Elsevier

Cardiology Clinics

Volume 20, Issue 2, May 2002, Pages 249-263
Cardiology Clinics

Nondrug interventions in hypertension prevention and control

https://doi.org/10.1016/S0733-8651(01)00003-0Get rights and content

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Salt intake

The required daily intake of sodium (Na) in the human diet is estimated as 8 to 10 mmol, which is equivalent to approximately 500 mg of sodium chloride (NaCl), the principal form of sodium [4]. Under stable homeostatic conditions, sodium intake (essentially from intrinsic food content and additives in food processing, preparation, and consumption) and sodium loss (almost entirely through urinary excretion and perspiration) are in balance, and the intracellular and extracellular concentrations

Overview of the research

The National Heart, Lung, and Blood Institute (NHLBI) Workshop on Sodium and Blood Pressure, which convened January 28–29, 1999, resulted in a balanced, up-to-date, readily accessible, and well-referenced review that appeared in both the journal format and, in somewhat extended form with additional references, on the NHLBI Web site [5]. Another current review can be found in the Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2000, published by the

Current policies

Existing policies on sodium intake provided by Shiriki Kumanyika as a personal communication are presented in Table 1. Countries listed in the main body of the table were known as of 1999 to have had specific quantitative targets for sodium intake: Japan, the USA, The Netherlands, the Nordic countries, Singapore, and China. Eleven other countries, shown in the footnote, were known to have policies calling for reduced sodium intake but without quantitative goals.

In 1983, the World Health

Summary—salt intake

The body of evidence now available, including results of the most recent trials of dietary change and their effects on BP in persons with and without hypertension—African-Americans and whites, men and women—supports the conclusion that policies to reduce sodium intake in most populations should be more widely adopted and implemented. Specific guidelines have been accepted in several countries. The USDA's Dietary Guidelines for Americans allow for more than 10 times the daily requirement of

Other dietary factors

Most studies on the impact of individual nutritional factors on cardiovascular disease and hypertension have yielded equivocal results [18], [19], [20], [21], [22] including studies of fish oil, fiber, fat, isoflavonoids, caffeine, green teas, protein, antioxidants, and micronutrients and macronutrients. These studies have suffered, however, from being too short for an effect to appear, having a small sample, and other methodologic flaws. Furthermore, the effects of individual nutrients may be

Alcohol consumption

The public health community has been concerned for a long time about the widespread habitual consumption of alcohol and the relationship of this habit to the immense global burden of HBP and of consequent cardiovascular conditions such as CHD, heart failure, and stroke. Alcohol consumption has paradoxic effects on the cardiovascular system, however, with a J-shaped risk profile for alcohol intake reflecting the protective effect of small amounts of alcohol against coronary atheroma. This

Physical activity

The American public is generally knowledgeable about the benefits to cardiovascular health of undertaking exercise and other lifestyle modifications that have been promulgated through published guidelines, health promotion efforts, and medical advice. Even so, only about one fourth of US adults meet recommended levels of physical activity [39]. The benefit of physical activity to the primary prevention of hypertension has been shown by both clinical trials and longitudinal studies [40], [41],

Obesity

The increasing prevalence of obesity in the United States has become widely recognized in recent years. More than one third of the adult population is currently obese (BMI of >30 kg/m2) and its prevalence increased 40% from 1980 to 1990 [56]. Some claim that obesity is the most important modifiable risk factor for hypertension [54]. In the Nurses' Health Study, excess body weight, alcohol consumption, and older age were strong predictors of incident and prevalent hypertension [26]. In addition,

Cigarette smoking

Smoking interpedently raises BP, although epidemiologically the relationship between smoking and hypertension is often confounded by factors associated with both. Higher alcohol intake and lower consumption of fruits and vegetables are more often found in smokers than nonsmokers, and these both are associated with hypertension. Lower BMI is frequently found in smokers [72]. Even in long-term tobacco users, each cigarette raises BP [73]. Frequent smokers can have a sustained rise in BP, as shown

Stress reduction and biofeedback

The role of stress in the development and maintenance of hypertension is unsettled. Some evidence of a link has accumulated in findings that job stress in particular may lead to long-term BP elevation [33]. For example, in a longitudinal study of job strain and ABP among 215 men, an effect on SABP of cumulative past exposure to job stress plus current exposure was shown [75]. Those with 50% of their employment lifetime (average: 25 years) exposed to job strain as well as current job strain had

Summary

This review was undertaken to address the relation of various factors to HBP and their potential for preventing and controlling this widespread problem. With respect to salt intake and BP, the 1999 Workshop on Sodium and Blood Pressure of the (US) National Heart, Lung, and Blood Institute [5] will serve the reader well as a point of departure. The body of the present review provides more detailed discussion especially of recent epidemiologic research, including the DASH-Sodium trial, published

Acknowledgements

The authors are grateful to Dr. Shiriki Kumanyika for providing information on national guidelines for sodium intake and other information contributing to this review.

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