Dietary, lifestyle factors affect hypertension levels

By Grace Segran

DENPASAR, Bali (JP): Did you know that what you eat and what you do play a major role in determining whether you get hypertension or not?

Speaking at the first meeting of the Asian-Pacific Society of Hypertension in Bali recently, Professor Lawrie Beilin from the University Department of Medicine and the West Australian Heart Research Institute at the Royal Perth Hospital in Western Australia said, "There is now abundant evidence that dietary and lifestyle factors critically determine an individual's blood pressure level and the prevalence of hypertension in populations."

He added that it was estimated that some 80 percent of patients currently diagnosed with hypertension had a preventable disorder.

Dr. Ashikin Hanafiah, the professor of cardiology at the University of Indonesia and chairman of the medical board of the Harapan Kita Cardiac Center in Jakarta, said it was estimated 15 percent of adults in Indonesia aged 25 years and above suffer from hypertension.

Normal blood pressure is 130/80mmHg and any reading higher than the borderline of 140/90mmHg constitutes hypertension, said Ashikin.

Ashikin warned that hypertension could affect other organs as well. The areas that we need to keep a careful eye on if we suffer from hypertension are the eyes, brain, heart, kidney and peripheral arteries.

Hypertension is one of the major risk factors for coronary heart disease and the biggest single factor influencing stroke. "Given the burden of heart disease and stroke, it is vital to increase awareness of current evidence offering opportunities for better prevention and management of hypertension," said Beilin.

Beilin said excess body fat remains the biggest single factor related to blood pressure elevation and hypertension. Weight reduction trials have shown clear reductions of blood pressure with weight loss as little as five kilograms.

The effects on weight loss can be enhanced by simultaneously increasing physical fitness, reducing alcohol consumption, reducing salt intake and by regular dietary consumption of fish.

"Randomized trials combining these various measures have been shown to reduce blood pressure by 10-15mmHg systoles in treated or untreated hypertensives, with effects as great as those seen with antihypertensive drug therapy," said Beilin.

The benefits of weight control extend beyond those with just blood pressure reduction. It also results in a general reduction in your risk of getting heart disease due to improvements in lipid profile, glucose tolerance, a reduced cardiac load and heart rate.

The effects of alcohol on hypertension are well-documented but are still generally underestimated by the medical profession. From a study of 20 44-year-old working men, it was estimated that some 70 percent of hypertension cases could be prevented by moderating alcohol to below 2 standard drinks per day and controlling weight and obesity.

Doctors tend to be ambivalent over alcohol because of the bivalent effect of alcoholic beverages on cardiovascular disease. However, it is important to note that the lowest mortality rates occur in people drinking one standard drink per day or none at all.

"Vegetarian diets characterized by a relatively low-saturated fat intake and a high consumption of fruit, vegetables and fiber have been shown to be associated with low blood pressure," said Beilin.

The recently published DASH study from the United States involved 459 mildly hypertensive subjects who either continued their normal diet, increased fruit and vegetable consumption or combined the latter with a reduction in total and saturated fat intake and increased low fat milk consumption.

Consumption of lean meat and fish were encouraged.

The largest blood pressure reduction of 5.5 to 3mmHg was seen in those on the combined diet, while those increasing only fruit and vegetables showed a fall in blood pressure of 2.8 to 1.1mmHg. The study demonstrates how dietary changes which could be acceptable to the general population are likely to achieve significant blood pressure control.

"High salt intake remains a major contributor to hypertension, especially when potassium is low," said Beilin. He also added that smoking has a dominant effect in increasing the cardiovascular risk in hypertensives.

In practice, many lifestyle factors operate in concert and have additive or interactive effects. "Moreover, people tend to demonstrate a clustering of unhealthy habits," said Beilin. For example, heavy smokers are more prone to drinking heavily, eating more saturated fat, adding salt to their food and being physically inactive. Risk factors are also more common among the lower socioeconomic group.

What can we do then to ensure our blood pressure remains at an acceptable level? Ashikin advocates that we follow the Indonesian Heart Foundation's slogan S.E.H.A.T. (health). The acronym stands for: seimbang gizi (balanced nutrition), enyahkan rokok (kick the smoking habit), hindari stress (avoid stress), awasi hipertensi (beware of hypertension and to have blood pressure checked regularly) and Teratur olahraga (exercise regularly).

Hence, it seems that our best bet against hypertension is also the cornerstone for staying healthy: eat a balanced diet with lots of fruit and vegetables; go easy on the fat, salt and alcohol; stop smoking; avoid stress; exercise regularly and reduce excess body fat.