DIET FOR HYPERTENSION

INTRODUCTION:

• Hypertension is defined as a condition in which there is an elevation of systemic arterial pressure above a certain threshold value.
• BP is commonly expressed as the ratio of systolic BP(pressure exerts on the arterial walls when the heart contracts) and the diastolic BP(the pressure when the heart relaxes)
• It can be caused by unhealthy lifestyle habits like alcoholism, drug addiction, smoking, high stress, and non modifiable attributes like age, gender, hereditary and genetic constitution  and racial or ethnic disparities.

CLASSIFICATION OF BP:

                              

CATEGORY	SYSTOLIC (mmHg)	DIASTOLIC(mmHg)
Optimal	<120	<80
Pre-Hypertension	120-139	80-89
Stage 1	140-159	90-99
Stage 2	160-179	100-109
Stage 3	>180	>110

PATHOPHYSIOLOGY:

Cardiac output & peripheral resistance :

Maintenance of normal BP depends on cardiac output & peripheral vascular resistance. Most patients with hypertension have a normal cardiac output but a raised peripheral resistance.

Renin-Angiotensin Aldosterone System:

It is an endocrine system that regulates blood pressure and fluid and electrolyte balance as well as systemic vascular resistance.

Autonomic nervous system:

Sympathetic nervous system stimulation can cause both arteriolar  constriction & arteriolar dilatation. Thus the autonomic nervous system has an important role in maintaining a normal blood pressure. It is also important in mediating short term changes in blood pressure in response to stress and physical exercise.

Endothelial dysfunction:

vascular endothelial cells play a key role in cardiovascular regulation by producing a number of local vasoactive agents including vasodilator molecule nitric oxide and vasoconstrictor peptide endothelin. Dysfunction of endothelium has been implicated in hypertension.

PGI2-Prostacyclin, eNOs-endothelial nitric oxide synthase, ET-1=Endothelin 1 
 SMC- Smooth Muscle Cells

Vasoactive Substances:

Many other vasoactive systems and mechanisms affecting sodium transport and vascular tone are involved in the maintenance of a normal blood pressure.

it includes bradykinin, endothelin, and atrial natriuretic peptide.Any changes in these substances causes elevation of blood pressure.

NATUROPATHIC INTERVENTION:

AIM:

• To reduce the high blood pressure.

• To prevent the complications.

• To reduce the mortality (death) rate.

• To improve the quality of life.

DIETARY COMPONENTS:

DASH DIET:(Dietary Approach to Stop Hypertension)

• It was formulated by US National Institute Of Health.

• It is a flexible and balanced eating plan that helps in lowering blood pressure. 

• This diet is rich in fruits, vegetables, whole grains and low fat dairy products.

• It is limited in sugar sweetened foods and beverages red meat and added fats.

• DASH eating pattern promotes blood pressure reduction by encouraging the consumption of foods that are low in saturated fat, total fat, cholesterol and sodium and high in potassium, calcium, magnesium, fiber and protein.

Serving guidelines for a patient following DASH diet is as follows:

1. Vegetables: about 5 servings/ day
2. Fruits: about 5 meals/day
3. carbohydrates: about 7 servings/day
4. Low fat dairy products: about 2 servings/day
5. Lean meat products: about 2 or fewer servings/day
6. Nuts and seeds: 2 to 3 times/week

FRUITS & VEGETABLES:

1. POMEGRANATE JUICE:

• contains phytochemicals and polyphenols.

• reduces blood pressure via inhibition of angiotensin converting enzyme(ACE).

2. ORANGE & GRAPEFRUIT JUICE:

• Helps in reducing both systolic & diastolic blood pressure due to its high polyphenolic content.

3. GARLIC:

• It contains Allicin (a sulphur compound) inhibits Angiotensin II.

• It causes smooth muscle relaxation.

• It promotes vasodilation via the production of nitric oxide(a potent vasodilator).

4. CUSTARD APPLE:

• The leaf extract of the plant has been reported to lower an elevated blood pressure by decreasing peripheral vascular resistance.

5. BLACK BEAN:

• It contains saponins  & medicogenic acid glucoside.

• It has been reported to cause fall in systolic as well as diastolic blood pressure.

6. KARPURAVALLI:

• It  contains coleonol (a diterpene).

• It has a positive inotropic effect. 

• It causes vascular smooth muscle relaxation.

7. CARROT:

• It contains coumarin glycosides which causes blockade of calcium channels and thereby results in smooth muscle relaxation.

8. TOMATO:

• It contains carotenoids such as lycopene, beta carotene and Vitamin E which are known as effective antioxidants.

• It reduces BP by more than 10 mmHg systolic and more than 5 mmHg diastolic pressure.

9. MURUNGAI:

• It contains thiocarbamate and isothiocyanate.

• Reduces Blood Pressure. 

10. BASIL:

• It contains Eugenol which blocks calcium channels and thereby reduces blood pressure by relaxing smooth muscles.

11. RADISH:

• It has cardiovascular inhibitory effects & it mediates through the activation of muscarinic receptors. 

• Reduces blood pressure.

12. COCOA BEAN:

• It is enriched with flavonoids.

• Stimulates the formation of nitric oxide which causes vasodilation & reduces endothelial dysfunction.

• Daily consumption of dark or milk chocolate 46 to 105 g daily providing cocoa phenols can lower systolic BP by about 5mmHg and diastolic BP by about 3mmHg.

  

13. BLACK PLUM:

• It contains kaempferol, ellagic acid, anthocyanins, glucoside & myrecetin.

• After oral administration, both systolic and diastolic BP were significantly reduced within 45 minutes & began to return normal after 2 hours.

14. GINGER;

• It contains gingerols, paradol, shogaols and other terpene compounds.

• It improves blood circulation and relaxes muscles surrounding blood vessels.

• It has BP lowering effect & it is mediated through blockade of voltage gated calcium channels.

• It reduces the formation of pro-inflammatory prostaglandins and thromboxane and thus lowering the clotting ability of the blood. 

15.WHEAT BRAN:

• increasing dietary wheat bran intake by 3 to 6 g/day modestly reduces systolic and diastolic BP. 

HERBS:

CORIANDRUM SATIVUM:

• Intake of 200-300 mg/kg inactivates reactive oxygen species (ROS) produced by 𝛃-adrenoreceptor stimulation and thereby reduces free radical induced oxidative damage to blood vessel.

HIBISCUS SABDARIFFA:

• 720 ml/day of tea for 6 weeks  reduces BP.

• Reduces free radical induced damage to blood vessels.

• reduces BP by up regulating nitric oxide production (vasorelaxant effect), by inhibition of calcium channels and opening of K ATP channels.

GREEN TEA:

• It contains epigallacto catechin gallate (EPCG), chlorogenic acid, theogallin, theanine and coumarylquinic acid. 

• 120 ml/day significantly reduces the risk of developing hypertension.

• epicatechin improves impaired endothelium dependent relaxation response to acetylcholine.

• it also induces a decrease in endothelin-1 release, systemic and vascular oxidative stress & inhibition of NADPH oxidase activity.

DIETARY FIBER:

• A meta-analysis of 40 randomized controlled trials reported that increase in fiber intake by 14 g/day reduces systolic BP by about 1.6mmHg and diastolic BP by about 2.0mmHg.

SEEDS:

SESAME SEEDS:

• It contains sesamin, sesaminol.

• It remarkably reduces oxidative stress & simultaneously increases glutathione peroxidase, super oxide dismutase and catalase activities.

• Reduces blood pressure.

FLAX SEEDS:

• It contains 𝜶-linolenic acid (omega-3 fatty acids).

• Helps in reducing serum cholesterol, platelet aggregation, & inflammatory markers.

• Daily consumption of 15 to 50 g/day of ground flaxseed can modestly reduce total cholesterol & low density lipoprotein concentration.

SPICES:

 CINNAMON:

• It increases the production of endogenous  nitric oxide  and thereby exhibits a vasorelaxant effect.

PEPPERS:(RED,YELLOW,PAPRIKA)

• It contains capsaicin which decreases the release of calcitonin gene-related peptide from myocardial C fibers.

• it exerts a strong inhibitory effect on angiotensin converting enzyme(ACE).

BLACK PEPPER:

• It contains piperine which normalizes blood pressure via blockade of voltage-dependent calcium channels.

TURMERIC:

• It contains curcumin which maintains blood vessel elasticity & reduces bloods pressure.

TRACE ELEMENTS:

COPPER & ZINC:

• Helps in maintaining blood pressure.

MAGNESIUM: 

• It reduces blood pressure by modulating vascular tone & reactivity.

SODIUM:

• Dietary salt intake has impact on blood pressure.

• it should be limited to reduce the risk of hypertension.

• American Heart Association Guidelines suggest that restriction of sodium intake to 1.5 g/day helps in reducing blood pressure.

POTASSIUM:

• Recommended potassium intake for adults is 4.7 g/day.

• helps in reducing blood pressure.