Medical Nutrition Therapy Hypertension Case Study

2. Group Members
• Meera Maraj
• Omari Joseph
• Nailah Antoine
• Mikhail Lutchmedial
• Kern Rocke

3. Patient Profile and
Medical Records Data
Age= 50 years
Sex= Male
Ethnicity= African American
Occupation= High School Football Coach
Height= 6 feet 3 inches
Weight= 220 lbs
BP= 160/100
Medical Hx= Stage 2 (essential) Hypertension
P.A.= Walks 30 mins, 4-5 times per week
Previously a 2- pack a day smoker
Previous Dietary Tx= 4-gm Na Diet
Pharmacological Tx = 25 g hydrochlorothiazide qd

4. Patient Profile and
Medical Records Data
Chief Complaint:
Difficulty in adhering to a reduction of salt in the diet.
Food tastes bland and tasteless.

5. Pathophysiology
of Hypertension

6. Pathophysiology of
Hypertension
• Hypertension is the chronic elevation of blood
pressure that, in the long-term, causes end-organ
damage and results in increased morbidity and
mortality.
• Occurs due to the abnormal functioning of the
arterial pressure related to the central nervous
system, renin-angiotensin-aldosterone system,
endothelial dysfunction, genes and even due to
certain environmental factors.

7. Pathophysiology of
Hypertension
• Factors which contribute to the development of
hypertension are:
 Aging
 Genetics
 Obesity
 Smoking
 Salt Sensitivity
 High Frequent Alcohol Consumption
 High Fat Diet
 Low Fiber Diet
• Normal blood Pressure is calculated as: 120/80 in
healthy adults.

8. Pathophysiology of
Hypertension
• Resting Blood Pressure ≥ 140/90 on two separate
occasions in an individual is characterized as either
Stage I or Stage II Hypertension.
• Resting Blood Pressure ≥ 130/80 in diabetic patients
increases their risk for the development of heart
disease.

9. Nutritional
Assessment

10. Anthropometrics
• Weight= 220 lbs / 2.2 lbs
= 100 kg
• Height= 6’3”= 75 inches
= 75 x 2.54
= 190.5 cm = 1.905 m
• B.M.I = 100 kg/ (1.905)2 m
=27.56 (overweight)

11. Anthropometrics
• Height = 6 feet 3 inches
=5 feet + (12 inches for the additional foot + 3
inches)
=5 feet + 15 inches
• IBW = 106 lbs + (6lbs * 15 inches)
=106 lbs + 90 lbs
=196 lbs
• %IBW = (220 lbs/ 196 lbs) * 100
= 112.24% (overweight)

12. Anthropometrics
• BMR = 66 + (13.7 x 100kg) + (5 x 190.5cm) – (6.8 x 50)
x 1.48
= 66 + 1370 + 952.5 – 340 x 1.48
= 2048.5 x 1.48
= 3031.8 kcals/ day
• EER = 864 – (9.72 x 50) + PA x (14.2 x 100) + (503 x 1.905)
=864 – 486 + (PA x 1420 + 958.2)
=378 + (PA x 2378.2)
=378 + (1.27 x 2378.2)
=378 + 3020.3
=3398.3 kcals/ day

13. Biochemical
Biochemical Patient value – mg/dl Normal value – mg/dl
parameter
Total cholesterol 300 140-199
LDL cholesterol 135 <130
HDL cholesterol 35 37-70
Triglycerides 250 35-160

14. Biochemical
• Altered Lipid Values as a result of:
1) High Saturated Fat and Trans-Fat Intake
2) High Sugar Intake
3) High Alcohol Intake
4) Overweight

15. Clinical
Healthy, male who looks his age
Temp= 98.6 0F BP= 160/100 mmHg
HR= 80 bpm RR= 15 bpm
Regular rate and rhythm, normal heart sounds (No
clicks, murmurs, or gallops)
No edema present on the skin and on hands and feet

16. Clinical
• Diagnosis of Stage 2 (Essential) Hypertension 1 year
ago
• Medical History shows that the subject’s mother
died from a Myocardial Infarction Related to
Uncontrolled Hypertension
• Hypertension of subject may have been caused
due to genetic history of hypertension

17. Dietary- History
24-hr Recall
Usual dietary intake:
AM: 1 c coffee (black)
Hot (oatmeal with 1 tsp margarine and 2 tsp sugar) or cold (Frosted
Mini- Wheats) cereal.
½ c 2% milk
1 c orange juice
Snack 2 c coffee (black)
1 glazed donut
Lunch: 1 can Campbell’s tomato bisque soup
10 saltines
1 can diet cola
After work: 2 (usually) gin and tonics (3 oz gin with 5 oz tonic)
PM: 6 oz baked chicken (white meat no skin) (seasoned with salt pepper,
garlic)
1 large baked potato with 1 T butter, salt and pepper
1 c glazed carrots (1 tsp sugar, 1 tsp butter)
Dinner salad with ranch – style dressing (3 tsp)- lettuce, spinch,
croutons, sliced cucumber
HS snack: 2 c butter pecan ice cream

18. Dietary- Analysis
Parameter Patient Intake
Calories (kcals) 4100 !
Protein (% Calories) 12 !
Carbohydrate (% Calories) 45
Dietary Fiber (g) 30
Total Fat (% Calories) 34
Saturated Fat (% Calories) 13 !
Monounsaturated Fat (% Calories) 13
Polyunsaturated Fat (% Calories) 6
Cholesterol (mg) 411 !
Calcium (mg) 1546
Potassium (mg) 6309
Sodium (mg) 5849 !
Vitamin B6 (mg) 3.6
Vitamin B12 (mg) 4.7
Vitamin C (mg) 4118
Vitamin D (µg) 8 !
Vitamin E (mg) 13 !

19. Recognition of
Diet/ Drug
Interaction

20. Recognition of Diet/ Drug
Interaction
• High intakes of salt in the diet increases the excretion
of Potassium while taking hydrochlorothaizde can
lead to development of hypokalemia
• High intakes of Caffeine while taking
hydrochlorothaizde can lead to a strong diuretic
effect on the body thereby leading to dehydration
• Untreated dehydration can lead to heart injury,
cerebral edema, kidney failure, hypovolemic shock
and even death.

21. Nutritional
Needs
Calculations

22. Nutritional Needs
Calculations
CHO requirements = 45% - 65% based on a 2000 calorie
intake
If 45% - 65% of carbohydrates are recommended based on
a 2000 calorie intake
X % - Y of carbohydrates are recommended based on a
3031.8 calorie intake
X% - Y% = (45% - 65%) * 3031.8 / 2000
= (136,431% - 197,067) / 2000
= 68.2g – 98.5g

23. Nutritional Needs
Calculations
• PRO requirements = 10% - 35% based on a 2000 calorie
intake
If 10% - 35% of proteins are recommended based on a 2000
calorie intake
X % - Y of proteins are recommended based on a 3031.8
calorie intake
X% - Y% = (10% - 35%) * 3031.8 / 2000
= (30,318% - 106,113) / 2000
= 15.2 g – 53.1g

24. Nutritional Needs
Calculations
FAT requirements = 40% - 65% based on a 2000 calorie
intake
If 40% - 65% of proteins are recommended based on a 2000
calorie intake
X % - Y of proteins are recommended based on a 3031.8
calorie intake
X% - Y% = (40% - 65%) * 3031.8 / 2000
= (121,272% - 197,067) / 2000
= 60.6 g – 98.5 g

25. Nutrition
Diagnosis

26. Nutrition Diagnosis
• Overweight as related to high carbohydrate and fat
diet as evidenced by BMI of 27.56 and % IBW of
112.24 %.
• Altered nutrition related laboratory values related to
high fat diet as evidenced by total blood
cholesterol of 300mg/dL, blood triglycerides of
250mg/dL, LDL of 135mg/dL and HDL of 35mg/dL.
• Altered metabolic status (hyper) related to high salt
and fat intake, family history of hypertension as
evidenced by blood pressure of 160/100 mmHg
and death of patient’s mother from MI related to
uncontrolled hypertension.

27. Nutrition Diagnosis
• Inadequate mineral intake (Potassium and
Calcium) related to low dietary intake as
evidenced by dietary intake of 81.1% Potassium
and 84.2% Calcium.
• Low adherence to nutrition recommendations
related to patient’s low adherence to a 4mg sodium
diet as evidence by chief complaint of foods being
bland and tasteless.

28. Nutrition Care
Plan

29. Nutrition Care Plan
Problem Goal Strategies Monitoring and
Evaluation
Overweight To achieve a weight To provide a 2925 24 hr recall, food
loss of 20-22 lbs in 10 kcal/day low sodium frequency
months. and Low fat, questionnaire,
reduced diet. monthly weight
check-up.
Altered nutrition The patient will To provide a diet To monitor pt.
related laboratory achieve lower low in lipids laboratory values.
values laboratory values to (saturated fat and
reach normal range. cholesterol) and to
Cholesterol = 140-199 increase daily
mg/dL physical activity
LDL-C = < 130 mg/dL levels.
HDL-C = >40 mg/dL
To educate pt. on
TG = 35-160 mg/dL
choosing foods low
in saturated fat,
cholesterol and
triglycerides.

30. Nutrition Care Plan
Problem Goal Strategies Monitoring and
Evaluation
Altered metabolic status Patient should achieve a To increase activity Monthly blood pressure
(hyper) normotensive BP of (aerobic) to 60 minutes, 5 measurements, food
≤ 120 mmHg times/week. frequency questionnaire
80 To provide a low sodium and 24-hr recall.
diet (< 2300 mg/day) –
based on the DASH Diet.
To decrease the
consumption of fast
foods on weekends from
Fridays and Saturdays
once/week to Fridays
and Saturdays once
every 3 weeks.
To increase consumption
of low sodium home
cooked meals.

31. Nutrition Care Plan
Problem Goal Strategies Monitoring and
Evaluation
Inadequate mineral To increase consumption To provide a diet rich in Food frequency
intake (Potassium (K) of foods rich in K and Ca. K and Ca using foods questionnaire, monthly
and Calcium(Ca)) such as low-fat dairy biochemical tests.
products (Ca), mango
(K), tomatoes (K),
tomatoes (K), leafy green
vegetables (Ca and K),
fish (K).
Low adherence to To increase adherence to a To provide nutrition Food frequency
nutrition related low sodium diet. education and questionnaire, 24-hr
recommendations counselling on the recall.
importance of adherence
to a low sodium diet to
patient and patient’s
wife.

32. Menu
Breakfast:
2 servings of whole wheat cereal
2 servings of a medium sized banana (sliced)
2 servings of 1% or low fat milk
1 serving of garlic tea
Snacks: (AM)
1 large mango
1 20oz bottle water

33. Menu
Lunch:
2 servings of mackerel (steamed / lemon)
3 servings of whole wheat pasta
1 serving of cooked pigeon peas
2 servings of vegetables – 1 toss salad (1c lettuce, carrots)
1 serving of olive oil
3 servings of vegetable / fruit juice – beet root (1.5 serv) &
pineapple juice (1.5 serv)
Snack: (PM)
1 20oz bottle water
1 medium orange
3 servings of Trail Mix

34. Menu
DINNER:
4 servings of whole wheat bread (Home-made, low
sodium)
1 serving tomatoes
1 serving lettuce
1 serving salmon
1 cup of water (8oz)

35. Nutrient Content of Menu
Parameter Patient Intake
Calories (kcals) 2756
Protein (% Calories) 20
Carbohydrate (% Calories) 69
Dietary Fiber (g) 63
Total Fat (% Calories) 16
Saturated Fat (% Calories) 3
Monounsaturated Fat (% Calories) 7
Polyunsaturated Fat (% Calories) 5
Cholesterol (mg) 153
Calcium (mg) 1340
Potassium (mg) 6595
Sodium (mg) 1816
Vitamin B6 (mg) 3.8
Vitamin B12 (mg) 7.9
Vitamin C (mg) 434
Vitamin D (µg) 25
Vitamin E (mg) 15

36. Questions

37. References
Life Extension. 2012. “Risk Factors for High Blood Pressure.” Accessed November 10 th, 2012.
http://www.lef.org/protocols/heart_circulatory/high_blood_pressure_04.htm.
Mahan, L. Kathleen, and Escott- Stump, Sylvia. 2008. Krause’s Food and Nutrition and Diet
Therapy. 12th edition. Philadelphia: W.B. Saunders Co.
United States Department of Agriculture. (N.d.) “SuperTracker” Accessed 3rd November, 2012.
https://www.supertracker.usda.gov/default.aspx.
Vanlterson, Erik. 2010. “Proper Nutrition for Hypertension Patients.” Livestrong.com. November
2nd. Accessed November 12th, 2012. http://www.livestrong.com/article/295001-proper-
nutrition-for-hypertension-patients/.
Weber, Craig. 2009. “Diabetics and High Blood Pressure.” About.com. July 23. Accessed
November 10th, 2012.
http://highbloodpressure.about.com/od/highbloodpressure101/a/diabetes-hbp.htm.

38. Thank You