A4M SURE A SETS ANSWERS AND QUESTIONS SET
A+
✔✔HTN treatment- Combining food and nutrients with medications - ✔✔(1) Sesame
with beta blockers, diuretics and
nifedipine
(2) Pycnogenol with ACEI and CCB
(3) Lycopene with ACEI, CCB and diuretics
(4) alpha lipoic acid with ACEI or acetyl -L Carnitine
(5) Vitamin C with CCB's
(6) NAC with arginine
(7) Garlic with ACEI, diuretics and beta blockers
(8) Coenzyme Q10 with ACEI and CCB
(9) Taurine with magnesium
(10) Potassium with all antihypertensive agents
(11) Magnesium with all antihypertensive agents.
✔✔diuretic nutrient depletions - ✔✔decrease potassium, magnesium, phosphorous,
sodium, chloride, folate, vitamin B6, zinc, iodine and
coenzyme Q10
increase homocysteine, calcium and creatinine;
and elevate serum glucose by inducing insulin resistance
✔✔beta blocker depletes what nutrient? - ✔✔reduces coenzyme Q10
✔✔ACE and ARBs reduce? - ✔✔reduce zinc
✔✔weight reduction goals - ✔✔Body mass index < 25
Waist circumference: increasing the proportion of lean muscle
< 35 inches for women
< 40 inches for men
Total body fat:
< 22% for women
,< 16% for men
✔✔Polyphenols - ✔✔More than 8,000 types of polyphenols
micronutrients that we get through certain plant-based foods
naturally occurring organic compounds characterized by multiples of phenol unit
✔✔flavonoids - ✔✔account for around 60% of all polyphenols. Examples include
quercetin, kaempferol, catechins, and anthocyanins, which are found in foods like
apples, onions, dark chocolate, and red cabbage.
✔✔phenolic acids - ✔✔accounts for around 30% of all polyphenols. Examples include
stilbenes and lignans, which are mostly found in fruits, vegetables, whole grains, and
seeds.
✔✔Polyphenolic amides - ✔✔includes capsaicinoids in chili peppers and
avenanthramides in oats
✔✔other polyphenols - ✔✔resveratrol in red wine, ellagic acid in berries, curcumin in
turmeric, and lignans in flax seeds, sesame seeds, and whole grains
✔✔GGTP - ✔✔predominantly in hepatocytes and biliary epithelia, not present in bone
(helps you determine if alk phos is from liver or bone)
gamma-glutamyl transpeptidase
✔✔Dippers vs Non-Dippers - ✔✔at night you must drop BP 10% from day pressure.
arteries do not get relaxation at night if nondipper.
Excessive dipping > (20%) increases ischemic CVA
✔✔nocturnal non dipping treatment - ✔✔coreg and bystolic are only BB that will convert
but best tx: ACE ARB and CCB
✔✔what controls awake and asleep BP? - ✔✔Awake BP controlled by SNS
Asleep BP controlled by RAAS and SNS
✔✔BP drug treatment - ✔✔Most drugs may partially convert non-dippers to dippers if
given at night.
RAAS drugs work best at night.
Lack of BP dipping related to renal sodium reabsorption. These respond to diuretics
Drugs with dual action on SNS and RAAS control awake and sleep BP
, ✔✔what drugs will NOT convert non-dippers to dippers? - ✔✔HCTZ, chlorthaladone,
first and second generation BB
✔✔nocturnal hypertension - ✔✔night time BP over 120/70 mm Hg
treatment: ACEI, ARB, CCB, Nebivolol best for nocturnal BP treatment
✔✔morning BP surges (MBPS) treatment - ✔✔Best agents to reduce MBPS: ACEI ARB
CCB Nebivolol
✔✔central blood pressure - ✔✔CBP is the ascending aortic BP, exerted on heart and
brain.
CBP reduced by CCB, ACEI, and ARB.
CBP is increased or unchanged by older BB and some diuretics like HCTZ.
✔✔high PRA - ✔✔high ATII= volume constrictive HTN
• High renin hypertension (HRH): Decreased intravascular volume: PRA > 0.65 ng/ml/hr
70% of patients
• Very high renin: Volume depleted: PRA> 6.5 ng/ml/hr
tx: ACE or ARB
✔✔low PRA - ✔✔volume overload HTN
Low renin hypertension (LRH): Increased intravascular volume (volume dependent)
PRA < 0.65 ng/ml/hr 30% of patients
tx: CCB or diuretic
✔✔aldosterone renin ratio - ✔✔• ARR over 80 is LRH
• ARR over 40 is probably LRH
• ARR less than 10 is HRH
• ARR between 10 and 40 : not sure
✔✔exercise - ✔✔60 minutes 4x a week
40 minutes of resistance, 20 min of aerobics
✔✔sodium to potassium ratio - ✔✔Reduce sodium intake to 1500-2000 mg per day.
Increase potassium intake to 5 grams per day.
• This gives a K/Na ratio of 2.5-3.3/1.
A+
✔✔HTN treatment- Combining food and nutrients with medications - ✔✔(1) Sesame
with beta blockers, diuretics and
nifedipine
(2) Pycnogenol with ACEI and CCB
(3) Lycopene with ACEI, CCB and diuretics
(4) alpha lipoic acid with ACEI or acetyl -L Carnitine
(5) Vitamin C with CCB's
(6) NAC with arginine
(7) Garlic with ACEI, diuretics and beta blockers
(8) Coenzyme Q10 with ACEI and CCB
(9) Taurine with magnesium
(10) Potassium with all antihypertensive agents
(11) Magnesium with all antihypertensive agents.
✔✔diuretic nutrient depletions - ✔✔decrease potassium, magnesium, phosphorous,
sodium, chloride, folate, vitamin B6, zinc, iodine and
coenzyme Q10
increase homocysteine, calcium and creatinine;
and elevate serum glucose by inducing insulin resistance
✔✔beta blocker depletes what nutrient? - ✔✔reduces coenzyme Q10
✔✔ACE and ARBs reduce? - ✔✔reduce zinc
✔✔weight reduction goals - ✔✔Body mass index < 25
Waist circumference: increasing the proportion of lean muscle
< 35 inches for women
< 40 inches for men
Total body fat:
< 22% for women
,< 16% for men
✔✔Polyphenols - ✔✔More than 8,000 types of polyphenols
micronutrients that we get through certain plant-based foods
naturally occurring organic compounds characterized by multiples of phenol unit
✔✔flavonoids - ✔✔account for around 60% of all polyphenols. Examples include
quercetin, kaempferol, catechins, and anthocyanins, which are found in foods like
apples, onions, dark chocolate, and red cabbage.
✔✔phenolic acids - ✔✔accounts for around 30% of all polyphenols. Examples include
stilbenes and lignans, which are mostly found in fruits, vegetables, whole grains, and
seeds.
✔✔Polyphenolic amides - ✔✔includes capsaicinoids in chili peppers and
avenanthramides in oats
✔✔other polyphenols - ✔✔resveratrol in red wine, ellagic acid in berries, curcumin in
turmeric, and lignans in flax seeds, sesame seeds, and whole grains
✔✔GGTP - ✔✔predominantly in hepatocytes and biliary epithelia, not present in bone
(helps you determine if alk phos is from liver or bone)
gamma-glutamyl transpeptidase
✔✔Dippers vs Non-Dippers - ✔✔at night you must drop BP 10% from day pressure.
arteries do not get relaxation at night if nondipper.
Excessive dipping > (20%) increases ischemic CVA
✔✔nocturnal non dipping treatment - ✔✔coreg and bystolic are only BB that will convert
but best tx: ACE ARB and CCB
✔✔what controls awake and asleep BP? - ✔✔Awake BP controlled by SNS
Asleep BP controlled by RAAS and SNS
✔✔BP drug treatment - ✔✔Most drugs may partially convert non-dippers to dippers if
given at night.
RAAS drugs work best at night.
Lack of BP dipping related to renal sodium reabsorption. These respond to diuretics
Drugs with dual action on SNS and RAAS control awake and sleep BP
, ✔✔what drugs will NOT convert non-dippers to dippers? - ✔✔HCTZ, chlorthaladone,
first and second generation BB
✔✔nocturnal hypertension - ✔✔night time BP over 120/70 mm Hg
treatment: ACEI, ARB, CCB, Nebivolol best for nocturnal BP treatment
✔✔morning BP surges (MBPS) treatment - ✔✔Best agents to reduce MBPS: ACEI ARB
CCB Nebivolol
✔✔central blood pressure - ✔✔CBP is the ascending aortic BP, exerted on heart and
brain.
CBP reduced by CCB, ACEI, and ARB.
CBP is increased or unchanged by older BB and some diuretics like HCTZ.
✔✔high PRA - ✔✔high ATII= volume constrictive HTN
• High renin hypertension (HRH): Decreased intravascular volume: PRA > 0.65 ng/ml/hr
70% of patients
• Very high renin: Volume depleted: PRA> 6.5 ng/ml/hr
tx: ACE or ARB
✔✔low PRA - ✔✔volume overload HTN
Low renin hypertension (LRH): Increased intravascular volume (volume dependent)
PRA < 0.65 ng/ml/hr 30% of patients
tx: CCB or diuretic
✔✔aldosterone renin ratio - ✔✔• ARR over 80 is LRH
• ARR over 40 is probably LRH
• ARR less than 10 is HRH
• ARR between 10 and 40 : not sure
✔✔exercise - ✔✔60 minutes 4x a week
40 minutes of resistance, 20 min of aerobics
✔✔sodium to potassium ratio - ✔✔Reduce sodium intake to 1500-2000 mg per day.
Increase potassium intake to 5 grams per day.
• This gives a K/Na ratio of 2.5-3.3/1.
