‫)‪(2019/2020 Second Term‬‬

‫‪Faculty:‬‬ ‫التم ريض‬

‫‪:‬الكلية‬

‫‪Program:‬‬ ‫الشعبة ‪/‬‬ ‫عامة ‪ -‬بكالوريوس علوم تمريض‬

‫‪:‬البرنامج‬

‫‪Level:‬‬ ‫الث اني‬

‫‪:‬المستوى‬

‫‪Course:‬‬ ‫تغذي ة عالجي ة‬

‫‪:‬المقرر‬
‫‪Date:‬‬ ‫‪9/6/2020‬‬
‫‪:‬المقرر‬

‫‪Student name:‬‬ ‫اسم الطالب‬ ‫‪:‬حسن محمد عبدالفتاح عبدالهادي‬

‫‪National ID:‬‬ ‫‪29904141900191‬‬ ‫الرقم‬
‫‪:‬القومي‬

‫‪University ID:‬‬ ‫‪192605000199‬‬ ‫الرقم‬

‫‪:‬الجامعي‬
Presented about
" Hypertension (definition, pathophysiology, nutritional
problems, nutrition therapy, sample diet plan) "

Out line
Abstract:

Introduction:

Pathophysiology of Hypertension:

Definition of Hypertension:

Classification of Hypertension:

Risk factors of Hypertension:

Nutritional problems:

Nutrition Therapy:

Sample Diet plan:

Discussion:

Conclusion:

References:

Abstract:

Hypertension is a main health problem all over the world . Its

attendant morbidity and mortality complications have a great effects
on the quality of life and patients survival. It has been shown to
improve blood pressure control to improve overall health outcomes.
In addition to drug treatments, a non-pharmacological approach
such as dietary adjustment plays an important role in controlling
blood pressure. Several nutritional components such as sodium,
potassium, calcium and magnesium have been extensively studied in
the past decades. While some of these nutrients have clear evidence of
their recommendations, some are still controversial and are still
under study. Dietary adjustment is often discussed with patients and
can be a great help in controlling blood pressure. As such, a review of
existing evidence will be very helpful in guiding patients and their
physician or dietitian in the decision making process.
Introduction:
 Hypertension the major risk factor for cardiovascular disease, including
coronary heart disease and stroke, as well as for end-stage kidney disease
and peripheral vascular disease. The World Health Organization
estimates that almost one-third of all deaths worldwide are due to
hypertension. 
 High blood pressure, insulin resistance, obesity, and lipid abnormalities
(triglycerides and low HDL cholesterol levels) constitute metabolic
syndrome, a severe risk profile for cardiovascular disease.
 In the United States about 78 million people have high blood pressure.
Since it is usually asymptomatic, infected people often do not know that
they have this condition. In fact, 20% of people with high blood pressure
are unaware of their disease, and about half of those who realize it
achieves adequate control of blood pressure.
 The vast majority of cases are defined as primary or “essential,” meaning
that no particular cause has been identified (although diet, obesity, and
other controllable factors lead to “essential” hypertension).
Approximately 5 : 10 % of cases are secondary. they have a determining
contributing factor, such as renal or renal vascular disease, obstructive
sleep apnea, endocrine disease ‚or over-the-counter medications.
 Although hypertension usually does not contain signs or symptoms,
severe cases may be accompanied by a headache, changes in vision,
nausea, and vomiting.

Pathophysiology of Hypertension:
Definition of Hypertension:
 Hypertension is a chronic disorder in which the long-term
blood pressure against the artery walls is high enough to cause
health issues in the end.

 Hypertension is means as a systolic blood pressure (SBP) more

than 140 mmHg or a diastolic blood pressure (DBP) more than
90 mmHg.

Classification of Hypertension:
Risk factors of Hypertension:

Modifiable:

 Obesity.
 Salt intake.
 Potassium intake.
 Saturated fats.
 Alcohol.
 Dietary fibre.
 Smoking Stress.
 Physical activity.
 Socio - economic status.
 Non Modifiable:
 Age.
 Gender.
 Genetic factors.
 Ethnicity.

Nutritional problems:

Sodium Chloride:
 Sodium is one of the most dangerous dietary factors in
causing high blood pressure.

 Salt is the most common sodium dietary source.

 Most individuals ingest more sodium chloride than

recommended, which lead to water retention, blood volume
expansion, edema (the accumulation of excessive fluid in the
body), and high blood pressure.

Potassium:
 Increased potassium intake leads to increased sodium
excretion in the urine. Urinary sodium loss helps reduce
water retention, blood volume and blood pressure.

Calcium:
 Calcium can affect the constriction and dilation of the blood
vessel (narrowing and widening) by acting on smooth
muscle cells that make up arterial walls.

Magnesium:
 The way magnesium affects blood pressure is not clear.
Magnesium may relax the smooth vascular muscle cells,
alter the levels of inflammatory mediators, and reduce the
 synthesis of aldosterone induced by angiotensin, all of which
can lower blood pressure.

Riboflavin: " Vitamin B "

 Deficiency of Riboflavin can reduce the conversion of

homocysteine to methionine, and too much homocysteine in
the blood is associated with an increased risk of
hypertension.

Vitamin " D "

 Vitamin D affects the production of renin, an enzyme that
regulates blood pressure. Vitamin D deficiency can increase
the activity of the renin-angiotensin system and increase the
risk of hypertension.

Garlic:
 There are many ways that garlic may affect blood pressure.

 It works to narrow blood vessels.

Nutrition Therapy:
Sometimes‚ This nutrition therapy is called the DASH (Dietary
Approaches to Stop Hypertension) plan.

Sodium Chloride:
 Observational studies frequently show that higher sodium
intake is associated with higher blood pressure.

 The ratio of sodium to potassium consumed in the diet may be

even more important than sodium reduction alone. Hence,
most experts recommend reducing the intake of sodium
chloride (salt) while increasing Potassium intake at the same
time.
Potassium:

 A number of observational studies show that high potassium

intake is associated with low blood pressure.

 More important than intake of potassium alone is the ratio of

potassium to sodium in the diet. Most experts recommend
increasing your intake of potassium while reducing your intake
of NaCl (salt).

 Randomized controlled trials found that increased a potassium

intake, mostly in the form of potassium chloride
supplementation, had a moderate effect on lowering blood
pressure in people with normal or high blood pressure.
Calcium:

 A number of observational studies indicate that a higher

calcium diet is associated with systolic and diastolic
hypotension.

 Studies indicates that a calcium intake at the recommended

level of 1,000-1,200 milligrams/day may be helpful in the
prevention and treatment of moderate hypertension.
Magnesium:
 A number of large observational studies show that a higher
dietary intakes of magnesium are associated with lower blood
pressure and a decreased risk of developing hypertension.

 A combined analysis of randomized controlled trials with

magnesium supplementation has a beneficial effect in treating
hypertension. An average dose of magnesium is 410 milligrams
(mg) per day for 11.3 months reduce blood pressure in people
with high blood pressure.
Riboflavin: " Vitamin B "

 Individuals with a particular genetic variation (polymorphism)

in MTHFR may have an increased risk of developing high
blood pressure.

 In hypertensive patients with MTHFR c.677C>T

polymorphism (homozygotes), riboflavin supplementation
reduce both homocysteine concentration and blood pressure.
Vitamin " D "
 The higher status of vitamin D has been associated with lower
blood pressure.

Garlic:

 Garlic preparations may have an effect on lowering blood

pressure in individuals with high blood pressure. On average,
garlic preparations reduced systolic blood pressure by 9.1 mm
Hg and diastolic blood pressure by 3.8 mm Hg when consumed
for at least two months.
  No serious side effects were reported. The most common side
effect is garlic smell, taste and breath.
 Garlic should not be used in lieu of drugs that lower blood
pressure.
DASH Diet:
 The DASH plan shown below is based on 2000 calories per day.
The number of daily servings in the food group may differ
from the listed ones, depending on your caloric needs.
Lifestyle Modifications for Hypertension Management and
Prevention:
  Stop smoking.
 Maintaining a reasonable body weight. If necessary, lose
weight if possible.
 Decreased sodium intake to ≤ 2,300 mg daily.
 High level of physical activity; accumulate ≥ 30 minutes of
aerobic exercise most days of the week.
 Maintain sufficient potassium, magnesium, and calcium by
consuming a diet rich in fruits, vegetables, and low-fat dairy
products.
 Reduce saturated fat and cholesterol dietary intake .
 Limit alcohol intake.

Sample Diet plan:

Menu of one day

Breakfast:

 1 (commercial) whole-wheat bagel with 2 tablespoons of peanut

butter (no salt added).
 1 medium orange.
 1 cup fat-free milk.
 Decaffeinated coffee.

Lunch:

 Spinach salad made with:

o 4 cups fresh leaves of spinach.
o 1 sliced pear.
o 1/2 cup of canned mandarin orange sections.
o 1/3 cup slivered almonds.
o 2 tablespoons red wine vinaigrette.
 12 reduced-sodium wheat crackers.
 1 cup fat-free milk.
Dinner:

 Herbal Peeled Bread, 3 ounces cooked (about 4 ounces raw).

  1/2 cup of brown rice with vegetables.
 1/2 cup of fresh green beans, steamed.
 1 small sourdough roll.
 2 teaspoons olive oil.
 1 cup freshly chopped mint berries.
 Herbal iced tea.

Snack: (anytime)

 1 cup fat-free, low-calorie yogurt.

 4 vanilla wafers.

Nutritional Analysis:

Calories: 2,015 Cholesterol: 70 mg

Total fat: 70 g Sodium: 1,607 mg

Saturated fat: 10 g Total carbohydrate: 267 g

Trans fat: 0g Dietary fiber: 39 g

Monounsaturated fat: 25 g Total sugars: 109 g

Potassium: 3,274 mg Protein: 90 g

Calcium: 1,298 mg Magnesium: 394 mg

Discussion:
Hypertension can't be cured, but can be controlled by lifestyle changes
and prescriptive medications. While there are medicines available for
treating hypertension, research has shown that modest lifestyle and
changes in diet can help treat and often delay or prevent high blood
pressure. This study has shown clearly a high prevalence of overweight
and obesity among hypertensive patients who are of Yoruba ethnic
group in south western part of Nigeria due to dietary lifestyle. Most
respondents were between the ages of 36 and 65 years (60.8%). This is
in consonance with similar studies in some other countries. Contrary to
the general opinion that the very elderly (>75 years) are more prone to
hypertension, the very elderly in this study were 31 (25.8%) while those
in the middle age group were more than half of the registered
hypertensive patients. This is in agreement with a study done by Barer
et al….

Conclusion:
Lifestyle changes such as weight loss, cessation of smoking and
reduced alcohol intake have beneficial effects on BP levels. Dietary
patterns such as low-sodium DASH diet or the Mediterranean diet
remain as important strategies for preventing and controlling HTN.
Regular physical activity, mainly aerobic exercise should also be
included among lifestyle changes to reduce BP and delay the incidence
of HTN. All major guidelines are unanimous about the benefits of diet
and exercise among patients with HTN, as adjuvant to drug therapy to
improve the quality of life and reduce mortality rates in these
individuals.

References:
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