hypertension in spinal cord patients
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Hypertension in Spinal Cord Patients. Rebecca Linstead. Hypertension is…. Systolic BP > 140 mmHg OR Diastolic BP > 90 mmHg. Regulation of Blood Pressure. Baroreceptor Reflex. One Significant Difference in SCI…. Autonomic Dysreflexia. Parasympathetic. S ympathetic. Etiology. - PowerPoint PPT PresentationTRANSCRIPT
Rebecca Linstead
Hypertension in Spinal Cord Patients
Hypertension is…
Systolic BP > 140 mmHg OR
Diastolic BP > 90 mmHg
One Significant Difference in SCI…
Parasympathetic
Sympathetic
Autonomic Dysreflexia
Etiology
What to watch for…• Sweating above the level of injury
• Hypertension
• Nausea
• Cold, clammy skin below the level of injury
• Goose bumps
• Blotching of the skin
Emerging Research:Testing an alternative mineral salt• Inclusions/Exclusions• Methods• Results
Smart Salt; n=22
NaClKMg
Regular Salt; n=23
NaCl
VS
Emerging Research …Regular Salt Smart Salt
Avg Energy Intake 2000 kcal 2200 kcal
Avg amount of table salt used
1.3 g/day 1.9 g/day
Avg NaCl intake per dU-Na
insignificant 2.0g/day*
SBP at end of intervention
3.8 mmHg p<0.002
7.5 +/- 10 mmHg* p<0.002
DBP at end of intervention
1.5 mmHg p = 0.014
2.7 +/- 4.5 mmgH* p = 0.014
Emerging Research …
Emerging Research:Protein Supplementation
Protein Supplement; n=43
PeaEgg WhiteSoyMilk Protein Isolate
CHO Supplement; n=51
MaltodextrinVS
• Inclusions• Methods• Results
Emerging Research …
MNT for Hypertension• Potassium• Magnesium• Fruits/veggies• Lean meats• Healthy fats• Whole grains
• Highly processed meats and cheeses
• High sugar foods• Sedentary lifestyle
Special Considerations
Smoking cessation
Adequate fluid intake
Lose excess weight
B.B. – 75 y/o WM• Diagnoses: atherosclerosis of extremities with gangrene, pressure
ulcers, GERD, DB, Autonomic Dysreflexia, HTN, hyperlipidemia
• Admitted June 2013 for worsening pressure ulcers
• Allergies: Amikacin, hydrochlorothiazide
• Current medications:• Laxative/Stool softener : Docusate• Antihypertensive: Metoprolol• DB regimen: SSI, 6 units @ bedtime, 16 units every morning• Vitamin D2: ergocalciferol
• Bowel training 3x/week
B.B.• Currently on a 2200 CHO diabetic diet
• Supplements include 1 Prostate with each meal (discontinued Boost Glucose Control 10/24)
• Main concern: maintain blood sugars <180 and heal pressure ulcers
Referenceshttp://apbrwww5.apsu.edu/thompsonj/Anatomy%20&%20Physiology/2020/2020%20Exam%20Reviews/Exam%201/CH19%20Blood%20Pressure.htm
http://betterthandormfood.com/2012/02/do-you-really-need-8-cups-of-water-per-day/
http://www.spinalcordinjury-paralysis.org/heartandnerve/2012/07/31/foodie-fest
http://www.studyblue.com/notes/note/n/spinal-cord-injuries/deck/5449625
http://eprimarycare.onf.org/AutonomicDysreflexia.html
http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/P/PNS.html
http://pvamag.com/pn/article/5039/autonomic_dysreflexia_an_emergency_situation
http://hyper.ahajournals.org/content/55/3/636.full
http://www.spinal-injury.net/autonomic-dysreflexia.htm
http://www.ninds.nih.gov/disorders/sci/detail_sci.htm
ReferencesTeunissen-Beekman KF, Dopheide J, Geleijnse JM, Bakker SJ, Brink EJ, de Leeuw PW, van Baak MA. Protein supplementation lowers blood pressure in overweight adults: effect of dietary proteins on blood pressure (PROPRES), a randomized trial. Am J Clin Nutr. 2012 Apr;95(4):966-71
Sarkkinen ES, Kastarinen MJ, Niskanen TH, Karjalainen PH, Venäläinen TM, Udani JK, Niskanen LK. Feasibility and antihypertensive effect of replacing regular salt with mineral salt -rich in magnesium and potassium- in subjects with mildly elevated blood pressure. Nutr J. 2011 Sep 2;10:88. doi: 10.1186/1475-2891-10-88.
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