Part 3 Non pharmacological management

 

  Part   3. How do these diets actually work?

Both the Mediterranean diet and the Dietary Approaches to Stop Hypertension diet are relatively easy to adhere to and are palatable, high in fruit, vegetables, whole grains, nuts, and unsaturated oils ¹⁷ ; moreover, both minimize the consumption of red and processed meat, and are in accordance with dietary recommendations for cardiovascular health. The difference is that the Dietary Approaches to Stop Hypertension diet is more suitable for recommending a low sodium intake, ¹⁸ , ¹⁹ whereas this is not a feature of the Mediterranean diet. Second, it may well be that the Dietary Approaches to Stop Hypertension diet includes more proteins since it includes poultry and fish and emphasizes the consumption of free‐ or low‐fat dairy products (two or three servings per day). ¹⁸ , ¹⁹ In this regard, either a higher protein intake or protein supplementation has been shown to decrease BP. ²⁰ , ²¹ Concerning dairy products, in particular, the addition of conventional non‐fat dairy products to the routine diet has hypotensive effects. ²² Moreover, a recent systematic review has shown a favorable association between a higher dairy intake and a lower risk of hypertension. ²³ One of the reasons could also be the lower salt consumption associated with vegetables and fruits etc The Dietary Approaches to Stop Hypertension diet reduces high BP by lowering the amount of sodium in your diet to 2300 milligrams (mg) a day. Lowering sodium to 1500 mg a day reduces BP even more. It also includes a variety of foods rich in nutrients that help some people lower BP, such as potassium, calcium, and magnesium. The Mediterranean diet may mediate its effects in part through the maintenance of BP and endothelial function. ²⁴ The consumption of a diet that is high in fruit, vegetables, nuts, and unsaturated oils and low in sodium can lower BP. ²⁵ , ²⁶ In addition, a number of components of a Mediterranean dietary pattern have been shown to improve endothelial function. ²⁷

Intermittent Fasting is another method which can be implemented easily by the patients. There are two major subcategories of intermittent fasting: (a) fasting 1‐4 d per week, that is, alternate‐day fasting or the 5:2 diet [1]; or (b) fasting every day for a 14 to 20 h period, that is, time restricted feeding. ²⁸ Cardioprotective effects of the alternate‐day fasting diet are associated with a reduction of visceral fat tissue, increased adiponectin, decreased leptin and low‐density lipoproteins cholesterol. Intermittent fasting has also shown a beneficial effect on prevention of stroke. ²⁹ In 2018, Erdem et al, 2018 ³⁰ undertook a study with the Cappadocia cohort of 60 prehypertensive and hypertensives, where SBP was 120—139 and ≥ 140; DBP values were 80‐89 and ≥90 mmHg. A decrease in SBP (P < .001) and DBP values (P < .039) was observed. Intermittent fasting inhibits the development of atherosclerotic plaque by reducing the concentration of inflammatory markers IL‐6 (Interleukin −6),

homocysteine, and C‐reactive protein. ²⁰ Intermittent fasting increases brain‐derived neurotrophic factor (BDNF) resulting in lowering BP by activating the parasympathetic system. ³¹ , ³²

Ref

J Clin Hypertens (Greenwich). 2021 Mar 18;23(7):1275–1283. doi: 10.1111/jch.14236SODIUM MAGNESIUM AND POTASSIUM INTAKE

Non‐pharmacological management of hypertension

Narsingh Verma 1,✉, Smriti Rastogi 1, Yook‐Chin Chia 2, Saulat Siddique 3, Yuda Turana 4, Hao‐min Cheng 5, Guru Prasad Sogunuru 6, Jam Chin Tay 7, Boon Wee Teo 8, Tzung‐Dau Wang 9, Kelvin Kam Fai TSOI 

10, Kazuomi Kario 11