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Hypertension is defined as a medical condition where the blood pressure (BP) of an individual is consistently higher than the normal range. The optimal systolic BP must be less than 120 mm hg/dl and diastolic BP is 80 mm hg/dl according to WHO. However, WHO suggests the BP must be lower than 130/85 mm hg/dl and if it is higher than this, the person is certainly having hypertension (Who.int, 2022). Hypertension is a condition that develops due to persistent pressure on the walls of blood vessels, especially on the arteries. A lot of factors contribute to the causes of this condition and the person suffering from hypertension can be symptomatic or asymptomatic at the same time.
The symptoms of primary hypertension are developed as a result of many conditions including due to family history such as obesity. The multifactorial causes of this condition are the reason why primary hypertension is also known as “Idiopathic Hypertension” or “Essential Hypertension”. The probability of occurrences of cardiac failure, kidney failure, stroke, vision loss, etc. enhances for people suffering from primary hypertension. Some symptoms of severe hypertension include nausea, tendency of vomiting, headache, occasional pain in the chest, anxiety, dizziness, shortness of breath, as well as muscle tremors. The secondary hypertension is different from the primary one as there is no family history of high BP. The symptoms include sudden increment in BP and even the medications do not respond to it. Sometimes the systolic BP can go as high as 180 mm hg/dl. The patient suffering from this condition may not be obese but have hypertension (Gupta-Malhotra et al. 2015). Hypertension can be present as a symptom itself with other diseases (Song et al. 2020). For example, a kidney patient can have high BP or a patient suffering from CVD (Cardiovascular Diseases) can have hypertension as a symptom.
According to the latest report published by WHO, around 1.28 billion adults are suffering from hypertension aged between 30 to 79 years. Most of the people or approximately two-thirds of the population belong to low as well as middle-income countries (Who.int, 2022). It states around 46% of adults are not even aware of the fact they are having this condition and do not undergo treatment or dietary modifications. In addition, 42% of the adults get themselves help to treat this condition. Other than that, 1 out of 5 adults make lifestyle changes to keep hypertension under control. It has been previously thought that hypertension-like diseases are more prevalent in males than in females. However, a study in Korea indicated although the overall prevalence is higher in males than in females, however, after the age of 60 women has more hypertension incidents than men (Cho et al. 2017). Other than that, people suffering from obesity having BMI or Body Mass Index higher than 30 are more prone to develop this condition. The waist to hip ratio is another key indicator of obesity to understand the prevalence. Studies say the prevalence of hypertension is high among those adults who are overweight or obese as compared to normal.
Hypertension is a condition that may result from CVD, renal diseases such as glomerulonephritis, hyperthyroidism, and disease in the pituitary. Other than that hereditary presence of hypertension, stress, obesity, smoking, and narrowing of blood vessels due to some hormonal changes or accumulation of fat can be some of the major causes of this condition. The causes of hypertension are described in the following section.
Heredity is one of the major contributors to hypertension. According to a study, environmental factors such as eating patterns along with genetic factors combine to give rise to hypertension among individuals following a complex physiological function (Patel et al. 2017). This study showed the chances are higher among those where grandparents, as well as parents, are suffering from the same condition. In addition, the “Twin and family-based study” also indicated the variance in blood pressure increases by 30-50% if hypertension is present in genes. The mutation of genes can be another cause of genetic hypertension. Moreover, some of the environmental factors such as consumption of food high in sodium, saturated fat, low in potassium, etc. as well are significant contributing factors.
Obesity is also considered to be a crucial contributor to hypertension. In order to understand the relation between obesity with hypertension, the reasons for obesity must be considered first. An imbalance between energy intake and its expenditure, consumption of high-calorie food, sedentary lifestyle as well as genetics are some of the reasons for excessive accumulation of fat in the body (Ruilope et al. 2018). Diet plays an extremely significant role in the development of both obesity and hypertension and is also responsible for diabetes. In addition, unhealthy lifestyles such as drinking, smoking, eating junk, mental stress are reasons for obesity and the development of hypertension as well (Bhupathiraju and Hu, 2016) Activity in “Sympathetic Nervous System (SNS)”, “hyperlipidemia”, and hormonal imbalance in obese people cause sodium retention in the body which results in increased water absorption. All these factors are directly related to hypertension in obese people (Jiang et al. 2016). Furthermore, these are significant contributors to renal disorders as well. The RAAS system of the body, also known as the "Renin-angiotensin-aldosterone system" is the regulator of renal BP.
The imbalance of these three hormones happen in chronic kidney diseases where the body is unable to maintain the osmotic pressure, sodium retention is more and at the same time, water re-absorption is high that resulting in high osmotic pressure (Te Riet et al. 2015). The vice versa condition occurs as well where high blood pressure leads to kidney damage. Over time high BP damages the arteries responsible for filtering the blood and production of urine. The blood that comes into the kidney is the source of oxygen and nutrients and when blood vessels get narrower sufficient amounts of both of these cannot reach the kidney that making the kidney unable to function properly. This causes the restricted secretion of aldosterone and increased BP. Accumulation of fat in the intima of the blood vessels give rise to atherosclerosis restricts the blood flow and gives pressure to arteries and results in hypertension (Johnson et al. 2018). Therefore, it can be said that hypertension is not just a cause of a single factor rather a complex interaction of several factors.
The Kempner’s diet, popularly known as the rice fruit diet, is best for patients suffering from hypertension. However, the DASH diet or “Dietary Approach to Stop Hypertension” is considered to be best for controlling BP in hypertensive people (Siervo et al. 2015). Before elaborating mentioning the DASH diets some general dietary modifications are discussed at first.
The energy intake must be carefully monitored especially for obese people. Hence it is prescribed that sedentary people should not consume more than 25 kcal/kg IBW (Ideal body weight). Alcohol consumption is strictly prohibited in this case. Good quality protein sources such as fish, poultry, and egg whites must be consumed instead of red meat. This is because red meat is high in saturated fat which enhances the probability of excess fat accumulation in the body and the blood vessels as well. Vegetarians can consider eating toned or skimmed milk, milk products, and legumes as sources of protein (Mills et al. 2020). 60g protein or 1g/kg IBW is suitable to avoid giving excess burden to kidneys.
In addition, 20g vegetable oil rich in “PUFA (Polyunsaturated fatty acid)” or “MUFA (Monounsaturated fatty acid)” is permitted as hypertensive patients are prone to CVDs as well. PUFA, specifically “omega-6 fatty acids” are responsible for decreasing bad cholesterol by reducing "LDL (Low-Density Lipoprotein)", "VLDL (Very Low-Density Lipoprotein)", “triglycerides'' etc. which accumulate fat to other body tissues from the liver. The MUFA, and “omega-3 fatty acids” does the same function and in addition, it enhances "HDL (High-Density Lipoprotein)" in the blood that scavenges excess fat from tissues and transfers all of them to the liver. Therefore, lipid modification in diet can help a hypertensive patient not to develop further complications such as CVDs. The main component of the “Mediterranean diet” is fish which is rich in omega-3 fatty acids too, beneficial for hypertensive patients in many ways (Kharazmi-Khorassani et al. 2021). Other than that, it is advised to consume easily digestible carbohydrates to manage BP.
Sodium restricted diet is the main modification in diet to avoid excess intravascular blood volume, cardiac output, and most importantly elevated BP. Moderate sodium restriction of 2-3g/day can help to reduce BP by 6-10 mm-hg/dl. Therefore, it is advised to restrict sodium and decrease the overall sodium-potassium ratio to avoid other associated complications of hypertension. Studies say that potassium plays a crucial role in a complex interplay between sodium, calcium as well as magnesium of all living cells. The risk of strokes decreases significantly with the increased amount of potassium intake in CVD patients. Hence, intake of food high in potassium is suggested to maintain the BP and avoid stroke.
The principles of this diet are the consumption of high amounts of fruits and vegetables along with low amounts of complex carbohydrates which are present in green leafy vegetables. Other than that inclusion of fish rich in omega-3 fatty acids, reduction of saturated fat in the diet, elimination of trans-fat and restricted consumption of sodium are principles of the DASH diet. Low-fat milk is a good replacement for animal meat to meet the protein demands without elevating lipid levels in the blood (Rebholz et al. 2016)).
Regular physical activity such as exercise is beneficial for hypertensive patients to control their high BP. Aerobic exercises are proven to be beneficial to improve heart strength and blood volume which are responsible for reducing excess burden and workload of the heart. The blood circulation gets improved as well with regular aerobic exercises. The systolic, as well as diastolic BP, get reduced by 5-7 mm-hg for hypertensive patients doing regular exercises in middle-aged males (Hegde and Solomon, 2015). In addition, exercise elevates HDL levels in blood creating a more favourable ratio of HDL to LDL. The oxygen-carrying capacity of blood improves with exercise that ensures the supply of sufficient oxygen to organs such as heart and kidney. The probability of development of renal disorders gets reduced significantly. Moreover, regular physical activities increase lipoprotein lipase concentration which in turn decreases "CHD (Coronary Heart Disease)" risks. However, the responses to exercise are different in people belonging to various ages, sex, as well as ethnicity. The responses differ depending on the type of exercise done, genetic and environmental factors. It is beneficial in improving insulin resistance as well.
People suffering from hypertension must follow some of the guidelines in order to reduce their high BP. As mentioned earlier, consumption of a low sodium diet is necessary to ensure maintaining the normal BP. Some of the richest sources of sodium must be reduced if possible eliminated from the diet for better outcomes. Common salt used in cooking must be restricted as much as possible depending on the type of hypertension. MSG or monosodium glutamate frequently used in restaurants as a taste enhancer is rich in sodium and hence must be avoided. Canned foods, pickles, chips, sauces, ketchup, etc. are some of the highly salted food items that are recommended to avoid for patients suffering from hypertension.
Cheese, peanut butter, salted butter, marine fish, shellfish, ready-to-eat as well as ready-to-cook food like instant noodles, prepared mixes, etc. are high in sodium and so, if hypertensive patients continue to eat all these this condition will certainly proceed to development of other CHDs. Biscuits, cakes, pastries, bread etc are highly salted as well and rich in trans fat that may worsen the condition in the long run. In order to restrict sodium intake, vegetables low in sodium should be chosen in a regular diet. Moreover, fruits high in potassium can be included in the regular diet.
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