the opposite is true. Nearly 50 percent of all
African-Americans have high blood pressure, often beginning
early in life.
Excessive consumption of dietary sodium chloride (salt),
coupled with diminished dietary potassium, induces an
increase in fluid volume and an impairment of blood pressure
regulating mechanisms. This results in hypertension in
susceptible individuals.
A high potassium-low sodium diet reduces the rise in blood
pressure during mental stress by reducing the blood vessel
constricting effect of adrenaline. Sodium restriction alone
does not improve blood pressure control; it must be
accompanied by a high potassium intake.
Most of us consume more salt than we need. NIH
recommends limiting the sodium consumption to less than
2.4 grams (2,400 milligrams [mg] ) of sodium a day. That
equals 6 grams (about 1 teaspoon) of table salt a day. The 6
grams include ALL salt and sodium consumed, including that
used in cooking and at the table. Recent research has shown
that people consuming diets of 1,500 mg of sodium had even
better blood pressure lowering benefits. So, your doctor may
advise eating less salt and sodium if you are suffering from
high blood pressure. The lower-sodium diets also can keep
blood pressure from rising and help blood pressure medicines
work better.
In a clinical study, researchers looked at the effect of a
reduced dietary sodium intake on blood pressure as people
followed either the DASH diet or a typical American diet.
Results showed that reducing dietary sodium lowered blood
pressure for both the DASH diet and the typical American
diet. The biggest blood pressure-lowering benefits were for
those eating the DASH diet at the lowest sodium level (1,500
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milligrams per day). This study showed the importance of
lowering sodium intake in your diet.
Watch what you eat. Do not add additional salt to your food.
If you have high blood pressure, avoid eating certain highly
processed, overly salted foods, such as frozen pizza, canned
salted vegetables, meals from fast-food restaurants, and the
like.
Beneficial Vegetables and Spices for Hypertension
A number of common vegetables and spices have beneficial
effects in controlling hypertension. Incorporate these into
your cooking. Alternately, you can make a tea or a vegetable
soup.
Celery (Apium graveolens). Oriental Medicine practitioners
have long used celery for lowering high blood pressure.
There are some experimental evidence that shows that celery
is useful for this. In one animal study, laboratory animals
injected with celery extract showed lowered blood pressure.
Eating as few as four celery stalks was found to be beneficial
in lowering blood pressure in human beings.
Garlic (Allium sativum). Garlic is a wonder drug for heart.
It has beneficial effects in all cardiovascular system including
blood pressure. In a study, when people with high blood
pressure were given one clove of garlic a day for 12 weeks,
their diastolic blood pressure and cholesterol levels were
significantly reduced. Eating quantities as small as one clove
of garlic a day was found to have beneficial effects on
managing hypertension. Use garlic in your cooking, salad,
soup, pickles, etc. It is very versatile.
Onion (Allium cepa). Onions are useful in hypertension.
What is best is the onion essential oil. Two to three
tablespoons of onion essential oil a day was found to lower
the systolic levels by an average of 25 points and the diastolic
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levels by 15 points in hypertension subjects. This should not
be surprising because onion is a cousin of garlic.
Tomato ( lycopene ). Tomatoes are high in gamma-amino
butyric acid (GABA), a compound that can help bring down
blood pressure.
Broccoli (Brassica oleracea). This vegetable contains
several active ingredients that reduce blood pressure.
Carrot (Daucus carota). Carrots also contain several
compounds that lower blood pressure.
Saffron (Crocus sativus). Saffron contains a chemical called
crocetin that lowers the blood pressure. You can use saffron
in your cooking. (It is a very popular spice in Arabic
cooking.) You can also make a tea with it. Many Indians add
a pinch of saffron in the brewed tea to give a heavenly flavor.
Unfortunately, it is very expensive.
Assorted spices
Spices such as fennel, oregano, black pepper, basil and
tarragon have active ingredients that are beneficial in
hypertension. Use them in your cooking
Table 1: The DASH Diet.
Food Group
Grains and grain products
Daily Servings Significance to the DASH Diet
7–8
Carbohydrates and fiber
Vegetables
4–5
Potassium, magnesium and fiber
Fruits
4–5
Potassium, magnesium and fiber
Low-fat or fat free milk or
milk products
2–3
Calcium, protein, potassium and
magnesium
20
Meats, poultry and fish
2 or less
Protein and magnesium
Nuts, seeds and beans
4 –5 a week
Magnesium, potassium, protein and
fiber
Source: “A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure.” New England Journal
of
Medicine. 1997.336:1117-1124.
Table 2: Sodium, calorie, calcium and potassium content of foods.
Food
Sodium Potassium Calcium
energy
(Na)
(K)
(Ca)
Food Amount Kcalories
mg
mg
mg
BEVERAGES
Fruit drinks, dehydrated, reconstituted:
Lemonade
1 cup
102
13
33
71
Orange
1 cup
115
12
49
61
Fruit juices, unsweetened:
Apple cider or juice
1 cup
117
5
250
15
Grapefruit juice
1 cup
75
4
360
32
Orange juice
1 cup
120
5
498
25
Grape juice, bottled
1 cup
159
8
279
27
Prune juice
1 cup
192
5
588
35
Cocoa mix, water
1 cup
110
232
176
107
added (Carnation)
Coffee, freeze-dried
1 cup
6
2
166
6
(using 2 tsp.)
DAIRY PRODUCTS
Natural cheese:
Cheddar 1 ounce 112
176
23
211
Colby 1 ounce 110
171
35
192
Cottage, 4 1/2% milk 1/2 cup 120
457
260
108
fat
Cream 1 ounce 99
84
34
23
Monterey Jack 1 ounce 105
152
23
209
Mozzarella, part skim 1 ounce 72
132
24
183
milk
Cream, sour
1
26
6
17
14
tablespoon
Milk:
21
Skim
Whole
1 cup
1 cup
89
149
126
120
406
370
Vanilla
1 cup
290
112
193
296
290
Ice Cream:
208
Yogurt:
272
345
Regular plain
1 cup
152
105
323
Fruit flavored with
1 cup
231
133
442
nonfat milk solids
EGGS, FISH, MEAT, POULTRY AND RELATED PRODUCTS
Eggs, whole (boiled)
1
78
59
62
26
Fish:
Salmon, broiled
Sardines, canned
Trout, brook, raw
Tuna, canned in water
Clams, raw, hard
Crab, canned
Lobster, boiled
(northern)
Scallops, steamed
Shrimp, canned
3 ounces
3 ounces
3 ounces
3 ounces
156
174
86
108
99
552
67
288
378
501
319
237
3 ounces 68
3 ounces 86
3 ounces 80
174
425
212
264
94
153
127
372
12
14
Shellfish:
58
38
55
3 ounces 95
3 ounces 324
225
1,955
405
122
98
9
Meat:
Beef, lean hamburger,
cooked
1 patty
140
55
480
14
Pork:
Bacon, cooked 2 strips 96
Ham 3 ounces 298
274
1,114
34
284
2
4
Poultry:
Chicken, roasted, 1/2 breast 142
breast without skin
Turkey, roasted, breast
3 1/2
189
with skin ounces
FRUITS
Apples, medium (2 1 apple 87
1/2 inches in
diameter)
Apricots 3 apricots 51
Avocado, raw, peeled
1
167
Banana, raw, medium
1
127
Strawberries, raw
1 cup
55
63
220
13
67
289
21
2
165
10
1
22
2
2
281
604
550
244
17
10
12
31
22
Cherries, raw, sweet
1 cup
82
150
Grapefruit, pink, raw,
1/2
40
1
medium
Oranges, raw
1
71
1
Grapes
10
31
1
Cantaloupe 1/2 melon 60
24
Peaches, raw
1
38
1
Pears, raw
1
122
1
Pineapple, raw
1 cup
69
1
Plums, raw
1
33
1
Raisins
1 cup
462
17
Watermelon 1/16 melon 152
10
GRAIN PRODUCTS
223
135
26
16
311
72
502
202
260
195
150
1,221
560
65
7
28
9
16
23
9
99
38
Bread:
White
Whole Wheat
1 slice
1 slice
62
56
114
132
24
63
Cream of Wheat,
regular
Oatmeal
3/4 cup
100
3
17
3/4 cup
111
1
98
27
28
16
151
48
70
30
2
27
7
120
85
16
Crackers:
3
1
1
11
131
293
N.L.
80
200
2
70
16
178
10
105
18
Graham
1
Saltine
2
Whole wheat
1
Macaroni, cooked, no
1 cup
salt
Muffin, English 1 medium
(Wonder)
Noodles, egg, cooked,
1 cup
no salt
Rice, brown, cooked,
1 cup
no salt
20
23
Cereals:
10
Snacks:
Corn chips, Fritos
Popcorn with oil and
salt
Potato chips
Pretzel sticks, Frito
Lay
1 ounce
1 cup
154
41
231
175
23
256
35
1
10
3
114
324
200
17
226
99
8
21
DESSERTS AND SWEETS
Cookies:
23
Brownies, iced, frozen
1
Chocolate chip 2 cookies
(commercial)
Oatmeal and raisins
2
Sandwich type (round)
2
Sugar
1
Doughnut, cake
1
(plain)
Angel
White
1/12
1/12
126
104
69
69
54
30
12
8
126
99
89
125
55
96
108
160
104
8
15
29
6
5
16
13
121
187
134
238
40
38
Cakes, from mix:
4
31
Pies, frozen:
13
12
Apple 1/8 of pie 160
208
76
Cherry 1/8 of pie 100
169
82
LEGUMES AND NUTS
Almonds, roasted and
1 cup
984
311
1,214
369
salted
Beans, baked, no pork
1 cup
236
606
832
100
Beans and peas, dry, cooked:
Northern
1 cup
118
5
416
50
Blackeye, cooked
1 cup
178
12
625
40
Pinto, calico, raw 1/2 cup 349
4
984
135
Split, cooked
1 cup
208
5
536
20
Kidney, canned
1 cup
225
844
660
72
Cashews, roasted
1 cup
561
1,200
464
38
Peanuts:
Dry, roasted, salted
1 cup
838
986
1,009
104
Unsalted
1 cup
838
8
1,009
104
Peanut butter
1
86
81
123
11
tablespoon
Pecans
1 cup
696
1
420
74
Pistachios
1 cup
594
6
972
131
Walnuts, English
1 cup
781
3
540
119
VEGETABLES
Asparagus, canned 4 spears 14
298
127
14
Snap beans, canned
1 cup
43
326
227
81
Beets, cooked, fresh
1 cup
54
73
344
24
Broccoli, raw 1 stalk 32
23
382
103
Cabbage, green, raw
1 cup
24
8
233
49
Carrots, raw, grated
1 cup
46
34
375
41
24
Cauliflower, raw,
flower pieces
Celery, raw
1 cup
27
17
295
25
1 stalk
(outer)
8
25
170
20
Corn:
Cooked, fresh
1 ear
Frozen
1 cup
Cream style, regular,
1 cup
canned
Cucumber 7 slices
Lettuce, iceberg,
1 cup
chopped
Mushrooms, raw
1 cup
Onions 1 medium
70
130
210
1
7
671
151
304
248
2
5
8
4
7
2
4
45
96
7
11
20
38
7
10
290
157
4
27
Peas:
Cooked
1 cup
106
Frozen, regular 3 ounces 58
Baked or boiled 1 medium
without skin
French fried 10 strips
Mashed with milk and
1 cup
salt
Pumpkin, canned
1 cup
139
5
755
34
16
Potatoes:
14
137
137
15
632
427
548
8
50
76
12
552
Raw, chopped
Frozen, chopped,
cooked
Squash, summer,
cooked
Squash, winter, baked,
mashed
1 cup
1/2 cup
14
23
49
65
259
333
58
Spinach:
51
113
1 cup
28
5
282
50
1 cup
126
2
922
56
Baked or boiled
2
80
294
116
1 sm.
141
20
300
potato
Canned, solid packed
1 sm.
108
48
200
potato
Tomato, raw 1 med. 33
14
366
Tomato
Tomato paste
1 cup
215
77
2,237
Tomato sauce
1 cup
97
1,498
1,060
CONDIMENTS, FATS AND OILS
Sweet potatoes:
40
25
20
71
32
25
Catsup
1
16
tablespoon
Mustard, prepared, 1 teaspoon 4
yellow
Olives, green, large 4 olives 18
Pickles, dill 1 lg. pickle 11
156
55
3
65
7
4
323
928
8
200
10
26
Sauces:
A-1
Barbecue
Worcestershire
Butter, regular
Margarine
Blue cheese
French, bottled
Italian, bottled
Mayonnaise
Thousand Island
1
1
tablespoon
1
tablespoon
1
tablespoon
1
tablespoon
1
tablespoon
1
tablespoon
1
tablespoon
1
tablespoon
1
tablespoon
1
tablespoon
12
275
51
3
15
130
28
3
12
206
120
15
108
116
4
4
108
140
3
3
Salad dressing:
11
71
153
5
57
214
11
2
77
116
2
2
61
78
1
2
70
109
16
2
J. Anderson, Colorado State University Extension food and nutrition specialist and professor; L.
Young, M.S., former graduate student; and E. Long, graduate student, food science and human
nutrition. 11/98. Revised 8/08.
26
Silent killer
Goal:
Control HTN among obese pt during 2009-10 by 20% at
KKUH.
27
Objective:
By the end of the program the pt will be able to :
-Define and list the symptom of HTN.
-Identify the relationship between HTN and obesity.
-List the complication of obesity HTN.
-Choose the diet that is benefit to his case, and increase
his physical activity.
-Monitor his Bp.
-Returned for follow-up visits more frequently.
-Complain with the treatment.
Target group:
Pt with his families.
Location:
The dietitian clinic at KKUH at second floor.
And The waiting area.
Time:
I will start at 2009 until the end of 2010.
Team member:
Health educator, physician, nurse, dietitian, pt, family,
pharmacies, social work.
plan:
I will implement my program through individual
teaching and group teaching.
1-individual teaching:
Objective:
By the end of the program the pt will be able to:
-define what is HTN , causes, risk factor that increase the
chance of being HTN and list HTN symptom.
- list the complication of HTN (e.g. Damage to the
artery, heart failure, blocked of blood vessels, metabolic
syndrome, and trouble with memory).
28
-Identify the relationship between HTN and obesity, and
the important to lose wt in order to reduce BP.
-Choose the diet that is benefit to his case(follow a
vegetarian diet, increase soluble fiber ,low fat, low sugar,
high potassium, moderate sodium restriction in his diet )
and increase his physical activity.
- measure &monitor his Bp and daily check up at home.
-returned for follow-up visits more frequently.
-complain with the treatment.
Session plan:
Each pt will receive 6 sessions during 4 month in the
dietitian clinic at KKUH at second floor.
session
1
2
3
4
5
6
Week
1
3
5
7
9
13
time
30 min
30 min
30 min
45 min
15 min
15 min
Session 1: (30 minute)
At the session (1) I will give Information about HTN,
causes, risk factor that increase the chance of being HTN
and list HTN symptom.(give HTN procure the contain
this information) evaluate by oral test such as ask
question . (See page 3,4)
Session 2 :(30 minute)
29
At the session (2) I will informed the pt about the
complication of obesity HTN (such as.. Damage to the
artery, heart failure, blocked of blood vessels, metabolic
syndrome, and trouble with memory).
(Show video about complication of HTN obesity)
evaluate by written test. (see page 13,14)
Session 3: (30 minute)
I will informed the pt about the relationship between
HTN and obesity, the important to lose wt in order to
reduce BP. (procure about the relationship between HTN
and obesity, the important to lose wt in order to reduce
BP ) evaluate by oral test ask question.(see page 11)
Session 4:(45 minute)
I will help the pt to Choose the diet that is benefit to his
case by know his caloric daily need and follow a
vegetarian diet especially celery ,garlic , onion, tomato,
broccoli, carrot, increase water soluble fiber such as oat
bran, apple pectin, ,low fat, low sugar, high potassium
food such as banana Daily intake of potassium should
total 7 grams per day., moderate sodium restriction
limiting the sodium consumption to less than 2.4 grams
of sodium a day That equals 6 grams (about 1 teaspoon)
of table salt a day. The 6 grams include ALL salt and
sodium consumed, including that used in cooking and at
the table )( give the pt printed material contain table of
each food and its calorie ,sodium, potassium content to
know how to choose his diet according to his daily need
and by food model ). and informed the pt about the
importance to increase his physical activity. Evaluate by
30
check list ask the pt to check the food that high in
potassium as an e.g. and interview the pt .(see page
15..19 and the table 21..25)
Session 5:(15 minute)
I will help the pt to know how to monitor his Bp by
himself use Bp measure instrument
(sphygmomanometer) and need to daily check up at
home with recorded the result each time. (By bring
working model and let him try to measure his BP in the
clinic) evaluate by direct observation and see the result
that he record it.
Session 6:( 15 minute)
Returned for follow-up visits more frequently. And
check his complain with the treatment. Evaluate by
check his BP result.
2- Group teaching:
Session plan:
Each pt will receive 6 sessions during 4 month in the
dietitian clinic at KKUH at second floor.
session
1
2
3
4
5
6
Week
1
3
5
7
9
13
time
30 min
30 min
30 min
45 min
15 min
15 min
Objective:
By the end of the program the pt will be able to :
31
-define what is HTN ,causes, risk factor that increase the
chance of being HTN and list HTN symptom.
- list the complication of obesity HTN (Damage to the
artery, heart failure, blocked of blood vessels, metabolic
syndrome, and trouble with memory).
-Identify the relationship between HTN and obesity, and
the important to lose wt in order to reduce BP.
-Choose the diet that is benefit to his case(follow a
vegetarian diet, increase soluble fiber ,low fat, low sugar,
high potassium, moderate sodium restriction in his diet )
and increase his physical activity.
- measure &monitor his Bp and daily check up at home.
-returned for follow-up visits more frequently.
-complain with the treatment.
Session 1:(30 minute)
At the session (1) I will give Information about HTN,
causes, risk factor that increase the chance of being HTN
and list HTN symptom.(give procure the contain
Information about HTN causes, risk factor , symptom)
evaluate by oral test such as ask question .(see page 3,4)
Session 2 :(30 minute)
At the session (2) I will informed the pt about the
complication of obesity HTN (such as.. Damage to the
artery, heart failure, blocked of blood vessels, metabolic
syndrome, and trouble with memory).
(Show video about complication of HTN obesity)
evaluate by written test. (see page 13,14)
Session 3: (30 minute)
32
I will informed the pt about the relationship between
HTN and obesity, the important to lose wt in order to
reduce BP. (procure about the relationship between HTN
and obesity, the important to lose wt in order to reduce
BP) evaluate by oral test ask question. (See page 11).
Session 4:(45 minute)
I will help the pt to Choose the diet that is benefit to his
case by know his caloric daily need and follow a
vegetarian diet especially celery ,garlic , onion, tomato,
broccoli, carrot, increase water soluble fiber such as oat
bran, apple pectin, ,low fat, low sugar, high potassium
food such as banana Daily intake of potassium should
total 7 grams per day., moderate sodium restriction
limiting the sodium consumption to less than 2.4 grams
of sodium a day That equals 6 grams (about 1 teaspoon)
of table salt a day. The 6 grams include ALL salt and
sodium consumed, including that used in cooking and at
the table )( give the pt printed material contain table of
each food and its calorie ,sodium, potassium content to
know how to choose his diet according to his daily need
and by food model ). and informed the pt about the
importance to increase his physical activity. Evaluate by
check list ask the pt to check the food that high in
potassium as an e.g. and interview the pt . (see page
15..19 and the table 21..25)
Session 5:(15 minute)
I will help the pt to know how to monitor his Bp by
himself use Bp measure instrument
(sphygmomanometer) and need to daily check up at
home with recorded the result each time. (By bring
working model and let him try to monitor his BP in the
33
clinic) evaluate by direct observation and see the result
that he record it.
Session 6:( 15 minute)
returned for follow-up visits more frequently. and check
his complain with the treatment. Evaluate by check his
BP.
Material:
-procure the contain Information about HTN causes, risk
factor, symptom.
-video about complication of HTN obesity.
-procure about the relationship between HTN and
obesity, the important to lose wt in order to reduce BP.
-printed material contain table of each food and its
calorie ,sodium, potassium content to know how to
choose his diet according to his daily need .
Tools:
-Place (clinic).
- Procure.
-Food model
-Scale
-Bp measure instrument (sphygmomanometer)
-cup
-Computer
-TV
Resource:
Krause’s Mahan book Food, nutrition, and diet therapy.
Referral:
[email protected] o556255242
Health care team involves:
Health educator, physician, nurse ,dietitian, pt ,family
,pharmacies ,social work.
34
Evaluation:
Evaluate the understanding every time for every pt.
This done by oral test such as ask question, by written
test, check test interview direct observation pre and post
test evaluation.
And if there is problem correct and Reevaluate at the end
of the year.
Documentation:
. Documentation after each session in chart, report or in
the pt file I will give the pt schedule for the program and
call the pt to tell him with every lecture.
I will give report at the end of the program.
35