nutrition and hypertension pa tho genesis

8/8/2019 Nutrition and Hypertension Pa Tho Genesis

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Nutrition and Hypertension

Pathogenesis

Darmono SS


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Hypertension

WHO (2005), Joint National Committee on

Prevention, detection evaluation and

treatment of high blood pressure, dietary

approaches to stop hypertension :

Chronic degenerative diseasee

preventable

Behavioral affluence

Hectic,


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Hypertension

Neurohormonal disease, renin angiotension

Stress people

Consumptive life Immobility

Less exercise

High cost in health care

Fatal cases


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Epidemiology

Research in more than 42 countries, 52 center.

Prevalence : 11-60 %

90 % : essential of primary hypertension or

primary hypertension Indonesian Demographic & health survey since

1990, to 1994, the diseases list number 15increases to 9 and 7

Increase very dramatically. (SDKI 2004)

Commercial hospital care, most of BOR related todegenerative diseases (due to hypertension)


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Epidemiology

Riskesdas 2008 :

Prevalensi nasional hipertensi penduduk > 18

tahun : 29,8 %

10 propinsi mempunyai hipertensi di atas rata-

rataa

Daerah pesisir lebih tinggi dibanding pedalaman

10 kabupaten yang prevalensinya > 50 %

Silent killer, stroke, number one killer


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Pathophysiology

Stroke volume or cor : systole < 110 mmHg

Muscle relaxation of cor : diastole < 80 mmHg

Blood pressure : stroke volume X peripheriresistence.

Viscousity

Water load, electrolit inbalance

Blood volume (different position)


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Nutrient related to Blood Pressure

DahI hypotesis :

In animal & human experimental Na+, K+ ,

Sodium intake related to expanded bloodvolume, cardiovascular diseases

Health believe model : risk factor, diseases

occurance and perceiving of life changes


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Pathogenesis hypertension


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Health impact

Increasing morbidities

Increasing mortalities

Decreasing quality of life

Less productivities Complexes failure of target organ

Squealed

Cost of health care

Complication to target organ : brain (stroke),heart, renal, perifer blood vessels, ocular, cardiac-pulmonum


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Nutrition, metabolic risk factor

Ca,

Mg

Glucose

Refined ChO Glycosylated Hb

Alcohol (energy)

Cholesterol total, fibre

Ratio lipid profile Omega 6 (vegetable oil),

Omega 3 (eicosapentaenoic acid, marine) lesspotassium intake


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Nutrient related to blood pressure

Epidemiological research & hypertension

FDA : sodium intake

Sodium excretion & mean of blood pressure

Middle age man and women : average/gram ofsalt intake

6,3 mmHg systolic

2,2 mmHg diastolic per 10 % BW Nutrition review 2005, high salt diet related to

stroke


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Secondary causes 4-8 %

Renal diseases

glomerulonephritis,

Chronic pyelonephritis

Polycystic disease

Renal vascular disease


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Secondary causes 4 8 % Endocrine

Disease

Cushings syndrome

Conns syndrome

Phaeochromocytoma


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Secondary causes 4 8 % Drug

Induced

Contraceptive pill

Liquorice containing compounds

Steroids ingestion in patients takingmonoamine oxidase inhibitors


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Scundary causes 4 8 %

Coarctation of the aorta

Lead poisening, raised intracranial pressure

Attcks in porphyria


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Classification: Hypertension for > 18

years oldCategory Sistole BP (mmHg) Diastole BP (mmHg)

Optimal < 120 And < 80

Normal


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Table : secondary causes of hypertension

Renal Renal parenchymal disease (glomerulonephritis, polycystic

disease, diabetic nephropathy)

Renovascular disease (renal artery stenosis. Fibromuscular

dysplasia, vasculitis) Endocrine

Hypo-or hyperthiroidism

Hyperparthyroidism

Adrenocorticoid excess (Cushings syndrome, primaryaldosteronism)

Pheochromocytoma

Exogenous hormones (oral contraceptives, estrogenreplacement)


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Table : secondary causes of hypertension

Neurologic Disorder Brain tumors, sleep apnea, spinal cord injuries, lead

poisoning, porphyria

Stress Induced Pain, anxiety, hypoglycemia, alcohol withdrawal,

postoperative

Toxic / Pharmacologic Alcohol and drug use, NSAIDs, ephedrine, corticosteroids,

monoamine oxidase inhibitors

Miscellaneous Aortic Coarctation

Carcinoid Syndrome

pregnancy

Sumber : Andreoli et al. Cecil Essentials of medicine 6th , 2004


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Sodium

Biochemical vasometer

Inhibitor diuresis

Loading increase urinary excretion, serum

parathyroid hormone, 1,25 dehydroxy vitamin D

Periphery resistance, increase volume

Osmoses pressure, extra cellular space

Mostly related to over calories consumption

Food preservative, food taste, soda bread,medicines (sedative, analgetic, antitusive etc)


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Patogenesis

Natrium : major kation in extra celluler

K : anion in intra celluler

NaCl daily use (10 gram/day)

Na HCo3 : baking soda

Natrium benzoat : preservativeness

Mono sodium glutamat (tasty food)

Sodium diclofenac

Sodium medicine (cough, analgetic) etc


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Potassium

Natriuresis effect (WHO, should be natural

basis. Cheap, long term effect). Potassium

tablet not solve in gastric liquid.

Decreasing venticular ectopic

75 % client diet satisfication

Decreasing Aldosteron, vasopresin, plasmaangiotensin, plasma renin, prostaglandin.

Decreasing ectopic ventricular


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Calcium

Study in bio gerontology : CaCO3 decreasing

hypertension

Hypertension : low calcium intake & level (100research of hypertension)

1 gram Ca intake decreasing systolic 3 mmHg

Diastolic 2, 3 mmHg Not for medicine intervention (pharmacology

terminology)


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Cicletanine (potential mechanism to blocksympathetic nerve activity) decreasing BP &plasma nor epinephrine concentration

Nor epinephrine release from : symphatic postganglionic nerve terminal modulated bydietary sodium

Intracellular sodium conc

modifyepinephrine releases by affectingneurotransmitter re- uptake mechanism


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Central nerves system & alpha adrenergic

receptors

Renal control of renal function enhanced bysodium intake

Brain renin angiotensin system

Salt

induce enhancement Hypothalamic nor ephinephrine concentration

altered by sodium


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Increasing NaCl, decreasing norephinephrine

concentration in anterior & posterior

hypothalamus

Specific brain region paraventricular & supra

chiastic areas BP regulation and

neurotransmitter.

Beta adrenergic receptor (propanolol) salt

stress hypertension


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Affluence factors

Waist hip ratio women : > 0,85; men > 0,90 BMI

overweight, obesity increasing cardiac output

Cardiac pre & after loading tension

Cardiac hyper therapy

Insuline ressistance abnormal neuro endocrine

Stress response increasing catecholamine,

adrenaline response. Medical treatment : affect to electrolyte, lipid

profile


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Affluence factors

Neuronal discharge rate maintaining

homeostasis cardiovascular resting.

Renin angiotensin activity increasing betaadrenergic receptor.

Renin angiotensin aldosteron axis, sympatho

adrenal like natri uretic factor, atrial

natriuretic peptide, adenosin and vasopresin.


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Figure arteriogram of the distal aorta and its bifurcation into the common iliac arteries in a patient with left lower

extremity claudication. There is mild atherosclerotic disease of the distal aorta before its bifurcation and normal.

Sumber : Andreoli et al. Cecil Essentials of medicine 6th , 2004


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Hypertension case study in china

(2007)

Life style

Food habits

Socio demographic Body weight

Waist circumference

Fat free mass


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Hypertension


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nutrition and hypertension pa tho genesis

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