Managing Cardiometabolic Risk

Reducing blood pressure

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There is wealth of evidence tying salt (sodium chloride) intake to high BP. Accordingly, lowering salt intake can prevent hypertension in non-hypertensive individuals, lower blood pressure in conjunction with antihypertensive medication, and facilitate hypertension control (9, 21-23). Reducing sodium intake by 1.8 g per day (roughly 2/3 teaspoon of table salt) or limiting average daily consumption to 2.3 g (1 teaspoon of table salt) can significantly reduce systolic and diastolic BP (21-23).
Several scientific dietary reports and guidelines currently advocate the Dietary Approaches to Stop Hypertension (DASH) diet for preventing and treating BP in individuals with and without hypertension (5, 7, 21, 23-26). The DASH trial showed that a diet that emphasizes vegetables, fruits, low-fat dairy products, whole grains, poultry, fish, and nuts, and limits the amount of red meat, sweets, sugar-containing beverages, total fat, saturated fat, and cholesterol can substantially lower mean systolic BP by 7.1 mm Hg in people without hypertension and by 11.5 mm Hg in people with hypertension (21, 22). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends weight reduction, which may reduce systolic BP by 5 mm Hg to 20 mm Hg per 10 kg weight loss. It also recommends adopting the DASH diet and limiting daily dietary sodium intake to no more than 100 mmol or 2.4 g sodium or 6 g sodium chloride (one teaspoon of sodium chloride = 2.4 g of sodium) (27). 

The Canadian Hypertension Education Program has proposed lifestyle and dietary modifications in order to prevent and/or treat hypertension. These recommendations are as follows: 30 to 60 minutes of aerobic exercise per day, achieving and maintaining an ideal body weight and waist circumference, limiting alcohol intake, reducing total fat and cholesterol intake, and limiting salt consumption (28). 

Reference

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5. Krauss RM, Eckel RH, Howard B, et al. AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation 2000; 102: 2284-99.

7. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. 2000; 1-94.

9. Lichtenstein AH, Appel LJ, Brands M, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 2006; 114: 82-96.

21. Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 1997; 336: 1117-24.

22. Vollmer WM, Sacks FM, Ard J, et al. Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial. Ann Intern Med 2001; 135: 1019-28.

23. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001; 344: 3-10.

24. Lauber RP and Sheard NF. The American Heart Association Dietary Guidelines for 2000: a summary report. Nutr Rev 2001; 59: 298-306.

25. Svetkey LP, Sacks FM, Obarzanek E, et al. The DASH Diet, Sodium Intake and Blood Pressure Trial (DASH-sodium): rationale and design. DASH-Sodium Collaborative Research Group. J Am Diet Assoc 1999; 99: S96-104.

26. Zemel MB. Dietary pattern and hypertension: the DASH study. Dietary Approaches to Stop Hypertension. Nutr Rev 1997; 55: 303-5.

27. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 2560-72.

28. Khan NA, McAlister FA, Lewanczuk RZ, et al. The 2005 Canadian Hypertension Education Program recommendations for the management of hypertension: part II - therapy. Can J Cardiol 2005; 21: 657-72.

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