Nutrition , Diet , and

Hypertension

Endang Purwaningsih
 Introduction
 1971-1991 NHES: trend of blood pressure
levels & prevalence of hypertension in USA ?
Adoption of healthier lifestyles may have
contributed to this favorable trend
 1991-2000the prevalence of hypertension in
US increased by 3.7%
 -“-  major risk factor for CVD
 ~ 58 million people in the US have ↑ BP
systolic > 140 mmHg; diastolic > 90 mmHg
taking antihypertension medications
Blood pressure – associated risks ensue incrementally and
progressively over a wide range of blood pressure levels and
a critical value of
 blood pressure above which persons are classified as
“hypertensive” is arbitrary
 Among normotensive persons, blood pressure level is
predictive of morbidity and mortality from stroke,
heart disease, and renal impairment
 30-40% of all blood pressure-related cardiovascular
disease events occur in persons with average blood
pressure lower than currently defined defined
hypertensive levels but > 120/80 mmHg
A recent consensus report recommended that the
goal blood pressure levels at < 140/90 mmHg

 However in patients with hypertension and

diabetes or renal disease, the goal blood
pressure of 120 to 139 mmHg or for diastolic
blood pressure of 80 to 89 mmHg should be
considered “pre-hypertensive” and require
health-promoting lifestyle modifications to
prevent cardiovascular disease
Specific nutrients and interactions among nutrients
influence blood pressure

 Fig 68.1 hal 1096

Genetic influence within a population, overall
blood pressure responses to NaCl restriction may
mask individual variability

 Experimental models of hypertension and increasing

information in the human provide convincing
evidence for genetic susceptibility and genetic
resistance to the effects of dietary NaCl on arterial
blood pressure
 In human  a familial resemblance in the change of
blood pressure in response to salt restriction has been
described, and a phenotype of haptoglobin may be a
marker of NaCl sensitivity
Obesity  indicated a direct linier correlation
between body weight or BMI and blood pressure

 Insulin resistance
 obesity is associated with resistance to
insulin-stimulated glucose uptake and
hyperinsulinaemia; and weight loss increases
insulin sensitivity
  population studies : approximately 25-50%
nonobese, nondiabetic hypertensive persons
Higher insulin levels have been reported to be
associated with an increased risk of hypertension in
African Americans and whites
 Potassium
 Potassium loading prevents or ameliorates
development of hypertension in several animal
models of genetic and NaCl –induced
hypertension
 Conversely, in Dahl_R and Dahl-S rats on a
high-NaCl diet, low potassium intake results in
blood pressure elevation and renal vascular
remodeling that indicating increased renal
vascular resistance
Dietary potassium may effect morbidity and
mortality, independent of an effect on blood pressure

 Unrelated to changes of blood pressure, a

high-potassium diet was reported to decrease
stroke mortality and to decrease renal damage
in several rat models of hypertension
 In prospective clinical study  in the 12-year
risk of stroke death was associated with
potassium intake, independent of blood
pressure
In Japan  introducing a diet with a low
sodium-to-potassium ratio was associated
with reduced 10 year stroke mortality rate
 Calcium
 80 studies have reported that blood pressure is
lowered by increasing dietary calcium in
experimental models of hypertension
 This effect of calcium on blood pressure may
be more pronounced in models of salt-
sensitive hypertension
Within and among population  “ there is inverse
association between dietary calcium intake and
blood pressure, and low calcium intake is associated
with an increased prevalence of hypertension”

 Epidemiologic reports and animal studies

suggest a threshold for calcium intake below
which arterial pressure increases, and low
calcium intake may amplify the effects of a
high-NaCl diet on blood pressure
 In human, diets < 600 mg Calcium/day are
most clearly associated with hypertension
Magnesium relatively little information
High Mg intake lowers blood pressure in rat models
of hypertension: and in rat, blood pressure increases
in response to Mg deprivation
 In human, as with calcium, evidence suggests
an association between lower Mg in diet and
higher blood pressure
 Alcohol
 The contribution to the prevalence of hypertension
attributed to consuming more than two drinks of
alcohol per day has been estimated to be 5 to 7 %
 The contribution men > women; although in
women the risk of hypertension increased
progressively with alcohol intake in excess of 20
g/day

 In controlled studies reduction pf alcohol

consumption has been associated with
reduction of 4-8 mmHg in systolic blood
pressure and lesser reduction of diastolic
pressure
 The mechanism by which alcohol may affect
blood pressure has not been established
LIPIDS
 In animal and human  polyunsaturated n-3
and n-6 fatty acids play a role in blood
pressure regulation
 Experimental models of hypertension 
linoleic acid ( a long-chain n-6
polyunsaturated fatty acid) and fish oil (rich in
eicosapentanoic & docosahexaenoic acids both
n-3 fatty acids) attennate the development of
renin-dependent hypertension
Epidemiologic evidence
 a direct association between diets high in
saturated fats & blood pressure
 population with low mean blood pressure levels
consume diets low in total fat and saturated fatty
acids

Diet high in n-3 fatty acids may be associated with

lower blood pressure
Linoleic acids-enriched diets reduce blood pressure in
nornotensive & hypertensive persons
31 trial  statistically significant reduction of blood
pressureby fish oil ( 3.0/1.5 mmHg)
In hypertensive patients  dose-response
hypotensive effect of fish oil
In healthy normotensive persons  little or no
hypotensive effects of fish oil

  conclusion :
 *fish oil is unlikely to benefit healthy person for the
prevention or treatment of hypertension, given the
uncertainty of response and large dose required to
elicit small changes in blood pressure
 *fish oil in doses that reduce blood pressure in
hypertensive persons does not adversely affect insulin
sensitivity or glucose metabolism
Protein
 Intersalt study: blood pressure level is inversely
associated with dietary protein and fiber
consumption
 specific amino acids could effect
neurotransmitters or humoral substances that
control blood pressure
e.g : tryptophan or tyrosine
 Carbohydrate
 Simple carbohydrate feeding induces insulin
resistance
 High dietary intake of glucose, sucrose, and fructose
may increase arterial pressure in the normotensive
animal  may augment NaCl sensitivity of blood
pressure  potentiate development of hypertension
in several experimental models
*Prevention of obesity, beginning in childhood,
would seem important for the primary prevention of
hypertension and cardiovascular disease
*several trial  the efficacy of preventing
hypertension in adults through altered dietary
intake

 Reduce NaCl intake; control body weight;

consume adequate amounts of potassium;
calcium and magnesium; and moderate
alcoholic beverage intake

 See leaflet  Diit rendah garam !!