Wednesday, February 1, 2006

Dietary Approaches to Prevent and Treat Hypertension from the American Heart Association

Dietary Approaches to Prevent and Treat Hypertension: A Scientific Statement From the American Heart Association -- Appel et al. 47 (2): 296 -- Hypertension:
A substantial body of evidence strongly supports the concept that multiple dietary factors affect blood pressure (BP). Well-established dietary modifications that lower BP are reduced salt intake, weight loss, and moderation of alcohol consumption (among those who drink). Over the past decade, increased potassium intake and consumption of dietary patterns based on the "DASH diet" have emerged as effective strategies that also lower BP. Of substantial public health relevance are findings related to blacks and older individuals. Specifically, blacks are especially sensitive to the BP-lowering effects of reduced salt intake, increased potassium intake, and the DASH diet. Furthermore, it is well documented that older individuals, a group at high risk for BP-related cardiovascular and renal diseases, can make and sustain dietary changes. The risk of cardiovascular disease increases progressively throughout the range of BP, beginning at 115/75 mm Hg. In view of the continuing epidemic of BP-related diseases and the increasing prevalence of hypertension, efforts to reduce BP in both nonhypertensive and hypertensive individuals are warranted. In nonhypertensive individuals, dietary changes can lower BP and prevent hypertension. In uncomplicated stage I hypertension (systolic BP of 140 to 159 mm Hg or diastolic BP of 90 to 99 mm Hg), dietary changes serve as initial treatment before drug therapy. In those hypertensive patients already on drug therapy, lifestyle modifications, particularly a reduced salt intake, can further lower BP. The current challenge to healthcare providers, researchers, government officials, and the general public is developing and implementing effective clinical and public health strategies that lead to sustained dietary changes among individuals and more broadly among whole populations.
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1 comment:

Anonymous said...

Very interesting post - thank you.

I have a question about salt reduction in CRF patients. You're recommending a decrease in salt intake across the board, whether a person is hypertensive or not, at least as a prophylactic measure.

However, a June 2004 article on Medscape ( Dietary Approaches to Prevent and Treat Hypertension ) mentions the following: "In this large study (11,346 subjects) the main finding was that lower salt intake related to higher all-cause mortality." The article also mentions a higher incidence of MI in those who had a reduced salt intake.

It goes on to state: "Finally, those who deem salt restriction as not advisable or even harmful, support their view by postulating that the untoward biochemical effects of the commonly used thiazides (carbohydrate intolerance, increased plasma insulin, serum cholesterol, and low-density lipoprotein cholesterol levels) may counteract or attenuate the beneficial effects of blood pressure reduction. Moreover, it has been suggested that thiazide-induced renal potassium wasting may relate to increased ventricular arrhythmias and sudden death,[6] while normal body potassium may have protective effects on cardiovascular events, such as stroke, independent of blood pressure.[7]"

As a hypertensive CRF patient who is currently following the DASH diet, the information concerns me ... since a thiaziade (Hyzaar) is among several medications being used in my treatment.

Personally, I've found over the last couple of years that even with an extended increase in salt intake, for example over the holidays or during travel, that the BP did not seem to be adversely affected.

I'm wondering if perhaps salt is going to be one "those things" about which medical science eventually changes it's collective mind?