Hypertension Case Study

Brittni Filipiak
Madonna University
NFS 3250

Patient profile an health history

 Patient is a 50-year-old African American Male standing 63 tall

and weighing 220lbs. He is married and has children that are grown

and do not live at home. He holds a Masters degree and is a High

School football coach. A year ago the patient was diagnosed with stage

2 (essential) hypertension. After diagnosis of hypertension last year,

the patient started walking 30 minutes 4-5 times per week. This

resulted in a 10lb weight loss that has been maintained. During

football season he may miss walking. The patient reports that his

appetite is very good. After being diagnosed with stage 2

hypertension by his general medical doctor, a nurse told him to follow

a 4-gm NA diet. The nurse gave him a sheet of paper with the

information of the 4-gm NA diet. The patient and his wife started to

follow this, but did not succeed saying it was too bland and tasteless.

The patients wife does the shopping and cooks most meals. The

patient cooks breakfast on the weekend and he goes out to dinner

twice a week. When he eats a meal out, it is at a pizza restaurant or a

steakhouse and he consumes 2 regular beers with each meal. In

general, he eats 3 meals a day unless it is football season. During

football season, he may miss lunch so that, when it is time for dinner,

he is very hungry. After work, the patient will usually consume 1-2

mixed drinks before dinner. Patient has no know food allergies. Patient

takes a multivitamin/mineral every day. Patient medication is

Hydrochlorothiazide- 25mg qd. Before he was diagnosed with

2
Hypertension he did have problems with arthritis and Hay Fever. The

patient did smoke two packs of cigarettes a day, but quit cold turkey

once he was diagnosed with hypertension a year ago.

Overview of the Disease

Hypertension (HTN) is the chronic elevation of blood pressure. 1

The elevation of blood pressure is caused by the blood flow through the

arteries at a higher pressure than normal. Blood pressure is the force of

the blood against the artery walls as the heart pumps blood. 2 When

reading blood pressure, there are two numbers- the top number being

systolic and the bottom being diastolic. The systolic number is the

force of blood pumping into arteries. The diastolic number is when the

hear is resting between beats.2 A normal blood pressure reading would

be a systolic reading of less than or equal to 120mm Hg and a diastolic

reading of less than or equal to 80mm Hg.1 The Eighth Joint National

Committee and the American Heart Association classify hypertension

into two stages. A systolic reading between 140-159mm Hg for people

age 18-79 years old would be considered stage 1 hypertension. For

people over the age of 80 a systolic reading greater than or equal to

150mm Hg would put them at stage 1 hypertension. A diastolic reading

between 90-99m Hg would put a person at stage 1 hypertension. For a

person age 18-79 to be considered at stage 2 hypertension they would

need a systolic reading greater than 160mm Hg. A reading of greater

than 100mm Hg for a diastolic reading would put a person at stage 2

3
hypertension.1 Either systolic or diastolic readings can be elevated or,

both readings can be elevated to be diagnosed with stage 1 or stage 2

hypertension, but both do not have to be elevated.1 There are two

types of hypertension- essential and primary. Essential hypertension is

the most common and has no known causes; research suggests that it

usually develops over the years as people age. While the cause is not

known, it is believed that there are multiple factors contributing to

essential hypertension. Some of the factors that could contribute to

essential hypertension are differences in renin-angiotensin-aldosterone

control of blood pressure, difference in sodium retention genes and

individual lifestyle choices. The lifestyle choices that may contribute to

hypertension are dietary habits, sedentary lifestyle, obesity, smoking

and stress.1 Secondary hypertension is caused by medications or

associated with a disease. Secondary hypertension can be treated by

removing the cause of the hypertension whether it be medication or

the disease.1,2 Some diseases that are associated with secondary

hypertension are kidney, cardiovascular, endocrine or neurological

disease.1

One in five people do not know they have hypertension. Some

people call it the silent killer because hypertension does not have any

visible symptoms. If someone hypertension goes undiagnosed for

years, there can be damage to the heart, lungs, blood vessels, brain,

and kidneys if not treated.3 29% of people above the age of 18 have

4
hypertension. Prevalence of hypertension increases with age from 7%

of individuals with hypertension from age 18-39 to 67% prevalence of

4
hypertension in people over the age of 60. Hypertension is the

leading cause of stroke and is a major contributor to hearth disease.

The early stages of hypertension can go undiagnosed; this period of

time is considered pre hypertension. Pre hypertension blood pressure

readings would be 120-139 systolic pressure and 80-89 diastolic

reading. If blood pressure readings are in pre hypertension range, life

style changes should be considered.3 37% of adults have pre

hypertension and did not take antihypertensive meds. As people age

prevalence of pre hypertension increase for males to 43% prevalence

and for females to 39% prevalence.4

Hypertension is a lifelong condition that should be controlled by

lifestyle changes and medication. It is always important if someone has

Hypertension to monitor his or her blood pressure every day and keep

a log. These measures can help keep blood pressure under control and

prevent stroke, heart disease, and kidney failure. Stress has been

found to have an indirect connection to hypertension because it can

lead people to an unhealthy lifestyle, so stress management is

important.4 Stress management can be done by physical activity,

focusing on something calm, yoga, tai chi, or meditating.5 This

unhealthy lifestyle includes poor diet, alcohol consumption, smoking,

being overweight, and physically inactive, which all contribute to

5
hypertension.4, 5 Alcohol consumption can increase blood pressure so it

is important to limit alcohol intake to no more than 2 drinks for males

and 1 drink for females per day.4 12oz of beer, 5oz of wine, and 11/2 oz

of liquor is considered a serving.5 High sodium intakes can increase

blood pressure by causing fluid retention. The high level of fluid

retention in the body leads to a greater strain of the heart. The

American Heart Association recommends consuming less than

1,500mg per day of sodium.4 The DASH diet is considered the best diet

for hypertension patients. Along with the change in diet, physical

activity should be included. Physical activity can include gardening,

walking, bicycling, or yoga for 30 minutes 4-5 times a week. 4, 5 People

who smoke should strongly considered stopping.3 People should

maintain their weight and have a BMI between 18.5-24.9 to be

considered a healthy weight.5 Hypertension continues to be a big

public health challenge.4

The most effective treatment for hypertension is a combination

of medication and lifestyle change. It is important to make one lifestyle

change at a time so it does not become overwhelming. As lifestyle

changes are conquered, more lifestyle changes can be added.

Engaging in several lifestyle changes at once can lead to a lower blood

pressure and maintenance of normal blood pressure readings.

Medications the doctor can prescribe are diuretics, beta blockers, ACE

inhibitors, angiotensin II receptor blockers (ARBs), calcium channel

6
blockers, alpha-blockers, alpha-beta blockers, central acting agents,

and vasodilators. Diuretics work in lowering blood pressure by

removing excess sodium, which will reduce fluid in blood. Diuretics are

often combined with high blood pressure medication. Beta-blockers will

reduce heart beats allowing less force and allowing less blood to be

pumped through blood vessels, which helps lower blood pressure.5 ACE

inhibitors block the conversion of angiotension I to angiotension II

lowering blood pressure. ARBs blocks angiotension II hormone, so

vessels dont constrict or narrow, which in turn lowers blood pressure.10

Calcium channel blockers inhibit calcium from entering the heart and

blood vessel muscle cells. When calcium does not enter the muscle

cells of the heart and blood vessels, it allows blood to flow more freely

lowering blood pressure. Alpha blockers reduce nerve impulse that

tightens blood vessels allowing blood to flow more freely lowering

blood pressure. Alpha- Beta blockers reduce nerve impulse like alpha

blockers, but like beta blockers they also slow heartbeat lowering blood

pressure. Central acting agents lower blood pressure by decreasing

the nerve signals in the brain that usually narrow blood vessels.

Vasodilators relax the blood vessel wall muscles lowering blood

pressure.5

To go along with the high blood pressure medication, there

should be lifestyle changes made as well, the most important being

diet. The diet that helps treat hypertension is the DASH diet. The DASH

7
diet limits sodium intake from food and drinks. Even with medication,

sodium intake should be limited to between 1,500mg and 2,400mg per

day.1,6 Limiting sodium intake can be challenging, so a RDN can be very

helpful. In general, if one serving of a food has more than 300mg of

sodium in it, it should not be included in someones diet. Do not add

salt to foods and only use minuscule amounts when cooking.6 DASH

diet helps make sure that theres consumption of all food groups in

moderation while watching salt intake. It is important to consume

healthy fats including unsaturated and omega-3 fatty acids. Examples

of unsaturated are soybean, canola, olive, or sunflower oil. Omega-3

fatty acids are in fatty fish such as salmon, tuna, mackerel and

sardines and can also be found in flaxseed oil. Fats that should not be

consumed are saturated and trans fats because they are not

considered heart healthy. Saturated fats are found in fatty meat, whole

milk, butter, or cream. Trans fat includes anything with hydrogenated

oils which can be found in fried foods, crackers, chips and baked

goods .6 To help figure out more about the DASH diet and foods that

should or should not be consumed an RDN should be contacted.

They have done research on people who have hypertension and

read food labels. They found that people with hypertension read food

labels for sodium content so they can improve their health. The

findings were inconclusive on whether there was a direct affect with

reading nutrition fact food labels and lowering sodium intake in people

8
with hypertension. They know that the nutrition food label is valuable

information to consumers, but additional research needs to be done. 7

Another study looked into the value of nutrition knowledge and how it

would affect diet quality and ability to decrease blood pressure. The

study looked at employees of four manufacturing work places. They

implemented environmental dietary modifications alone as well as in

combination with nutrient education. The study found that high levels

of nutrient knowledge means better diet quality and decrease in blood

pressure, but the relationship between all variables is complex. There

was found to be significant value in nutrition education as a

component of workplace dietary interventions.8 This study can lead to

many more useful studies for finding ways to help decrease the

prevalence of hypertension.

With several treatment options available to control high blood

pressure, there is a chance for a good outcome when living with

hypertension. Treatment options include lifestyle changes and

medication. If hypertension is left untreated it will lead to serious

complications. These complications include stroke, heart disease and

heart attack, congestive heart failure, kidney problems, problems with

retina, impotence in men, and memory problems.10

Research is being done on ways to treat hypertension; some

main focuses of research were on physiological mechanisms possibly

involved with essential hypertension. One researcher looks into ways

9
to help lower blood pressure by finding the source of the problem. Most

patients with essential hypertension have a raised peripheral

resistance and a normal cardiac output. Renin-angiotensin system was

found to be very important in controlling blood pressure. In the lungs,

renin converts angiotensin I to angiotensin II by angiotension

converting enzyme (ACE). The angiotensin II that was produced in the

lungs can cause high blood pressure. Angiotension can also stimulate

the release of aldosterone, which will further increase blood pressure.

Research has found that the circulating renin-angiotensin system is not

directly related to increase in blood pressure for people with essential

hypertension, but can play a role in hypertension.10 From this research

they have been able to help solidify the role of ACE inhibitors in

lowering blood pressure. If they are able to find the key contributing

factors to hypertension, they will be able to better treat these patients.

The medications available for hypertension focus on the contributing

factors to hypertension that they have found through research. They

are now researching if birth weight has any correlation with someones

chances of getting hypertension. They found that if babies were born

at a smaller birth weight that in adolescence they would have higher

blood pressure and it would lead to hypertension in adults. This study

is important and will need to do a bigger study to ensure that this is a

key determinate for if someone is to get hypertension as an adult. 10

Researchers also seem to think that mothers having high blood

10
pressure during pregnancy can lead to hypertension. Mothers who

have high blood pressure tend to have babies at lower weights, which

goes back to the research on birth size affecting an adults chance of

getting hypertension.10

Nutrition assessment

The patient being a 50 years old African American male

increases his risk for hypertension. He is at an increased risk for

hypertension because of aging the prevalence of hypertension

increases to 37.1% for males age 45-54 years old.1 Ethnicity also is a

contributing risk factor; hypertensions prevalence for African American

males is 43%.1 The patients current weight is 220lbs with a BMI of

27.49kg/m2 and his ideal body weight is 196lbs. The patient is currently

overweight. His BMI indicates that he is overweight and needs to lose

weight. Being overweight is a risk factor, but obesity a greater risk

factor and, if he gains any more weight, his risk for more complications

associated with hypertension will increase. The patient is diagnosed

with stage 2 (essential) hypertension, meaning his blood pressure is

between 160-179/100-109. The essential part of his diagnosis means

that it is not caused by another disease. Being at stage 2 hypertension

can lead to stage 3 hypertensions, so he should take action to correct

11
his hypertension before it gets worse. Looking at his diet and changing

his lifestyle and taking medication will help reduce the patients blood

pressure.

The patients Cholesterol lab is at 300mg/dL. The normal range

for Cholesterol is 140-199mg/dL this is a contributing factor to the

patients hypertension and increases the risk for cardiovascular

disease. The patients HDL cholesterol is low at 35mg/dL and the

normal range is 37-70mg/dl. This is the good cholesterol that needs to

be present to clean up the arteries, so the patients HDL cholesterol

needs to be raised. Raising the HDL will help lower his risk for

cardiovascular disease. The patients LDL cholesterol is high at

135mg/dL. LDL cholesterol lab is usually at <130mg/dl. The LDL

cholesterol is the bad cholesterol that leaves fat and cholesterol

throughout the arteries making plaque, so this needs to be lowered.

The LDL being so high will contribute to his risk for cardiovascular

disease. The patients Triglyceride levels are at 250mg/dL, which is

high. The normal range for Triglycerides is 35-160mg/dl; having high

triglycerides contributes to his high blood pressure and increases his

risk that it will turn into heart disease. The patients blood pressure

(BP) is at 160/100mm Hg, which is considered mild hypertension. The

blood pressure reading is why he is considered to be stage 2

hypertension. The patient is taking hydrochlorothiazide- 25mg qd. This

is considered a diuretic, which removes sodium water and potassium.

12
Hydrochlorothiazide will help lower the patients blood pressure, but

potassium levels need to be checked for hypokalemia. It is also

important to check blood glucose and calcium levels annually. The

patient can use salt substitutes that have potassium in then and can

make sure to eat his daily-recommended servings of fruits and

vegetables.

The estimated energy requirements (EER) for the patient is

2,200kcals; this comes from the Harris- Benedict equation that takes

into account the patient being male and having a stress factor of 1.3

(moderate activity). This is based on his needs of kcals per day, but he

needs to lose weight, so a decrease of about 200kcals will be required.

Lowering the EER will allow for the patient to lose weight and lower his

risk of his hypertension getting worse or even leading to heart disease.

Protein intake was set at 110g/day. This would be a protein intake of

20% of patients daily kcals allowing him to fulfill daily nutrient

requirements. The fluid intake is set because he is on a thiazide, which

makes him lose water; his set fluid intake is 2,200mls. This fluid intake

is set based on 1ml/kcal. The MD office that he was diagnosed with

stage 2 hypertension told him to follow the 4-gm Na diet. He started to

do this diet, but said it was too hard and the food had no taste, so he

does not follow it. This diet was because he has hypertension and they

wanted to lower his salt intake, which can help lower BP.

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 Medications

The patient is taking Hydrochlorothiazide (HTCZ). This

medication should be taken in the morning with food or milk. When on

this medication the diet should have a decreased level of sodium

intake and calcium. The diet should have increased intake of potassium

and magnesium. Supplementation of potassium and magnesium may

be needed if dietary intake is not enough. It is important to monitor the

sodium levels to make sure that they do not become to low. If the

patients lab reflects hyponatremia, the sodium restriction should be

lifted.11 HTCZ can also contribute to hyperglycemia.1 When taking HTCZ

natural licorice root should be avoided.1,11 Unless there is a calcium or

vitamin D deficiency apparent in the patients lab values, they should

not be supplemented because it puts the patient at risk for

hypercalcemia. If vitamin D or calcium needs to be supplemented, they

should be watched closely because of the risk for hypercalcemia. HTCZ

can cause anorexia or increased thirst. Some side effects that could

affect dietary intake would be dry mouth, nausea and vomiting, GI

irritation, diarrhea and constipation. It is important to limit alcohol.

When on HTCZ the following should be monitored: electrolytes,

magnesium, calcium, renal function, uric acid, BP and glucose.11 HTCZ

can interact with other medications so it is important for the patient to

inform their doctor of all other prescriptions, non prescription drugs

and herbs they are taking. If the patient has questions they can also

14
ask check with their pharmacist to make sure the drug can be taken

with HTCZ. HTCZ can interact with cisapride, dofetilide and lithium

drugs. It is important to check the labels of medications such as cough

and cold products, diet pills, NSAIDS or naproxen. These medications

could increase blood pressure or cause edema. HTCZ can also cause

false positives with laboratory tests, so the lab person should be aware

that the patient is taking HTCZ.12

ADIME Note

Wednesday, March 1, 2017

A:
Patient is a 50-year-old male
220lbs, 63
BMI: 27.49kg/m2
IBW: 196lbs
Medical diagnosis: stage 2 (essential) hypertension
Labs: Cholesterol: 300mg/dL
HDL: 135mg/dL
LDL: 135mg/dL
Triglycerides: 250mg/dL
Blood pressure: 160/100mm Hg
Medication: Hydrochlorothiazide- 25mg qd
EER: 2,200kcals per day
Protein: 110g per day
Fluid: 2,200mls per day
Current diet order: 4-gm Na diet

D:
P: NB-1.6 limited adherence to nutrition- related
recommendations
E: As related to patient saying diet order is to hard to follow
S: As evidence by 24hr recall. Eating canned soup, adding salt to
food and eating donuts.

I:
Recommend no alcohol
Recommend <2300mg of sodium per day

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 Recommend 2,000kcals per day
Recommend 2,000mls of fluid per day
Recommend using salt substitutes
Recommend 3.4g of plant sterol per day
Recommend no trans fat
Recommend DASH diet
Recommend eat fatty fish (salmon, hearing, tuna) 2-3 times a
week
Recommend fiber intake starting at 20g per day and increasing
as tolerated to 30gs per day
Recommend less than or equal to 60g of fat per day
Recommend less than or equal to 22g from saturated fat per day
Recommend food with antioxidants (1 cup of blueberries or
grapes) 3 times a day
Recommend consume MUFA foods 2-3 times per week
(Avocados, olive oil, peanuts, peanut oil, canola oil)
Recommend 8-10 servings of fruit per day (1 medium fruit of
cup canned fruit or 4oz of 100% juice)
Recommend 4-5 servings of vegetables per day (1 cup raw leafy
vegetables or 1.2 cup cut or raw cooked vegetables)
Recommend 6-8 servings of grain products per day focusing on
whole grain (1 slice of bread or 1oz of dry cereal or 1.2 cup
cooked rice, pasta or cereal)
Recommend 4-5 servings of nuts, seeds, dried beans per week
(1/3 cup nuts, 2tbs seeds, cup cooked beans or peas)
Recommend 2-3 servings of dairy a day (1 cup skim milk, 1cup
yogurt, 1 1/2oz of cheese)
Recommend lean meats, poultry and fish 2 or less serving per
day (3oz cooked skinless poultry, seafood, or lean meats or 1
egg)
Recommend 2-3 servings of fats and oil a day (1tbs soft
margarine, 1tbs mayonnaise or 2tbs of salad dressing)
Recommend limit sweets to 5 or less serving a week
Recommend vitamin C, Beta carotene and vitamin E at DRI levels
Recommend potassium lab
Recommend Calcium lab
Recommend Blood glucose levels
Recommend weekly weights
Recommend check BP daily
Recommend walking, cycling or jogging 4-5 times a week for
30minutes

M/E:
Monitor weekly weight change
Monitor BP daily
Monitor potassium levels

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 Monitor Calcium levels
Monitor blood glucose levels
Monitor sodium intake

Signature:

Brittni Filipiak

Long term plan

After giving the patient recommendations he should be working

on reducing his sodium intake and working on the DASH diet. The long-

term goal for the patient is to slowly work through the goals set. The

first goal to be worked on could be sodium and then, once the sodium

levels are accomplished, more goals can be added. The patient must

come back for regular visits with any problems or concerns about what

has been discussed and then put into practice. The goal of the meeting

is to give the client nutrition education that he can take with him

throughout his life. The patients wife should be involved in some

meetings so that she can get educated and know the importance of his

diet change. His wife can play a big role in diet change because she

does the shopping and cooks the meals. The patient can have all the

information he needs, but if hes not the one shopping or cooking the

meals it wont matter. It will be important for him to lose 20lbs to get

him to his ideal body weight to lower his risk factor for worsening

hypertension or heart disease. In order for the patient to do this, he

should be working on the current recommendations discussed. He

17
should reduce his alcohol consumption because it tends to have high

sodium. The long term plan is to progress to a TLC diet. The TLC diet

will include <7% of his total kcals be saturated, MUFAs make up 20% of

his total kcals, total fat intake of 25-35% of total kcals, carbohydrate

intake of 50-60% of total kcals, daily fiber intake of 30g, protein intake

of 15% of total kcals, sodium intake of less than 2300mg per day and

intake of 3.4mg of plant sterol per day. To be able to reach the goal of

a TLC diet it will be important to educate him on how to eat out, how to

read food labels and eat a balanced diet based on the

recommendations. The most important thing he should be working on

for long term is reducing sodium intake. To help him reduce his sodium

intake, he will need proper tools for eating out because he does do that

every week. The information provided to him would include to avoid

fast food restaurants because most food is prepared with a lot of salt,

ask how the food is prepared and ask for it without added salt or no

salt if available, have limit condiments with high salt ingredients, and

choose fruits and vegetables for a side or dessert. It would be

important to inform the patient on how to read labels and what sodium

free, very low sodium, reduced sodium, light in sodium and no salt

added means. Once he starts accomplishing goals and putting the

goals together his overall health will improve and his risk for worsening

hypertension and cardiovascular disease should decrease.

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 Alternative therapies

The most effective and simple way to lower blood pressure

would be to change the food consumed and eat a healthier diet like the

DASH diet. Another good way to lower blood pressure would be to

exercise. This exercise to lower blood pressure involves walking,

jogging, cycling or a combination. They have many research studies

showing that for men and women blood pressure can be reduced by

physical activity almost as much as medication can. This involves

exercising 30-60 minutes three to four times a week. They have looked

into stress management and controlled breathing. They know that

blood pressure rises when stressed, so they need more studies to

prove that controlling stress will lead to lower blood pressure. Getting

involved in yoga, qigong, or tai chi was found to lower blood pressure

and stress levels if people participated every day for two months.

There was also a small study done on slow breathing 15 minutes a day

for 8 weeks, this study found that blood pressure was lowered. These

studies are a step in the right direction, but more studies are needed to

confirm this research. Some alternative herbs that may lower blood

pressure are snakeroot, tetradrine, ginseng and hawthorn. If a patient

decides to use these herbs, it is important for them to inform their

doctor because there are many risks involved. They have not done

many studies on these herbs because they are health risks associated

with them. There are three supplements they say can help lower blood

19
pressure, Coenzyme Q10, Omega-3 fatty acids and amino acids.

People who took Coenzyme Q10 and had mildly high blood pressure

had seen a drop in their blood pressure without any noticeable side

effects. Omega-3 fatty acids were shown to decrease blood pressure

because of the EPA and DHA, but other studies conflicted with those

results. Currently, it is believed that high amounts of omega- 3 fatty

acids will reduce blood pressure. For amino acids arginine and L-

taurine, they found that they would reduce blood pressure. Arginine

had a few small studies that were not controlled and possibly

suggested that it would only temporarily decrease blood pressure. L-

taurine may be able to lower blood pressure, but there is not

substantial research available yet. They also had acupuncture for

lowering blood pressure, but the studies conducted had many

weaknesses, so they will need to have more reliable studies take place

to better prove this claim.13

Questions and answers

1.

Q: Define blood pressure. How is blood pressure normally

regulated in t he body?

A: Blood pressure is the measurement of blood pushed against

the blood artery walls. If too much pressure builds up against the

artery walls it could cause problems like stroke and hypertension.

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 When reading blood pressure it is systolic over diastolic. Systolic

being the contraction phase where blood is ejected from the

ventricle into the aorta or the pulmonary artery. Diastolic is the

relaxation phase where blood fills the atria. Optimal blood

pressure is 120/80. High blood pressure is 140/90. Blood pressure

is normally regulated by sympathetic nervous system, renin-

angiotensin- aldosterone system and renal function.1,10

2.

Q: What causes essential hypertension?

A: There a no known causes of essential hypertension. In

patients that have been diagnosed with essential hypertension

their high blood pressure had developed over a period of time.1

5.

Q: What are the risk factors for developing hypertension?

A: The risk factors for developing hypertension include: being

African American, pregnant, being on birth control, family history,

smoking, people over 35, inactive lifestyle, overweight/obesity,

excessive drinking, high salt diet, to much fatty foods and sleep

apnea.1

6.

Q: What risk factors does Mr. Riddle currently have?

A: Mr. Riddles current risk factors for hypertension are being

African America, drinking more than recommended and family

21
 history. His family history includes his mother having

hypertension and dyeing from cardiovascular disease.

11.

Q: Dr. Thornton indicated in his admitting note that he will rule

out metabolic syndrome. What is this?

A: Metabolic syndrome is a risk indicator for atherosclerosis. This

means that the body does not dissolve blood clots properly. If

there are three of the five CAD risk factors for metabolic

syndrome present then it will be diagnosed. The five conditions

that contribute to metabolic syndrome are abdominal obesity,

low HDL, high blood pressure, high triglycerides and insulin

resistance. The more risk factors that acquire the greater the risk

for atherosclerosis. People with metabolic syndrome have higher

C-reactive protein (CRP) and plasminogen activator inhibitor type

1 levels (PAI 1). These high levels of CRP and PAI 1 are connected

with excess adipose tissue. The CRP is also a good indicator of

heart problems linked to atherosclerosis.1

Reference

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Pressure. WebMD Website. Available at:
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treatments#2. Accessed 2017.

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