Normal and Therapeutic Nutrition

Normal and Therapeutic Nutrition 3(2+1)

Lesson 28:Hypertension – causes, symptoms and dietary management

Diet management

Earlier Kempner's rice fruit diet was suggested for hypertension. This diet is very restrictive, deficient in many nutrients.

1. Energy An obese patient must be reduced to normal body weight with low calorie diet. About 20 k cal/kg of ideal body weight are prescribed for a sedentary worker and 25 k cal/kg of body weight for moderately active worker. Alcohol consumption should be reduced.
2. Protein A diet of 60g protein is necessary to maintain proper nutrition. In severe hypertension, protein restriction to 20g as advocated by Kempner may be necessary as a temporary measure since protein foods are rich in sodium.
3. Fats As they are prone to atherosclerosis, it is advisable to avoid a high intake of animal or hydrogenated fat. About 20g vegetable oil is permitted.
4. Carbohydrate Easily available carbohydrate is of great help in the management of high blood pressure.
5. Sodium Increased intake of sodium in diet leads to increased intravascular volume and thus increases cardiac output, elevating blood pressure. And at the cellular level, increased intracellular sodium is exchanged for increased intracellular calcium with its potent effects of augmented vascular tone and vascular hypertrophy with resulting persistent hypertension. Restricted sodium and a decrease in the sodium/potassium ratio in the diet is preferred. Moderate sodium restriction 2-3 g/day reduces diastolic pressure 6-10 mm of Hg and enhances the blood pressure lowering effect of diuretic therapy. American Heart Association prescribed 2g for mild and 1g sodium for moderate levels. Recent studies have shown that sodium restriction accompanied by weight reduction can effectively control mild or moderate arterial blood pressure. Pregnant women with toxemia need a moderate rather than low salt intake. Restrictions for a moderate low sodium diet of 1000 mg.
6. Potassium's role in hypertension is actually the result of a complex interplay with sodium, calcium and magnesium found in all living cells and in blood. For example, low levels of potassium cause the body to retain sodium and water and this can elevate blood pressure. Research suggests that the risk of stroke, a common consequence of high blood pressure, relates inversely with the amount of potassium in the diet and the lowest risk is among the high potassium low sodium group. Daily requirement of potassium is 3500 mg/day. Fruits and vegetables should be taken liberally to meet potassium requirement.