The silent killer
“Lower your blood pressure eat less salt”
The World Health Organization (WHO) 2012 report shows that one in three adults worldwide have raised blood pressure. Complications of hypertension account for 9.4 million deaths worldwide every year (WHO, 2014). This accounts for 57 million disability adjusted life years. Both men and women have high rates of raised blood pressure in the Africa region, with prevalence rates over 40%. The lowest prevalence of raised blood pressure was in the WHO Region of the Americas at 35% for both sexes (WHO, 2008).
Blood pressure is a measurement of the force against the walls of the arteries as the heart pumps blood through the body. Hypertension is another term used to describe high blood pressure. The word “hypertension” comes from the prefix “hyper” meaning “excessive” and the root word “tension” for “force.” Hypertension literally means “excess force.”
Blood pressure readings are given as two numbers. The top number is called the systolic blood pressure. The bottom number is called the diastolic blood pressure. The individual is hypertensive when a systolic blood pressure equal to or above 140 mm Hg and/or diastolic blood pressure equal to or above 90 mm Hg. Systolic and diastolic means the contraction and the relaxation of the heart respectively.
Hypertension, also known as high or raised blood pressure, is a condition in which the blood vessels have persistently raised pressure. When the pressure is higher in the blood vessels the harder the heart has to work in order to pump blood so as to sustain body cells and tissues got sufficient oxygen and nutrients and removal of wastes. If uncontrolled hypertension can lead to heart attack, an enlargement of the heart and finally heart failure. The blood supply to part of the brain cut off can cause stroke the blockage of the vessels by blood clot or in other words embolism, which eventually result paralysis of the limbs left or right. If the stroke occurs in the brain right side the left side of the body will be affected and the result will be paralysis on the left side of the body results vision problems, and memory loss. On the other hand if the stroke occurs in the brain left side the right side of the body will be affected and the result will be Paralysis on the right side of the body resulting speech/language problems, and Memory loss. Hypertension can also lead to kidney failure, blindness, and rupture of blood vessels. The risk factors for hypertension are being overweight or obese, smoking, sedentary life or no exercise, too much salt in the diet, stress, heredity. Salt is a contributor of risk to being affected by hypertension, we will indicate the amount needed in a minute during nutrition therapy of hypertension.
Nutritional Therapy of hypertension
“Dietary Approaches to Stopping Hypertension “DASH”
Carbohydrate: An evolving but complex body of evidence suggests that both amount and type of carbohydrate intake affect Blood Pressure. Normal Recommended Dietary Allowance (RDA) of Carbohydrate is 2100 kcal. If the patient is overweigh/obese, the RDA should be reduced in order to weight.
Protein from plants source is associated with low blood pressure; E.g. black beans, barley, green peas.
Sodium chloride: Dietary Guidelines for Americans recommend an intake of less than 2300 mg of sodium, the equivalent of teaspoon of sodium chloride (table salt), each day.
Potassium, Calcium, and Magnesium, have all been positively correlated with reduction of BP and treatment of hypertension. The role of these minerals as part of the nutrition therapy for hypertension is highlighted by the results of the DASH studies.
Potassium: The diet used in the DASH trials provided an average of 4–6 g equivalent approximately 1 teaspoon of potassium/day from fruits and vegetables; the main sources of potassium are banana (1/2), Mango (1 medium), Orange (1 medium), Dates (5 whole), Papaya (½ whole). The patient can select one of these sources available in his local community and as Somalis this is the best source that is attainable in our markets.
Calcium the relationship between calcium and hypertension has been studied for over 25 years. The most dramatic relationship has been seen to reduce blood pressure. Calcium intake >400 mg. Main sources are Fat-free (skim) or low-fat (1%) milk, fat-free or low-fat buttermilk, fat-free or low-fat regular or frozen yogurt, low-fat and fat-free cheese and cabbage.
Magnesium: High consumption of magnesium reduces the production of prostacyclin which is vasodilating and increases the release of thromboxane which is vasoconstricting (Prostacyclins and thromboxanes) are hormone like the one compounds referred to as eicosanoids that regulate Blood Pressure, clotting and other body functions). Magnesium also stabilizes calcium channels. Low blood magnesium lowers potassium level and leads to hypokalemia. Sources are spinach, white bean, green leafy vegetables, potatoes and oranges.
Fat and oils; (omega-3 polyunsaturated fat) might reduce Blood Pressure and that other types of fat (e.g. saturated fat) might raise Blood Pressure. Hence, the direction of the Blood Pressure effect might be direct (positive) or inverse, depending on the type of fats consumed. Monounsaturated is preferred (olive, peanut oils), Consume <7% kcal as saturated fat, (including <1% as trans-fat), Consume <200 mg cholesterol daily.
Fiber; consume 5–10 g soluble fiber daily. Source; Orange (1 medium) = 1.8 g fiber, Carrot=1.1 g fiber.
Restricted foods and beverages: Nonfat beverages: carbonated drinks, juices, tea, coffee; canned or Bottled Tomato Products, sugar-sweetened drinks, Eating too many baked goods frequently like cakes, and cookies. Whole Milk is a great source of calcium, but high-fat dairy sources, like whole milk, provides you fatter than you need. One cup serving of whole milk has about 8 grams of fat, 5 grams of which are saturated. Saturated fats are worse for you than other types and have been linked to heart disease.
Physical activity: Physical activity has measurable biological effects affecting cholesterol levels, insulin sensitivity and vascular reactivity. Moreover these effects are dose dependant such that the more the exercise, the greater the health benefits. The WHO (2002) describes the opportunities for people to be physically active in terms of 4 domains: at work; for transport; in domestic duties and leisure time Engaging in moderate level of physical activities such as intermittent walking for 30 to 45 minutes is recommended for prevention of Cardiovascular Disease. Moderate exercise such as walking may both lower LDL (Low-density lipoprotein) and raise HDL (High- density lipoprotein) levels if the activity is constantly pursued for a long time. Moderate means 30 minutes hurry walking (1.5-6 km) per hour, walking any exercise that will expend 200 calories per day.
Prevent and control obesity: Maintain a healthy body weight (body mass index of 18.5 to 24.9) Limitation of dietary fats is effective means to reduce both energy density and total energy. The diet should be within ≤30% of total kilocalories as fat to predict a weight loss of ½ kg per week (minus 500 to 1000kcal/day).
Manage stress: Stress may temporarily increase blood pressure. Learn to find healthy ways to cope with stress. Avoid coping with stress by eating high fat or high salt foods, or by smoking. Learning relaxation techniques and finding a time to walk each day are some good ways to start.
Written by: Hamse Adam Adde
Master’s in Foods, Nutrition and Dietetics