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all\tmajor\tmuscle\tgroups\ton\t2\tor\tmore\tdays\tfor\tall\tAmericans\t(\nUSDA,\t2015\n).\nTreatment\tof\thypertension\tin\tchildren\tand\tadolescents\nThe\tprevalence\tof\tprimary\thypertension\tamong\tchildren\tin\tthe\tUnited\tStates\tis\tincreasing\tin\tconcert\nwith\trising\tobesity\trates\tand\tincreased\tintakes\tof\thigh-calorie,\thigh-salt\tfoods\t(\nFlynn\tet\tal,\t2017\n). | [
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Flynn\tet\tal,\t2017\n).\nHypertension\ttracks\tinto\tadulthood\tand\thas\tbeen\tlinked\twith\tcarotid\n\tintimal-medial\tthickness,\tLVH,\nand\tfibrotic\tplaque\tformation.\tSecondary\thypertension\tis\tmore\tcommon\tin\tpreadolescent\tchildren,\nmostly\tfrom\trenal\tdisease;\tprimary\thypertension\tcaused\tby\tobesity\tor\ta\tfamily\thistory\tof | [
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hypertension\tis\tmore\tcommon\tin\tadolescents\t(\nMiller\tand\tJoye\tWoodward,\t2014\n).\tIn\taddition,\nintrauterine\tgrowth\tretardation\tleads\tto\thypertension\tin\tchildhood\t(\nLongo\tet\tal,\t2013\n).\nHigh\tblood\tpressure\tin\tyouth\tis\tbased\ton\ta\tnormative\tdistribution\tof\tblood\tpressure\tin\thealthy | [
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children.\tHypertension\tis\tdefined\tas\tan\tSBP\tor\tDBP\tof\tgreater\tthan\tthe\t95th\tpercentile\tfor\tage,\tsex,\nand\theight.\tThe\tdesignation\tfor\tprehypertension\tin\tchildren\tis\tSBP\tor\tDBP\tof\tgreater\tthan\tthe\t90th\npercentile.\tTherapeutic\tlifestyle\tchanges\tare\trecommended\tas\tan\tinitial\ttreatment\tstrategy\tfor\nchildren\tand | [
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and\tadolescents.\tUnfortunately,\tsustained\tweight\tloss\tis\tdifficult\tto\tachieve\tin\tthis\tage\tgroup.\tThe\nFramingham\n\tChildren’s\tStudy\tshowed\tthat\tchildren\twith\thigher\tintakes\tof\tfruits,\tvegetables\t(a\ncombination\tof\tfour\tor\tmore\tservings\tper\tday),\tand\tdairy\tproducts\t(two\tor\tmore\tservings\tper\tday) | [
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had\tlower\tSBP\tcompared\twith\tthose\twith\tlower\tintakes\tof\tthese\tfoods.\tCouch\tand\tcolleagues\t(2008)\nshowed\tthat\tadolescents\twith\tprehypertension\tand\thypertension\tcould\tachieve\ta\tsignificant\nreduction\tin\tSBP\tin\tresponse\n\tto\ta\tbehaviorally\toriented\tnutrition\tintervention\temphasizing\tthe\tDASH | [
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diet.\tBecause\tadherence\tto\tdietary\tinterventions\tmay\tbe\tparticularly\tchallenging\tamong\tchildren\nand\tteenagers,\tinnovative\tnutrition\tintervention\tapproaches\tthat\taddress\tthe\tunique\tneeds\tand\ncircumstances\tof\tthis\tage\tgroup\tare\timportant\tconsiderations\tin\tintervention\tdesign\t(see\t\nChapters\n16\n\tand\t\n17\n).\nTreatment\tof\tblood\tpressure\n\tin\tolder\tadults | [
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] |
Chapters\n16\n\tand\t\n17\n).\nTreatment\tof\tblood\tpressure\n\tin\tolder\tadults\nMore\tthan\thalf\tof\tthe\tolder\tpopulation\thas\thypertension;\tthis\tis\tnot\ta\tnormal\tconsequence\tof\taging.\nThe\tlifestyle\tmodifications\tdiscussed\tpreviously\tare\tthe\tfirst\tstep\tin\ttreatment\tof\tolder\tadults,\tas\twith | [
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promote\tadherence\tremains\ta\tchallenge\tfor\thealth\tprofessionals.\nBlood\tpressure\tshould\tbe\tcontrolled\tregardless\tof\tage,\tinitial\tblood\tpressure\tlevel,\tor\tduration\tof\nhypertension.\n\tSevere\tsodium\trestrictions\tare\tnot\tadopted\tbecause\tthese\tcould\tlead\tto\tvolume | [
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Whelton\tet\tal,\t2018\n).\nHeart\tfailure\nNormally\tthe\theart\tpumps\tadequate\tblood\tto\tperfuse\ttissues\tand\tmeet\tmetabolic\tneeds\t(\nFig.\t32.10\n).\nIn\t\nheart\tfailure\t(HF)\n,\tformerly\tcalled\tcongestive\n\tHF,\tthe\theart\tcannot\tprovide\tadequate\tblood\tflow\nto\tthe\trest\tof\tthe\tbody,\tcausing\tsymptoms\tof\tfatigue,\t\ndyspnea\n\t(shortness\tof\tbreath),\tand\tfluid | [
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The\tlifetime\trisk\tof\tdeveloping\tHF\tis\t20%\tfor\tAmericans\tage\t40\tor\tolder.\tApproximately\t5.1\tmillion\nin\tthe\tUnited\tStates\thave\tHF.\tThe\tincidence\tincreases\twith\tage,\trising\tfrom\tapproximately\t20\tper\n1000\tindividuals\t65\tto\t69\tyears\tto\tgreater\tthan\t80\tper\t1000\tin\tthose\tindividuals\t85\tand\tolder\t(\nStone\net\tal,\t2014 | [
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] |
Stone\net\tal,\t2014\n).\tBlack\tmen\thave\tbeen\tshown\tto\tbe\tat\tthe\thighest\trisk\tof\tHF;\twhite\twomen\thave\tthe\nlowest.\n\tHF\tin\tnon-Hispanic\tblack\tmales\tand\tfemales\thas\ta\tprevalence\tof\t4.5%\tand\t3.8%\trespectively,\nversus\t2.7%\tand\t1.8%\tin\tnon-Hispanic\twhite\tmales\tand\tfemales,\trespectively\t(\nStone\tet\tal,\t2014\n).\nPathophysiology | [
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Stone\tet\tal,\t2014\n).\nPathophysiology\nThe\tprogression\tof\tHF\tis\tsimilar\tto\tthat\tof\tatherosclerosis\tbecause\tthere\tis\tan\tasymptomatic\tphase\nwhen\tdamage\tis\tsilently\toccurring\t(stages\tA\tand\tB)\t(\nFig.\t32.11\n).\tHF\tis\tinitiated\tby\tdamage\n\tor\tstress\nto\tthe\theart\tmuscle\teither\tof\tacute\tMI\tor\tinsidious\t(hemodynamic\tpressure\tor\tvolume\toverloading)\nonset\t(see | [
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] |
onset\t(see\t\nTable\t32.5\n\tfor\tclassifications\tof\tHF). | [
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] |
FIG.\t32.11\nStages\tof\theart\tfailure\tand\trecommended\ttherapy\tby\tstage.\nACEI\n,\tAngiotensin-converting\tenzyme\ninhibitor;\t\nARB\n,\tangiotensin\treceptor\tblocker;\t\nCM\n,\tcardiomyopathy;\t\nEF\n,\tejection\tfraction;\t\nFHx\n,\tfamily\thistory;\nHF\n,\theart\tfailure;\t\nIV\n,\tintravenous;\t\nLV\n,\tleft\tventricular;\t\nLVH\n,\tleft\tventricular\thypertrophy;\t\nMI\n,\tmyocardial | [
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] |
LVH\n,\tleft\tventricular\thypertrophy;\t\nMI\n,\tmyocardial\ninfarction.\n\tSource:\t(From\tHunt\tSA,\tet\tal:\tACC/AHA\t2005\tguideline\tupdate\tfor\n\tthe\tdiagnosis\tand\tmanagement\tof\tchronic\theart\nfailure\tin\tthe\tadult:\ta\treport\tof\tthe\tAmerican\tCollege\tof\tCardiology/American\tHeart\tAssociation\tTask\tForce,\t\nJ\tAm\tColl\tCardiol\n\t46:e1,\n2005.)\nTABLE\t32.5 | [
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0.06562964618206024,
0.09637670964002609,
0.0245289858430624
] |
J\tAm\tColl\tCardiol\n\t46:e1,\n2005.)\nTABLE\t32.5\nClassifications\tof\tHeart\tFailure\nClass\tI\nNo\tundue\tsymptoms\tassociated\twith\tordinary\tactivity\tand\tno\tlimitation\tof\tphysical\tactivity\nClass\tII\nSlight\tlimitation\tof\tphysical\tactivity;\tpatient\n\tcomfortable\tat\trest\nClass\tIII\nMarked\tlimitation\tof\tphysical\tactivity;\tpatient\tcomfortable\tat\trest\nClass\tIV | [
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0.0004082798841409385
] |
Class\tIV\nInability\tto\tcarry\tout\tphysical\tactivity\twithout\tdiscomfort;\tsymptoms\tof\tcardiac\tinsufficiency\tor\nchest\tpain\tat\trest\nModified\tfrom\tHunt\tSA,\tet\tal:\tACC,\tAHA,\t2005\tguideline\tupdate\tfor\tthe\tdiagnosis\tand\tmanagement\tof\tchronic\theart\tfailure\tin\tthe\tadult:\ta\treport\tof\nthe\tAmerican\tCollege | [
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the\tAmerican\tCollege\n\tof\tCardiology/American\tHeart\tAssociation\tTask\tForce\ton\tpractice\tguidelines,\t\nJ\tAm\tColl\tCardiol\n\t46:e1,\t2005.\nThe\tprogressive\tinsult\talters\tthe\tfunction\tand\tshape\tof\tthe\tleft\tventricle\tsuch\tthat\tit\thypertrophies\nin\tan\teffort\tto\tsustain\tblood\tflow,\ta\tprocess\tknown\tas\tcardiac\tremodeling.\tSymptoms\tdo\tnot\tusually | [
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arise\tuntil\tmonths\tor\tyears\tafter\tcardiac\tremodeling\tbegins.\tMany\tcompensatory\tmechanisms\n\tfrom\nthe\tSNS,\tRAS,\tand\tcytokine\tsystem\tare\tactivated\tto\trestore\thomeostatic\tfunction.\tProinflammatory\ncytokines,\tsuch\tas\tTNF-α,\tIL-1,\tand\tIL-6,\tare\tincreased\tin\tblood\tand\tthe\tmyocardium\tand\thave\tbeen\nfound\tto\tregulate\tcardiac\tremodeling.\nAnother\tsubstance, | [
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found\tto\tregulate\tcardiac\tremodeling.\nAnother\tsubstance,\t\nB-natriuretic\tpeptide\t(BNP)\n,\tis\tsecreted\tby\tthe\tventricles\tin\tresponse\tto\npressure\tand\tis\tpredictive\tof\tthe\tseverity\tof\tHF\tand\tmortality\tat\n\tany\tlevel\tof\tBMI.\tBNP\tis\toften\thighly\nelevated\tin\tpatients\twith\tHF\t(greater\tthan\t100\tpg/mL\tis\tabnormal,\tand\tsome\tpatients\thave\tlevels | [
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] |
These\tneurohormones\tand\tthe\tproinflammatory\tcytokines\tcontribute\tto\tdisease\tprogression;\thence,\ncurrent\tstudies\tfocus\n\ton\tinhibition\tof\tthese\tundesirable\tpathways\tand\tpromotion\tof\tdesirable\tones.\nFor\tthe\tfinal\tstages\tof\tHF,\tthere\tis\ta\tsubjective\tscale\tused\tto\tclassify\tsymptoms\tbased\ton\tthe\ndegree\tof\tlimitation\tin\tdaily\tactivities\t(\nTable\t32.5 | [
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degree\tof\tlimitation\tin\tdaily\tactivities\t(\nTable\t32.5\n).\tThe\tseverity\tof\tsymptoms\tin\tthis\tclassification\nsystem\tis\tweakly\trelated\tto\tthe\tseverity\tof\tleft\tventricular\tdysfunction;\ttherefore\ttreatment\nencompasses\timproving\tfunctional\n\tcapacity\tand\tlessening\tprogression\tof\tthe\tunderlying\tdisease. | [
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TABLE\t32.6\nSkeletal\tMuscle\tChanges\tin\tHeart\tFailure\nFunction\tloss\nWeakness\nFatigability\nStructural\nLoss\tof\tmuscle\tmass\nAtrophy,\tfibrosis,\tno\t≠\tapoptosis\nFiber\ttype\tswitch\ttype\tI–type\tIIb\nLoss\tof\tmitochondria\nEndothelial\tdamage\nBlood\tflow\nCapillary\tdensity\t↓\nVasodilation\nPeak\tleg\tblood\tflow\t↓\nMetabolism\nProteolysis | [
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Vasodilation\nPeak\tleg\tblood\tflow\t↓\nMetabolism\nProteolysis\nOxidative\tmetabolism\t↓\tAcidosis\tglycolysis\t≠\nInflammation\nCytokine\tand\toxidative\tmarkers\nNeuroendocrine\nGH,\tIGF-1,\tepinephrine,\tnorepinephrine,\tcortisol\nInactivity\nTNF-α\t≠\t≠\nGenetic\tfactors\nMyostatin,\tIGF\nGH\n,\tGrowth\thormone;\t\nIGF\n,\tinsulin-like\tgrowth\tfactor;\t\nTNF- | [
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GH\n,\tGrowth\thormone;\t\nIGF\n,\tinsulin-like\tgrowth\tfactor;\t\nTNF-\nα,\ttumor\tnecrosis\tfactor\talpha.\nFrom\tStrassburg\tS,\tet\tal:\tMuscle\twasting\tin\tcardiac\tcachexia,\t\nInt\tJ\tBiochem\n\tCell\tBiol\n\t37:1938,\t2005.\nIn\tHF\tthe\theart\tcan\tcompensate\tfor\tpoor\tcardiac\toutput\tby\t(1)\tincreasing\tthe\tforce\tof\tcontraction, | [
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(2)\tincreasing\tin\tsize,\t(3)\tpumping\tmore\toften,\tand\t(4)\tstimulating\tthe\tkidneys\tto\tconserve\tsodium\nand\twater.\tFor\ta\ttime\tthis\tcompensation\tmaintains\tnear-normal\tcirculation,\tbut\teventually\tthe\theart\ncan\tno\tlonger\tmaintain\ta\tnormal\toutput\t(decompensation).\tAdvanced\tsymptoms\n\tcan\tdevelop\tin\nweeks\tor\tmonths,\tand\tsudden\tdeath\tcan\toccur\tat\tany\ttime. | [
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weeks\tor\tmonths,\tand\tsudden\tdeath\tcan\toccur\tat\tany\ttime.\nThree\tsymptoms—fatigue,\tshortness\tof\tbreath,\tand\tfluid\tretention—are\tthe\thallmarks\tof\tHF.\nShortness\tof\tbreath\ton\texertion,\tor\teffort\tintolerance,\tis\tthe\tearliest\tsymptom.\tThe\tshortness\tof\nbreath\tknown\tas\torthopnea\tis\tbreathlessness\twhile\tlying\tdown.\tFluid\tretention\tcan\tmanifest\tas | [
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pulmonary\tcongestion\tor\tperipheral\tedema.\n\tEvidence\tof\thypoperfusion\tincludes\tcool\tforearms\tand\nlegs,\tsleepiness,\tdeclining\tserum\tsodium\tlevel\tcaused\tby\tfluid\toverload,\tand\tworsening\trenal\nfunction.\nDecreased\tcranial\tblood\tsupply\tcan\tlead\tto\tmental\tconfusion,\tmemory\tloss,\tanxiety,\tinsomnia,\nsyncope | [
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syncope\n\t(loss\tof\toxygen\tto\tthe\tbrain\tcausing\tbrief\tloss\tof\tconsciousness),\tand\theadache.\tThe\tlatter\nsymptoms\tare\tmore\tcommon\tin\tolder\tpatients\tand\n\toften\tare\tthe\tonly\tsymptoms;\tthis\tcan\tlead\tto\ta\ndelay\tin\tdiagnosis.\tOften\tthe\tfirst\tsymptom\tin\tolder\tadults\tis\ta\tdry\tcough\twith\tgeneralized\tweakness\nand\tanorexia.\nCardiac\tcachexia | [
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flabby.\tIn\taddition,\tthere\tare\tstructural,\tcirculatory,\tmetabolic,\tinflammatory,\tand\tneuroendocrine\nchanges\tin\tthe\tskeletal\tmuscle\tof\tpatients\twith\n\tHF\t(\nDelano\tand\tMoldawer,\t2006\n)\t(\nTable\t32.6\n).\tSome\nchanges\tin\tcardiac\tfunction\tcan\tbe\tattributed\tto\taging\tand\tare\tlisted\tin\t\nBox\t32.7\n.\nBOX\t32.7 | [
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Box\t32.7\n.\nBOX\t32.7\nPrincipal\tEffects\tof\tAging\ton\tCardiovascular\tStructure\tand\nFunction\nIncreased\tvascular\tstiffness\nIncreased\tmyocardial\tstiffness\nDecreased\tbeta-adrenergic\tresponsiveness\nImpaired\tmitochondrial\tATP\tproduction\nDecreased\tbaroreceptor\tresponsiveness\nImpaired\tsinus\tnode\tfunction\nImpaired\tendothelial\tfunction | [
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Impaired\tsinus\tnode\tfunction\nImpaired\tendothelial\tfunction\nNet\teffect:\tMarked\treduction\tin\tcardiovascular\treserve\nATP,\n\tAdenosine\ttriphosphate.\nFrom\tRich\tMW:\tOffice\tmanagement\tof\theart\tfailure\tin\tthe\telderly,\t\nAm\tMed\n\t118:342,\t2005.\nCardiac\tcachexia\tis\ta\tserious\tcomplication\tof\tHF\twith\ta\tpoor\tprognosis\tand\tmortality\trate\tof\t50% | [
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in\t18\tmonths\t(\nCarlson\tand\tDahlin,\t2014\n).\tSymptoms\tthat\treflect\n\tinadequate\tblood\tsupply\tto\tthe\nabdominal\torgans\tinclude\tanorexia,\tnausea,\ta\tfeeling\tof\tfullness,\tconstipation,\tabdominal\tpain,\nmalabsorption,\thepatomegaly,\tand\tliver\ttenderness.\tAll\tof\tthese\tcontribute\tto\tthe\thigh\tprevalence\tof | [
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with\tTNF-α,\tadiponectin\tlevels\talso\tare\tcorrelated\tinversely\twith\tBMI.\tPharmacologic\ttreatments\tfor\nmuscle\twasting\tare\tbeing\texplored.\nRisk\tfactors\nThe\tFramingham\tHeart\tStudy\t(see\t\nFocus\tOn:\n\tFramingham\tHeart\tStudy\n)\tshowed\tthe\trisk\tfactors\tfor\nHF\twere\thypertension,\tdiabetes,\tASCVD,\tand\t\nleft\tventricular\thypertrophy\t(LVH)\n\t(enlargement\tof | [
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left\tventricular\thypertrophy\t(LVH)\n\t(enlargement\tof\nthe\tleft\tventricle\tof\tthe\theart).\tAntecedent\thypertension\n\tis\tpresent\tin\tabout\tthree\tfourths\tof\tHF\npatients.\tIndividuals\twho\thave\tdiabetes\tmellitus\tand\tischemic\theart\tdisease\tmore\tfrequently\tdevelop\nHF\tcompared\twith\tpatients\twithout\tdiabetes\t(\nRosano\tet\tal,\t2006\n).\tLeft\tventricular\tdysfunction | [
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Rosano\tet\tal,\t2006\n).\tLeft\tventricular\tdysfunction\nwithout\tischemia\tis\toften\trelated\tto\texcessive\talcohol\tintake.\tDiabetes\tis\tan\tespecially\tstrong\trisk\nfactor\tfor\tHF\tin\twomen.\tThe\tprevalence\tof\thypertension\tand\tdiabetes\n\tincreases\twith\tage,\tmaking\tthe | [
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increases\twith\tage,\tmaking\tthe\nelderly\tparticularly\tvulnerable\tto\tHF.\tAnother\tlarge\tcohort\tstudy\tof\tolder\tadults\t(70\tto\t79\tyears\told)\nshowed\tthat\twaist\tcircumference\tand\tpercentage\tof\tbody\tfat\twere\tthe\tstrongest\tpredictors\tof\twho\nwould\tdevelop\tHF\t(\nNicklas\tet\tal,\t2006\n).\tA\trecent\tstudy\tof\telderly\tindividuals\twith\tHF\tfound\ta\tstrong | [
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).\tA\trecent\tstudy\tof\telderly\tindividuals\twith\tHF\tfound\ta\tstrong\nassociation\tbetween\tvitamin\tD\tdeficiency\tand\tHF\trisk\t(\nPorto,\t2018\n).\tData\tfrom\tthe\tMulti-ethnic\nStudy\tof\tAtherosclerosis\t(also\tknown\tas\tMESA)\tconcluded\tthat\thigh\tEPA\tblood\tlevels\twere\nsignificantly\tinversely\tcorrelated\twith\trisk\tof\tHF\t(\nBlock,\t2019 | [
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significantly\tinversely\tcorrelated\twith\trisk\tof\tHF\t(\nBlock,\t2019\n).\tNumerous\tchanges\tin\tcardiovascular\nstructure\tand\tfunction\talso\tplace\tthe\telderly\tat\thigh\trisk\tfor\tdeveloping\tHF\t(see\t\nBox\t32.7\n).\nPrevention\nBecause\tlong-term\tsurvival\trates\tfor\tpersons\twith\tHF\tare\tlow,\tprevention\n\tis\tcritical.\tHF\tis | [
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] |
is\tcritical.\tHF\tis\ncategorized\tinto\tfour\tstages\tranging\tfrom\tpersons\twith\trisk\tfactors\t(stage\tA—primary\tprevention)\tto\npersons\twith\tadvanced\tHF\t(stage\tD—severe\tdisease).\tFor\tstages\tA\tand\tB\tthe\taggressive\ttreatment\tof\nunderlying\trisk\tfactors\tand\tdiseases\tsuch\tas\tdyslipidemia,\thypertension,\tand\tdiabetes\tis\tcritical\tto | [
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prevent\tstructural\tdamage\tto\tthe\tmyocardium\tand\tthe\tappearance\tof\tHF\tsymptoms.\n\tSuch\tprevention\nhas\tbeen\tvery\teffective.\tEven\tpatients\twho\texperience\tan\tMI\tcan\treduce\tthe\trisk\tof\tHF\twith\nantihypertensive\ttherapy.\tPatients\tare\toften\tasymptomatic\tduring\tthese\ttwo\tstages. | [
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thyroid\tdisorders,\narrhythmias),\tavoidance\tof\thigh-risk\tbehaviors\t(tobacco,\texcessive\talcohol,\tillicit\tdrug\tuse),\tand\nlifestyle\tchanges\t(weight\treduction,\texercise,\treduction\tof\tsodium\tintake,\theart-healthy\tdiet)\tare\nrecommended.\tAll\tthese\trecommendations\tare\tcarried\tthrough\tthe\tother\tstages.\tIn\taddition,\tan | [
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implantable\tdefibrillator,\twhich\tshocks\tthe\theart\twhen\tit\tstops,\tcan\tbe\tplaced\tin\tpatients\n\tat\trisk\tof\nsudden\tdeath.\tPharmacologic\ttreatment\tof\tHF\tis\tthe\thallmark\tof\ttherapy\twith\tprogressive\tstages.\nThe\tlast\tstage\talso\tincludes\tsurgically\timplanted\tventricular-assist\tdevices,\theart\ttransplantation,\nand\tcontinual\tintravenous\ttherapy. | [
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and\tcontinual\tintravenous\ttherapy.\nThe\tshort-term\tgoals\tfor\tthe\ttreatment\tof\tHF\tare\tto\trelieve\tsymptoms,\timprove\tthe\tquality\tof\tlife,\nand\treduce\tdepression\tif\tit\tis\tpresent.\tThe\tlong-term\n\tgoal\tof\ttreatment\tis\tto\tprolong\tlife\tby\tlessening,\nstopping,\tor\treversing\tleft\tventricular\tdysfunction.\tMedical\tmanagement\tis\ttailored\tto\tclinical\tand | [
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take\ta\tdiuretic,\taldosterone\tantagonists,\tdigitalis,\tand\tvasodilators\t(e.g.,\thydralazine).\n\tBasically\tthese\nmedications\treduce\texcess\tfluid,\tdilate\tblood\tvessels,\tand\tincrease\tthe\tstrength\tof\tthe\theart’s\ncontraction.\tSeveral\tof\tthese\tmedications\thave\tneurohormonal\tbenefits\talong\twith\ttheir\tprimary | [
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] |
mechanism\tof\taction.\tFor\texample,\tACE\tinhibitors\t(e.g.,\tcaptopril,\tenalapril)\tnot\tonly\tinhibit\tthe\tRAS\nbut\talso\timprove\tsymptoms,\tquality\tof\tlife,\texercise\ttolerance,\tand\tsurvival.\tSimilarly,\n\tspironolactone\nhas\tdiuretic\tand\taldosterone-blocking\tfunctions\tthat\tresult\tin\treduced\tmorbidity\tand\tmortality\tin | [
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patients.\tMost\tof\tthese\tmedications\tcan\taffect\tnutrition\tstatus\t(see\t\nChapter\t8\n). | [
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Medical\tnutrition\ttherapy\nThe\tRDN\tprovides\tMNT,\twhich\tincludes\tassessment,\ta\tnutrition\tdiagnosis,\tand\tinterventions\n(education,\tcounseling).\tAs\tpart\tof\ta\tmultidisciplinary\tteam\t(physician,\tpharmacist,\n\tpsychologist,\nnurse,\tand\tsocial\tworker),\tthe\tRDN\tpositively\taffects\tpatient\toutcomes.\tReduced\treadmission\tto\tthe | [
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with\tmild\tHF.\tRestricting\tsodium\tand\tfluids\talong\twith\tdiuretic\ttherapy\tis\trecommended\tto\trestore\nfluid\tbalance.\nDietary\tassessments\tin\tHF\tpatients\treveal\tthat\tmore\tthan\thalf\thave\tmalnutrition,\tusually\trelated\tto\nthe\tcardiac\tcachexia\n\tmentioned\tearlier.\tNegative\tenergy\tbalance\tand\tnegative\tnitrogen\tbalances\tcan | [
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and\thigh\tin\tfiber,\twhole\tgrains,\tfruits,\tand\tvegetables\tis\trecommended.\tFor\tpersons\twith\nhypertension,\tthe\tDASH\tdiet\tis\trecommended.\tBoth\tof\tthese\tdietary\tpatterns\n\temphasize\tlower-\nsodium\tfoods\tand\thigher\tintake\tof\tpotassium.\tTotal\tenergy\texpenditure\tis\thigher\tin\tHF\tpatients | [
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because\tof\tthe\tcatabolic\tstate;\tadequate\tprotein\tand\tenergy\tshould\tbe\tprovided\t(\nAcademy\tof\nNutrition\tand\tDietetics,\tEvidence\tAnalysis\tLibrary,\t2017\n).\nSalt\trestriction\nExcessive\tsodium\tintake\tis\tassociated\twith\tfluid\tretention\tand\t\nedema\n.\tA\t2-g\tsodium\trestriction\tis\nregularly\tprescribed | [
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] |
recommendation\tis\tfor\t2\tg\t(\nGupta\tet\tal,\t2012\n).\tThe\tupdated\tAHA\trecommendation\tis\tfor\t“moderate”\nsodium\trestriction.\t\nTable\t32.7\n\tsummarizes\n\tthe\trecommendations\tfrom\tmultiple\torganizations.\tThe\ninconsistencies\tin\tthe\tdifferent\torganizations\tare\tdue\tto\tthe\tweak\tdatabase\tof\tstudies.\tMany\thave | [
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] |
small\tsample\tsizes\tand\tmany\twere\tnot\trandomized\ttrials.\tThree\tof\tthe\tlarger\tstudies\tthat\twere\nrandomized\thad\tconsistent\tresults\tbut\tshowed\tthat\tsodium\trestriction\twas\tassociated\twith\tworse\noutcome\t(\nGupta\tet\tal,\t2012\n).\tIt\tis\thypothesized\tthat\tthis\n\teffect\tmay\tbe\trelated\tto\tneurohormones | [
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effect\tmay\tbe\trelated\tto\tneurohormones\nincluding\taldosterone,\tnorepinephrine,\tand\tangiotensin\tII,\tall\tof\twhich\tincreased\twith\tdietary\nrestriction.\tThese\thormones\tact\tto\tconserve\tfluid,\tthus\ttrying\tto\trestore\tblood\tflow.\tAldosterone\npromotes\tsodium\treabsorption,\tand\tvasopressin\tpromotes\twater\tconservation\tin\tthe\tdistal\ttubules\tof | [
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the\tnephron.\tThis\tcomplex\tbalance\tis\tfurther\tcomplicated\tby\tthe\tmedications\n\tused\tfor\tHF. | [
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TABLE\t32.7\nDietary\tSodium\tIntake\tin\tHeart\tFailure\nGuideline\nYear\nSodium/Fluid\tRestriction\nRecommendations\nLevel\tof\nEvidence\nNational\tHeart\tFoundation\tof\nAustralia/Cardiac\tSociety\tof\nAustralia\tand\tNew\tZealand\n2006\n<3\tg/day\tfor\tNYHA\tclass\tII\twithout\tperipheral\nedema/<2\tg/day\tfor\tNYHA\tclass\tIII\tand\tIV\nC\n<2\tL/day\tfor\tall\tpatients\tand\t<1.5\tL/day\tduring | [
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C\n<2\tL/day\tfor\tall\tpatients\tand\t<1.5\tL/day\tduring\nfluid\tretention\tepisodes\nHeart\tFailure\tSociety,\tIndia\n2007\n<2\tg/day\nNot\tstated\n<2\tL/day\nEuropean\tSociety\tof\tCardiology\n2008\nModerate\trestriction\t1.5-2\tL/day\tin\tpatients\twith\nsevere\tsymptoms\tand\tespecially\twith\nhyponatremia\nC\nCanadian\tCardiovascular\tSociety\n2008\n<2\tg/day\nNot\tstated\n2\tL/day | [
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C\nCanadian\tCardiovascular\tSociety\n2008\n<2\tg/day\nNot\tstated\n2\tL/day\nAmerican\tCollege\tof\nCardiology/American\tHeart\nAssociation\n2009\nModerate\trestriction\t(≤2\tg/day\tif\tvolume\noverload,\tfollowed\tby\tfluid\tintake\trestriction\nto\t2\tL/day\tif\tfluid\tretention\n\tpersists)\nC\nRoyal\tCollege\tof\tPhysicians\n2010\nSalt\treduction\nFluid\trestriction\nLimited;\nfurther | [
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2010\nSalt\treduction\nFluid\trestriction\nLimited;\nfurther\nresearch\nrequired\nHeart\tFailure\tSociety\tof\tAmerica\n2010\n2-3\tg/day;\t<2\tg/day\tmay\tbe\tconsidered\tin\nmoderate\tto\tsevere\theart\tfailure\nC\n<2\tL/day,\tif\tfluid\tretention\tpersists\tand\tif\tsevere\nhyponatremia\t(serum\tNa\t<130\tmEq/L)\tis\npresent\nScottish\tIntercollegiate\tGuidelines\nNetwork\n2010\n<2.4\tg/day | [
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present\nScottish\tIntercollegiate\tGuidelines\nNetwork\n2010\n<2.4\tg/day\n\ttailored\tfluid\trestriction\n1+\nAmerican\tDietetic\tAssociation\n2011\n<2\tg/day\t1.4-1.9\tL/day\tdepending\ton\tclinical\nsymptoms\nFair\nLevel\tof\tEvidence:\t\nC\n,\tLimited\tpopulations\tevaluated.\tOnly\tconsensus\topinion\tof\texperts,\tcase\tstudies,\tor\tstandard\tof\tcare;\t\nFair\n,\tBenefits\texceed\tthe | [
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] |
Fair\n,\tBenefits\texceed\tthe\nharms\tbut\tquality\tof\tevidence\tis\tnot\tas\tstrong;\t\n1\n+,\twell-conducted\tmeta-analysis,\tsystemic\treviews,\tor\trandomized\tcontrolled\n\ttrials\twith\tlow\trisk\tof\nbias.\nNYHA\n,\tNew\tYork\tHeart\tAssociation.\nFrom\tAmerican\tHeart\tAssociation:\t\nContemporary\treviews\tin\tcardiovascular\tmedicine\n\t(website). | [
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Contemporary\treviews\tin\tcardiovascular\tmedicine\n\t(website).\nhttp://circ.ahajournals.org/content/126/4/479/T1.expansion.html\n,\t2015.\nPatient\tcompliance\twith\tsodium\trestriction\tof\t2\tg/day\thas\tbeen\tshown\tto\tbe\tpoor.\tThis\tcan\tlead\tto\ngenerally\tinadequate\tnutritional\tintake\tthat\tmay\tbe\ta\tcontributing\n\tfactor\tto\tpoor\toutcomes | [
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factor\tto\tpoor\toutcomes\nassociated\twith\tsodium\trestriction.\tA\tone-size-fits-all\tsodium\trestriction\tis\tnot\tpossible.\tThe\tHF\nstage,\tamount\tof\tedema\tpresent,\toverall\tnutritional\tstatus,\tand\tmedications\tmust\tbe\ttaken\tinto\nconsideration.\tThere\tis\tconsensus\tthat\thigh\tsodium\tintake\t(above\t3\tg/day)\tis\tcontraindicated\tfor\tHF. | [
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The\tdegree\tof\trestriction\tdepends\ton\tthe\tindividual\t(see\t\nFocus\tOn:\n\tSodium\tand\tSalt\tMeasurement\nEquivalents\n).\n\t\nFOCUS\tON\nSodium\tand\tSalt\tMeasurement\tEquivalents\nSodium\tchloride\tis\tapproximately\t40%\t(39.3%)\tsodium\tand\t60%\tchloride.\tTo\tconvert\ta\tspecified | [
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0.007710388395935297
] |
weight\tof\tsodium\tchloride\tto\tits\tsodium\tequivalent,\tmultiply\tthe\tweight\tby\t0.393.\tSodium\talso\tis\nmeasured\tin\tmilliequivalents\t(mEq).\tTo\tconvert\tmilligrams\tof\tsodium\tto\tmEq,\n\tdivide\tby\tthe\tatomic\nweight\tof\t23.\tTo\tconvert\tsodium\tto\tsodium\tchloride\t(salt),\tmultiply\tby\t2.54.\tMillimoles\t(mmol)\tand | [
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2.1158725664068398e-33,
0.018102038651704788,
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0.04746305197477341,
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0.05010022222995758,
0.010313555598258972,
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0.03533683344721794,
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0.08086919784545898,
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0.01813783310353756,
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0.0005079660913906991,
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0.029277034103870392,
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0.07668636739253998,
0.04946569353342056,
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0.062336139380931854,
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0.03852924704551697,
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0.09295996278524399,
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0.006939122918993235,
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0.07021507620811462,
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0.05279229208827019,
0.0024079177528619766
] |
milliequivalents\t(mEq)\tof\tsodium\tare\tthe\tsame.\tFor\texample:\n1\ttsp\tof\tsalt\t=\tapproximately\t6\tg\tNaCl\t=\t6096\tmg\tNaCl\n6096\tmg\tNaCl\t×\t0.393\t=\t2396\tmg\tNa\t(approximately\t2400\tmg)\n2396\tmg\tNa/23\t=\t104\tmEq\tNa\n1\tg\tNa\t=\t1000\tmg/23\t=\t43\tmEq\tor\tmmol\n1\ttsp\tof\tsalt\t=\t2400\tmg\tor\t104\tmEq\n\tNa | [
-0.07863481342792511,
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1\ttsp\tof\tsalt\t=\t2400\tmg\tor\t104\tmEq\n\tNa\nAdherence\tto\tsodium\trestrictions\tcan\tbe\tproblematic\tfor\tmany\tindividuals,\tand\tindividualized\ninstruction\tis\trecommended.\tEthnic\tdifferences\tin\tsodium\tconsumption\tmust\tbe\tconsidered.\tSome\ncultures\thave\ttraditional\tdiets\tthat\tare\tvery\thigh\tin\tsodium\tsuch\tas\tKosher\tand\tAsian\tdiets.\tIn\tsome | [
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Positive\toutcomes\t(i.e.,\tdecreased\turinary\tsodium\texcretion,\tless\tfatigue,\tless\tfrequent\tedema)\nhave\tbeen\tobserved\tin\tHF\tpatients\treceiving\tMNT.\tThe\ttype\tof\tsodium\trestriction\tprescribed\tshould\nbe\tthe\tleast\trestrictive\tdiet\tthat\twill\tachieve\tthe\tdesired\tresults.\tThe\tfirst\tstep\tis\tto\tminimize\tor | [
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] |
eliminate\tthe\tuse\tof\ttable\tsalt\tand\thigh-sodium\tfoods\t(\nBox\t32.8\n)\t(see\t\nAppendix\t46\n\tfor\tsodium\tcontent\nof\tfoods).\nBOX\t32.8\nTop\tTen\tCategories\tof\tHigh-Sodium\tFoods\n1.\t\nSmoked,\tprocessed,\tor\tcured\tmeats\tand\tfish\t(e.g.,\tham,\tbacon,\tcorned\tbeef,\tcold\tcuts,\thot\ndogs,\tsausage,\tsalt\tpork,\tchipped\tbeef,\tpickled\therring,\tanchovies,\ttuna,\tand\tsardines) | [
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2.\t\nTomato\tjuices\tand\ttomato\tsauce,\tunless\tlabeled\totherwise\n3.\t\nMeat\textracts,\tbouillon\tcubes,\tmeat\tsauces,\tMSG,\tand\ttaco\tseasoning\tand\tother\tpackaged\nseasonings\n4.\t\nSalted\tsnacks\t(potato\tchips,\ttortilla\tchips,\tcorn\tchips,\tpretzels,\tsalted\tnuts,\tpopcorn,\tand\ncrackers)\n5. | [
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crackers)\n5.\t\nPrepared\tsalad\tdressings,\tcondiments,\trelishes,\tketchup,\tWorcestershire\tsauce,\tbarbecue\nsauce,\tcocktail\tsauce,\tteriyaki\tsauce,\tsoy\tsauce,\tcommercial\tsalad\tdressings,\tsalsa,\tpickles,\nolives,\tand\tsauerkraut\n6.\t\nPackaged\tmixes\tfor\tsauces,\tgravies,\tcasseroles,\tand\tnoodle,\trice,\n\tor\tpotato\tdishes;\nmacaroni\tand\tcheese;\tstuffing\tmix\n7. | [
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0.04847128316760063,
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0.041332922875881195,
0.028982367366552353,
0.060071151703596115,
-0.02377813309431076
] |
or\tpotato\tdishes;\nmacaroni\tand\tcheese;\tstuffing\tmix\n7.\t\nCheeses\t(processed\tand\tcheese\tspreads)\n8.\t\nFrozen\tentrees\tand\tpot\tpies\n9.\t\nCanned\tsoup\n10.\t\nFoods\teaten\taway\tfrom\thome\nNote:\tReading\tlabels\tis\tmost\timportant;\tsome\tbrands\tare\tlower\tin\tsodium\tthan\tothers.\nMSG\n,\tMonosodium\tglutamate. | [
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0.033661454916000366,
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0.11246365308761597,
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] |
MSG\n,\tMonosodium\tglutamate.\nPoor\tadherence\tto\tlow-sodium\tdiets\toccurs\tin\tpart\tas\ta\tresult\tof\tlack\tof\tknowledge\tabout\tsodium\nand\n\tlower-sodium\tfood\tchoices\tby\tthe\tpatient,\tand\tperception\tthat\tthe\tdiet\tinterferes\twith\tthe\tsocial\naspects\tof\teating.\tLack\tof\tcooking\tskills\tor\tadequate\tcooking\tfacilities\tis\tanother\tobstacle\tbecause\tit | [
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0.07465589046478271,
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0.006816483568400145,
0.10934989899396896,
0.03503438085317612,
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