Hypertension

Blood pressure levels are a function of cardiac output multiplied by peripheral resistance (the resistance in the blood vessels to the flow of blood)

Hypertension The major factors which help maintain blood pressure (BP) include the sympathetic nervous system and the kidneys. Optimal healthy blood pressure is a systolic blood pressure of <120 mmHg and a diastolic blood pressure of <80 <120/80.

Hypertension CategorySystolic Blood Pressure Diastolic Blood Pressure Normal< 120<80 Pre-hypertension Hypertension – Stage Hypertension – Stage 2 >160>100

Hypertension Approximately one in four American adults has hypertension. As many as 2.8 million children also have high blood pressure. The prevalence of hypertension increases with age.

Prevalence of Hypertension by Age Age % Hypertensive

Hypertension When the normal regulatory mechanisms fail, hypertension develops. Hypertension is so dangerous because it gives off no warning signs or symptoms.

Untreated hypertension can result in: Arteriosclerosis--Kidney damage Heart Attack--Stroke Enlarged heart--Blindness

Factors Influencing the Development of Hypertension High-normal blood pressure Family history of hypertension African-American ancestry Overweight

Factors Influencing the Development of Hypertension Excess Consumption of Sodium Chloride Certain segments of the population are ‘salt sensitive’ because their blood pressure is affected by salt consumption

Factors Influencing the Development of Hypertension Alcohol consumption

Factors Influencing the Development of Hypertension Exercise Less active individuals are % more likely to develop hypertension.

Factors Influencing the Development of Hypertension Other Dietary Factors Potassium: Calcium: Magnesium:

Treatment for Hypertension Maintain a healthy weight, lose weight if overweight. Be more physically active. Drink alcoholic beverages in moderation. Reduce the intake of salt and sodium in the diet to approximately 2400 mg/day.

The DASH Diet DAS H The D ietary A pproaches to S top H ypertension clinical trial (DASH) Diet rich in fruits, vegetables, and low fat dairy foods, can substantially lower blood pressure in individuals with hypertension and high normal blood pressure.

Dash Study Control: Ca, Mg, & K ~ 25% of US diet Macronutrients and fiber ~ US average Fruits and Vegetables Fruits and vegetables increased to 8.5 servings K and Mg to 75% Combination: Add 2-3 servings low-fat dairy to fruit & vegetable diet. Ca, K and Mg increased to 75%

Dash Study Outcomes Fruit and Vegetable Diet: Decrease in systolic and diastolic blood pressure in entire study group and in the hypertensive subgroup. Combination Diet: Significant decrease in both systolic and diastolic blood pressure in both groups. Greatest drop was in systolic BP in hypertensive group (11.4 mmHg)

Dash Diet Implications Combination diet affects comparable to pharmacological trails in mild hypertension. Population wide reductions in blood pressure similar to DASH results would reduce CHD by ~ 15% and stroke by ~27% Great potential in susceptible groups: African Americans and elderly.

The DASH Diet DASH Diet The DASH Diet includes: 7-8 servings of grains and grain products 4-5 servings of vegetables 4-5 servings of fruits 2-3 servings of low fat dairy products 2 or less servings of meat, poultry and fish 2-3 servings of fats and oils Nuts, seeds and dry beans 4-5 times /week Limited ‘sweets’ low in fat.

Effects of increasing Calcium-Rich Dairy Food in Black Hypertensives Increases urinary sodium excretion Decreases volume Decreases peripheral vascular resistance Decrease blood pressure Reduces left ventricular mass and risk of left ventricular hypertrophy Effects sustained for one-year period of study

Sodium in Foods Conversion of milligrams to milliequivalents (mEq): mg/atomic weight x valence = mEq. Atomic weight sodium = 23, valence = mg/23 x 1 = mEq sodium

Reducing Sodium in the Diet Use fresh poultry, fish and lean meat, rather than canned or processed. Buy fresh, plain frozen or canned with “no salt added” vegetables. Use herbs, spices and salt-free seasoning blends in cooking and at the table; decrease or eliminate use of table salt. Choose ‘convenience’ foods that are lower in sodium.

Reducing Sodium in the Diet When available, buy low- or reduced- sodium or ‘no-salt-added’ versions of foods like: Canned soup, canned vegetables, vegetable juices cheeses, lower in fat condiments like soy sauce crackers and snack foods like nuts processed lean meats

Food Labels ClaimAmount Low Sodium>140 mg/serving Very Low Sodium>35 mg/serving Sodium Free>5 mg/serving Reduced Sodium25% less than original