Nutrition in management of Hypertension

This article is written by Fitday Expert panel member, Dr. Umashri Rao Francis (M.B.B.S)

In these modern times with increased professional competition, a hectic lifestyle, the stress of meeting targets and deadlines, there is an increase in the incidence of hypertension amidst population. Statistics show that the incidence of hypertension among adults is 29%. A breakdown of the hypertension occurrence statistics shows:

Diagnosing Hypertension in youth

Young patients these days present themselves with symptoms of headache and giddiness and on general examination, the blood pressure checkup is found to be on the higher side. On hearing this most of the times these patients are in a state of denial, unable to comprehend hypertension at their age. After ruling out secondary reasons like thyroid and kidney problems it’s mostly found to be due to an excessive amount of stress.

Many young individuals with the problem, that have been diagnosed are those who have hectic work schedules, or where they sleep during the day and work all night on a US time schedule. When from birth you have followed the cycle of sleeping at night and working during the day, a sudden change in the entire schedule will naturally be protested by your body. It is not that all who work at night get hypertensive but if there is a strong family history or other predisposing factors then one may develop hypertension due to the predisposing factors and the lifestyle changes.

What is hypertension?

Before going further into the subject let us understand what hypertension is all about. The pressure exerted by the blood column laterally on the wall of the artery is called as blood pressure. Normal blood pressure of an adult is 120/80 mm of Hg.

According to the World Health Organization, a person is considered to be hypertensive when his or her blood pressure is above 140 mm of Hg when the heart is contracting and above 90 mm Hg when the heart is relaxed.

Most people with hypertension have no symptoms at all, therefore it is known as the silent killer. Sometimes hypertension causes symptoms such as headache, shortness of breath, dizziness, chest pain, palpitations and sometimes nose bleed.

Preventing Hypertension- habits and food patterns

Hypertension is the most important preventable cause of heart disease, stroke, and kidney failure worldwide. The factors which contribute towards causing hypertension include tobacco use, unhealthy diet, obesity, high cholesterol, diabetes, use of alcohol and a lack of physical activity. Other factors which risk the cause for development of hypertension are age and a family history.

There is strong evidence that good diet not only can improve wellness but reverse this disease too. High intake of sodium in form of common salt is one of the main causes for rise in blood pressure. When you eat too much salt, the sodium in it makes your body retain more water which in turn stresses the body.

Consuming animal fat and margarine, seasoned, commercially baked and deep-fried foods also adds to the risk of developing hypertension. While obesity is a major cause for high blood pressure, high levels of constant stress, and a sedentary lifestyle are in today’s time major predisposing factors for hypertension.

Selection of practices to prevent hypertension:

• Maintain ideal body weight, as per your age and height
• Be active – low to moderate workout 3-5 times a week
• Limit intake of fat and oils
• Limit intake of added sugars, especially sweetened foods and beverages
• Limit salt intake
• Eat a variety of fresh and/or organic foods everyday
• Eat cereals preferably whole grains – oats, muesli, bran
• Eat more vegetables and fruits
• Eat unsalted nuts and seeds 
• Eat fish at least twice a week
• Consume low fat milk and dairy products
• Choose poultry and lean meat over red meat
• Drink lots of water and stay hydrated

DASH diet: The Nutritional considerations to prevent hypertension

Nutritional factors play a role not only in reducing risk of development of hypertension, but also in managing it after the condition is diagnosed. A DASH diet, also known as Dietary Approaches to Stop Hypertension, is the key to control the condition.

The DASH diet focuses on fruits, vegetables, whole grains and lean meat, keeping red meat, salt and added sugars and fat intake very low. This was a diet that was designed to combat high blood pressure and reduce people’s risk of developing heart disease.

The regular DASH diet encourages no more than one teaspoon of salt and doesn’t list specific foods to eat. Instead it recommends specific servings of different food groups, which are:

• Whole grains: 6-8 servings a day
• Fresh Vegetables: 4-5 servings a day
• Dairy products: 2-3 servings a day
• Lean chicken or meat or fish: less than 6 servings a week
• Nuts, seeds, legumes: 4-5 servings a week
• Fats and oils, preferably cold-pressed: 2-3 servings a day
• Candy and sugars in beverages: very few servings a week (<1-2 servings)

The fresh produce/foods that help lower blood pressure include:

• Leafy greens: their Potassium helps kidneys to get rid of excessive sodium through urine and hence lowers blood pressure
• Berries: are rich in flavonoids and help in lowering blood pressure
• Red beets: They help in opening the blood vessels and lower blood pressure as they are rich in nitrates
• Skimmed milk and yogurt
• Oatmeal: rich in fiber, with low fat and sodium
• Bananas: as they are rich in potassium
• Fish: are a great source of lean proteins and high in omega -3-fatty acids. Same fish sources give vitamin D which helps lower blood pressure
• Unsalted seeds: are high in potassium, magnesium and other minerals that are known to reduce blood pressure
• Dark chocolate: is associated with lower risk of Cardiovascular disease 
• Pistachios: are a healthy way to decrease blood pressure by reducing peripheral resistance i.e. blood vessels tightening, and regulating your heart rate
• Olive oil: contains polyphenols which are inflammation fighting compounds that can help to reduce to blood pressure 
• Pomegranates: also help in lowering blood pressure

The Foods to be avoided by hypertension patients are:

• Butter, margarine
• Regular salad dressings- creamy, processed dressings
• Fatty meats, red meat
• Whole milk/full fat milk, dairy products
• Fried food
• Salted snacks
• Fast foods

Supplements for hypertension patients

As high blood pressure over a period of time can damage your blood vessels and put you at a high risk of stroke or heart attack, it is necessary to take some supplements to control this damage and maintain the blood vessels in good condition. Some recommended ones are:

Folic acid: During pregnancy high blood volume due to pregnancy can increase the blood pressure. Folic acid helps as good supplements for baby’s development in womb and reduces risk of hypertension. Alternatively, Folic acid  rich food are Broccoli, leafy vegetables, peas, breakfast cereals , nuts , seeds , legumes, eggs, flax seeds , walnuts , and citrus fruits.

Vitamin D: Low levels of Vitamin D can be linked to hypertension. They can be improved by spending time out in morning sun and can also be derived from cheese and eggs. 

Magnesium: Magnesium is required for regular cell function. Magnesium supplement is known to have some effect on blood pressure. Some sources are flax seeds, pumpkin seeds, chia seeds, dry beans, almonds, cashews, low fat dairy products, tofu and dark chocolate. 

Potassium: Potassium counters the effect of sodium and hence reduces the blood pressure. It is present highly in green leafy vegetables like kale, turnip greens, spinach and also in bananas, coconut water, etc. 

Coenzyme Q10: It is an antioxidant also present in organ meat, muscle meat, fatty fish, leafy vegetables, oranges, nuts like pistachios, canola oil, soya bean oil, and sesame seeds. 

Calcium: is important for healthy blood pressure because it helps blood vessels tighten and relax when they need to. We can get it from natural resources like dairy products, and fish like salmon or sardine. Under the supervision of the physician calcium supplement may be taken. 

Omega3 fish oils: The Omega-3 fish oil contains both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Omega-3 fatty acids are essential nutrients that are important in preventing and managing high blood pressure. 

Findings show omega-3 fatty acids may help to:

• Lower blood pressure
• Reduce triglycerides
• Slow the development of plaque in the arteries
• Reduce the chance of abnormal heart rhythm
• Reduce the likelihood of heart attack and stroke
• Lower the chances of sudden cardiac death in people with heart disease

In most cases, no one knows what causes high blood pressure, but it is known that the foods you eat can affect it, in both good ways and bad. Even the World Health Organization recommends salt restricted healthy diet and physical exercise as the first line of treatment for newly diagnosed hypertension patients.

Hypertension in today’s world is a common issue, and in a borderline case it can be very easily maintained by having a good balanced blood pressure friendly diet by following Established nutrition recommendations that are proven to be helpful in reducing blood pressure along with its related complications and overall mortality.

References:
• Image 1.: https://www.webmd.com/hypertension-high-blood-pressure/ss/slideshow-hypertension-low-bp-foods
• Image 2.: https://blog.ohiohealth.com/dash-diet-lower-blood-pressure/
• Image 3.: https://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_tools/hypertension_low_bp_foods_slideshow/1800ss_thinkstock_rf_dash_diet_foods.jpg?resize=650px

About Dr. Umashri Rao Francis: Dr. Francis has been practicing Medicine for over 26 years. She is an experienced General Physician successfully treating a vast majority of the local population, in particular the poorly diagnosed and difficult cases. Dr. Francis is a regular contributor to the #FitBlog and is available to answer your article related questions at drumashri2002@yahoo.co.in