Hypertension

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Hypertension
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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)

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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 lt120 mmHg and a diastolic blood
  pressure of lt80
• lt120/80.

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Hypertension
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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.

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Prevalence of Hypertension by Age

• Age
• 18-29
• 30-39
• 40-49
• 50-59
• 60-69
• 70-79
• 80

• Hypertensive
• 4
• 11
• 21
• 44
• 54
• 64
• 65

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Hypertension

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

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

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Factors Influencing the Development of
Hypertension

• High-normal blood pressure
• Family history of hypertension
• African-American ancestry
• Overweight

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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

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Factors Influencing the Development of
Hypertension

• Alcohol consumption

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Factors Influencing the Development of
Hypertension

• Exercise
• Less active individuals are 30-50 more likely to
  develop hypertension.

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Factors Influencing the Development of
Hypertension

• Other Dietary Factors
• Potassium
• Calcium
• Magnesium

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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.

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The DASH Diet

• The Dietary Approaches to Stop Hypertension
  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.

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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

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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)

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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.

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The 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.

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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

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Sodium in Foods

• Conversion of milligrams to milliequivalents
  (mEq)
• mg/atomic weight x valence mEq.
• Atomic weight sodium 23, valence 1
• 2400 mg/23 x 1 104.3 mEq sodium

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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.

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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

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