Nutritional management of hypertension: past, present, and future

1986 ◽  
Vol 64 (6) ◽  
pp. 836-839 ◽  
Author(s):  
Jacques Genest
Keyword(s):  
Blood Pressure ◽  
Sodium Intake ◽  
Water Hardness ◽  
Future Research ◽  
Nutritional Management ◽  
Small Magnitude ◽  
Unsaturated Fat ◽  
Low Sodium Diet ◽  
Alcohol Water ◽  
Fat Diets

A succinct overview of the nutritional management of hypertension, past, present, and future is presented. Prior to 1945, the low sodium diet and the rice–fruit diet were shown to be effective in reducing the blood pressure to normal levels in 35–40% of hypertensive patients. Between 1945 and the present, many studies were made on the effects of alcohol, water hardness, obesity, moderate restriction of sodium with increased potassium intake, increased dietary calcium, low animal and high unsaturated fat intake, and increased amounts of fiber in the diet. Criticisms are made of the very small magnitude, even if statistically significant, of blood pressure decreases and the too-short control periods in many instances, and also concerning the assumption of use of 24-h urinary sodium as an accurate index of the sodium intake, and of urinary creatinine as a physiological reference standard against the excretion of sodium. The author mentions, for possible future research, long-term studies of the effects of diets moderately restricted in sodium and high in potassium, of reducing weight and increasing physical activity in obese hypertensives, and of low animal and high polyunsaturated fat diets in patients with mild essential hypertension.

The Effect of a Reduced Sodium Intake on Post-Renal Transplantation Hypertension in Rats

1984 ◽  
Vol 66 (3) ◽  
pp. 269-276 ◽  
Author(s):  
M. H. De Keijzer ◽  
A. P. Provoost ◽  
E. D. Wolff ◽  
W. J. Kort ◽  
I. M. Weijma ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Sodium Intake ◽  
Plasma Renin ◽  
Normal Diet ◽  
Transplant Recipients ◽  
Plasma Renin Concentration ◽  
Sodium Diet ◽  
Low Sodium Diet ◽  
Low Sodium

1. In an experimental model of post-renal transplantation hypertension in rats, we studied the effect of a reduction of sodium intake on the development of this type of hypertension. 2. Systolic blood pressure, plasma- renin concentration and renal function were measured regularly in recipients of an allogeneic kidney transplant that had previously undergone active immunological enhancement. 3. Transplant recipients on a normal diet showed a rise in systolic blood pressure during the second week after transplantation. The systolic blood pressure of recipients on a low sodium diet remained normotensive throughout the 15 weeks follow-up period. 4. The plasma renin concentration was low in the hypertensive recipients on a normal diet, as compared with unilaterally nephrectomized controls. Although the plasma renin concentration of recipients on a low sodium diet fell below that of unilaterally nephrectomized controls on a low sodium diet, it was higher than that of recipients on a normal diet. 5. The renal function of transplant recipients was greatly reduced compared with that of control rats. The glomerular filtration rate was reduced to a greater extent than the effective renal plasma flow. 6. In a separate experiment it was revealed that a similar reduction in the glomerular filtration rate of kidneys permanently damaged by temporary ischaemia did not result in an increase in the systolic blood pressure. 7. Survival up to 6 weeks after transplantation was the same for both groups of recipients. Recipients on a low sodium diet, however, showed a better 15 weeks survival, probably owing to the absence of hypertension in this group. 8. The prevention of the development of hypertension by means of a reduction of sodium intake, points to an involvement of sodium retention in this post-transplantation hypertension model.

scholarly journals A Novel Just-in-Time Contextual Mobile App Intervention to Reduce Sodium Intake in Hypertension: Protocol and Rationale for a Randomized Controlled Trial (LowSalt4Life Trial) (Preprint)

2018 ◽  
Author(s):  
Michael P Dorsch ◽  
Lawrence C An ◽  
Scott L Hummel
Keyword(s):  
Blood Pressure ◽  
Sodium Intake ◽  
Controlled Trial ◽  
Mobile App ◽  
Just In Time ◽  
Grocery Stores ◽  
Randomized Controlled ◽  
Low Sodium Diet ◽  
Tailored Messages ◽  
Low Sodium

BACKGROUND High sodium intake is a significant public health problem in the United States. Interventions that lower sodium intake can decrease blood pressure and improve cardiovascular outcomes. Restaurants and grocery stores are prime targets for intervention with about 77% of all sodium intake in the average US diet coming from processed and restaurant foods. OBJECTIVE This study proposes that a mobile app intervention that promotes low-sodium alternatives at grocery stores and restaurants will reduce dietary intake of sodium and improve confidence following a low-sodium diet in hypertension. METHODS In this single-center, prospective, open-label study, patients will be randomized to a mobile app or usual care for 8 weeks. We will randomize 50 patients (age>18 years) diagnosed with hypertension and on antihypertensive therapy for at least 3 months in a 1:1 manner stratified by gender. Study subjects will receive the mobile app, LowSalt4Life, or usual dietary advice for 8 weeks. LowSalt4Life provides a multifaceted intervention based on just-in-time contextual tailored messages at grocery stores and restaurants. The primary endpoint is the change in the estimated 24-hour urinary excretion of sodium from spot urine. Secondary outcomes include change in the sodium content of the food frequency questionnaire, confidence in following a low-sodium diet, urine chloride and creatinine dipsticks, and blood pressure. RESULTS The project was funded in May 2016 until April 2018. This trial is currently enrolling patients. To date, 26 of the 50 patients needed have been enrolled. Results will be available in the Spring of 2019. CONCLUSIONS This randomized controlled trial will test the efficacy of just-in-time contextual tailored messages through a novel mobile app 8-week intervention on urinary sodium excretion in patients with hypertension. We will address a critical evidence gap in the care of patients with hypertension. If effective, this intervention could be scaled to assess effects on blood pressure and cardiovascular events in hypertension. CLINICALTRIAL ClinicalTrials.gov NCT03099343; https://clinicaltrials.gov/ct2/show/NCT03099343 (Archived by WebCite at http://www.webcitation.org/735HNzKlQ) INTERNATIONAL REGISTERED REPOR PRR1-10.2196/11282

Effects of Nifedipine during Low, Normal and High Intakes of Sodium in Patients with Essential Hypertension

1982 ◽  
Vol 63 (s8) ◽  
pp. 447s-450s ◽  
Author(s):  
Gloria Valdés ◽  
M. Eugenia Soto ◽  
Hector R. Croxatto ◽  
Teresa Bellolio ◽  
Ramón Corbalán ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Sodium Intake ◽  
Plasma Renin ◽  
Hypotensive Effect ◽  
Sodium Balance ◽  
Hypotensive Action ◽  
High Sodium ◽  
High Sodium Intake ◽  
Low Sodium Diet

1. Nifedipine (20 mg) was given by mouth to seven patients with moderate essential hypertension receiving a low, normal or high sodium intake. The drug produced an important hypotensive effect. Normal sodium intake enhanced the hypotensive action of the drug compared with that during the low and high sodium regimens. Blood pressure remained significantly lower 3 h after drug ingestion. 2. Increases in heart rate and plasma renin activity under all conditions reflected enhanced adrenergic activity. 3. A short-term natriuresis followed nifedipine ingestion in spite of increased aldosterone excretion during the low sodium diet and a decrease in urinary kallikrein during the low and high sodium diets. 4. Nifedipine increased urinary volume only during the high sodium intake. 5. Apart from vasodilatation, nifedipine induces important changes in neurogenic, renal and adrenal mechanisms that regulate blood pressure homoeostasis. Different conditions of sodium balance modulate most of these effects.

scholarly journals PENERAPAN ANJURAN DIET DASH DIBANDINGKAN DIET RENDAH GARAM BERDASARKAN KONSELING GIZI TERHADAP PENURUNAN TEKANAN DARAH PADA PASIEN HIPERTENSI DI PUSKESMAS LARANGAN UTARA

2021 ◽  
Vol 44 (1) ◽  
pp. 109-120
Author(s):  
Agustina Pungki Astuti ◽  
Didit Damayanti ◽  
Iskari Ngadiarti
Keyword(s):  
Blood Pressure ◽  
Nutritional Status ◽  
Diastolic Blood Pressure ◽  
Sodium Intake ◽  
Hypertensive Patients ◽  
Dash Diet ◽  
Sodium Diet ◽  
Low Sodium Diet ◽  
Low Sodium ◽  
Significant Difference

The low sodium and Diet Approaches to Stop Hypertension (DASH) are diets for reducing high blood pressure. This study aimed to analyze the effect of nutrition counseling on the DASH diet compared to low sodium diet on blood pressure in hypertensive patients. The study design was an experimental study that randomly allocated 34 respondents to DASH diet and 35 respondents to low sodium diet. The ages of respondents were 43 to 76 years and women were 74.3 percent. Nutrition counseling was conducted by researchers to respondents who visited health center or Posbindu Larangan Utara. Nutritional counseling was conducted for an average of 20 minutes using existing brochures. Low sodium diet emphasizes reducing sodium intake while DASH diet emphasis more on consuming lots of vegetables, fruit, nuts and low-fat products. Variables collected were the characteristics of respondent, disease, drugs taken and nutritional status, while blood pressure using a sphygmomanometer, food intake including sodium were measured before and 2 weeks after nutritional counseling. Results showed that there was a significant difference in diastolic blood pressure after patients were given DASH diet compared to low sodium diet (p 0.05) and there was a significant difference in delta of systolic and diastolic reduction in DASH diet compared to low sodium diet. Test also showed a significant reduction in systolic, diastolic blood pressure and sodium intake (p 0.001) in both diet groups after receiving counseling. It concluded that DASH diet can be recommended to decrease blood pressure in hypertensive patients with consider nutritional status. ABSTRAK  Diet Rendah Garam (RG) dan Diet Approaches to Stop Hypertension (DASH) adalah diet untuk menurunkan tekanan darah tinggi. Penelitian ini bertujuan untuk menganalisa pengaruh konseling gizi diet DASH dibandingkan diet RG terhadap tekanan darah pasien hipertensi. Rancangan penelitian adalah eksperimen yang secara acak mengalokasi diet DASH kepada 34 orang dan diet RG kepada 35 orang responden. Usia responden antara 43 hingga 76 tahun dan sebagian besar perempuan (74,3%). Konseling gizi dilakukan oleh tim peneliti kepada pasien hipertensi yang memeriksakan diri ke puskesmas atau posbindu Larangan Utara. Konseling gizi dilakukan rata-rata 20 menit menggunakan brosur yang sudah ada. Diet RG menekankan pengurangan asupan natrium sedangkan diet DASH lebih menekankan ke banyak konsumsi sayur, buah, kacang-kacangan dan produk rendah lemak. Variabel yang dikumpulkan adalah karakteristik responden, penyakit dan obat yang diminum serta status gizi sedangkan tekanan darah menggunakan sfigmomanometer, asupan makanan, zat gizi termasuk natrium diukur sebelum dan 2 minggu setelah konseling gizi dilakukan. Hasil menunjukkan adanya perbedaan yang bermakna pada tekanan darah diastolik setelah pasien diberi diet DASH dibandingkan dengan pasien yang diberi diet RG (p0,05) dan terdapat perbedaan delta penurunan sistolik dan diastolik bermakna pada diet DASH dibanding diet RG. Analisa juga menunjukkan adanya penurunan tekanan darah sistolik, diastolik dan asupan natrium  yang bermakna (p0.001) pada kedua kelompok diet setelah mendapat konseling diet DASH dan diet RG. Disimpulkan diet DASH dapat direkomendasikan untuk membantu menurunkan tekanan darah pada pasien hipertensi dengan memperhatikan status gizi. Kata kunci: hipertensi, tekanan darah, diet rendah garam, diet DASH

scholarly journals Effects of a Novel Contextual Just-In-Time Mobile App Intervention (LowSalt4Life) on Sodium Intake in Adults With Hypertension: Pilot Randomized Controlled Trial

10.2196/16696 ◽  
2020 ◽  
Vol 8 (8) ◽  
pp. e16696
Author(s):  
Michael P Dorsch ◽  
Maria L Cornellier ◽  
Armella D Poggi ◽  
Feriha Bilgen ◽  
Peiyu Chen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sodium Excretion ◽  
Sodium Intake ◽  
Urinary Sodium Excretion ◽  
Mobile App ◽  
Urinary Sodium ◽  
Just In Time ◽  
Spot Urine ◽  
Low Sodium Diet ◽  
Low Sodium

Background High dietary sodium intake is a significant public health problem in the United States. High sodium consumption is associated with high blood pressure and high risk of cardiovascular disease. Objective The aim of this study was to evaluate the effect of a just-in-time adaptive mobile app intervention, namely, LowSalt4Life, on reducing sodium intake in adults with hypertension. Methods In this study, 50 participants aged ≥18 years who were under treatment for hypertension were randomized (1:1, stratified by gender) into 2 groups, namely, the App group (LowSalt4Life intervention) and the No App group (usual dietary advice) in a single-center, prospective, open-label randomized controlled trial for 8 weeks. The primary endpoint was the change in the 24-hour urinary sodium excretion estimated from spot urine by using the Kawasaki equation, which was analyzed using unpaired two-sided t tests. Secondary outcomes included the change in the sodium intake measured by the food frequency questionnaire (FFQ), the 24-hour urinary sodium excretion, blood pressure levels, and the self-reported confidence in following a low-sodium diet. Results From baseline to week 8, there was a significant reduction in the Kawasaki-estimated 24-hour urinary sodium excretion calculated from spot urine in the App group compared to that in the No App group (–462 [SD 1220] mg vs 381 [SD 1460] mg, respectively; P=.03). The change in the 24-hour urinary sodium excretion was –637 (SD 1524) mg in the App group and –322 (SD 1485) mg in the No App group (P=.47). The changes in the estimated sodium intake as measured by 24-hour dietary recall and by FFQ in the App group were –1537 (SD 2693) mg and –1553 (SD 1764) mg while those in the No App group were –233 (SD 2150) mg and –515 (SD 1081) mg, respectively (P=.07 and P=.01, respectively). The systolic blood pressure change from baseline to week 8 in the App group was –7.5 mmHg while that in the No App group was –0.7 mmHg (P=.12), but the self-confidence in following a low-sodium diet was not significantly different between the 2 groups. Conclusions This study shows that a contextual just-in-time mobile app intervention resulted in a greater reduction in the dietary sodium intake in adults with hypertension than that in the control group over a 8-week period, as measured by the estimated 24-hour urinary sodium excretion from spot urine and FFQ. The intervention group did not show a significant difference from the control group in the self-confidence in following a low sodium diet and in the 24-hour urinary sodium excretion or dietary intake of sodium as measured by the 24-hour dietary recall. A larger clinical trial is warranted to further elucidate the effects of the LowSalt4Life intervention on sodium intake and blood pressure levels in adults with hypertension. Trial Registration ClinicalTrials.gov NCT03099343; https://clinicaltrials.gov/ct2/show/NCT03099343 International Registered Report Identifier (IRRID) RR2-10.2196/11282

scholarly journals Is too much salt harmful? Yes

2019 ◽  
Vol 35 (9) ◽  
pp. 1777-1785 ◽  
Author(s):  
Róbert Agócs ◽  
Dániel Sugár ◽  
Attila J. Szabó
Keyword(s):  
Blood Pressure ◽  
Salt Intake ◽  
Sodium Intake ◽  
Blood Pressure Reduction ◽  
Great Part ◽  
Risk Groups ◽  
Vulnerable Groups ◽  
High Sodium ◽  
Salt Consumption ◽  
Low Sodium Diet

AbstractThe contribution of high sodium intake to hypertension and to the severity of immune-mediated diseases is still being heatedly debated in medical literature and in the lay media. This review aims to demonstrate two conflicting views on the topic, with the first part citing the detrimental effects of excessive salt consumption. Sodium plays a central role in volume and blood pressure homeostasis, and the positive correlation between sodium intake and blood pressure has been extensively researched. Despite the fact that the average of global daily salt consumption exceeds recommendations of international associations, health damage from excessive salt intake is still controversial. Individual differences in salt sensitivity are in great part attributed to this contradiction. Patients suffering from certain diseases as well as other vulnerable groups—either minors or individuals of full age—exhibit more pronounced blood pressure reduction when consuming a low-sodium diet. Furthermore, findings from the last two decades give insight into the concept of extrarenal sodium storage; however, the long-term consequences of this phenomenon are lesser known. Evidence of the relationship between sodium and autoimmune diseases are cited in the review, too. Nevertheless, further clinical trials are needed to clarify their interplay. In conclusion, for salt-sensitive risk groups in the population, even stricter limits of sodium consumption should be set than for young, healthy individuals. Therefore, the question raised in the title should be rephrased as follows: “how much salt is harmful” and “for whom is elevated salt intake harmful?”

scholarly journals Effects of a Novel Contextual Just-In-Time Mobile App Intervention (LowSalt4Life) on Sodium Intake in Adults With Hypertension: Pilot Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Michael P Dorsch ◽  
Maria L Cornellier ◽  
Armella D Poggi ◽  
Feriha Bilgen ◽  
Peiyu Chen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sodium Excretion ◽  
Sodium Intake ◽  
Urinary Sodium Excretion ◽  
Mobile App ◽  
Urinary Sodium ◽  
Just In Time ◽  
Spot Urine ◽  
Low Sodium Diet ◽  
Low Sodium

BACKGROUND High dietary sodium intake is a significant public health problem in the United States. High sodium consumption is associated with high blood pressure and high risk of cardiovascular disease. OBJECTIVE The aim of this study was to evaluate the effect of a just-in-time adaptive mobile app intervention, namely, LowSalt4Life, on reducing sodium intake in adults with hypertension. METHODS In this study, 50 participants aged ≥18 years who were under treatment for hypertension were randomized (1:1, stratified by gender) into 2 groups, namely, the App group (LowSalt4Life intervention) and the No App group (usual dietary advice) in a single-center, prospective, open-label randomized controlled trial for 8 weeks. The primary endpoint was the change in the 24-hour urinary sodium excretion estimated from spot urine by using the Kawasaki equation, which was analyzed using unpaired two-sided <i>t</i> tests. Secondary outcomes included the change in the sodium intake measured by the food frequency questionnaire (FFQ), the 24-hour urinary sodium excretion, blood pressure levels, and the self-reported confidence in following a low-sodium diet. RESULTS From baseline to week 8, there was a significant reduction in the Kawasaki-estimated 24-hour urinary sodium excretion calculated from spot urine in the App group compared to that in the No App group (–462 [SD 1220] mg vs 381 [SD 1460] mg, respectively; <i>P</i>=.03). The change in the 24-hour urinary sodium excretion was –637 (SD 1524) mg in the App group and –322 (SD 1485) mg in the No App group (<i>P</i>=.47). The changes in the estimated sodium intake as measured by 24-hour dietary recall and by FFQ in the App group were –1537 (SD 2693) mg and –1553 (SD 1764) mg while those in the No App group were –233 (SD 2150) mg and –515 (SD 1081) mg, respectively (<i>P</i>=.07 and <i>P</i>=.01, respectively). The systolic blood pressure change from baseline to week 8 in the App group was –7.5 mmHg while that in the No App group was –0.7 mmHg (<i>P</i>=.12), but the self-confidence in following a low-sodium diet was not significantly different between the 2 groups. CONCLUSIONS This study shows that a contextual just-in-time mobile app intervention resulted in a greater reduction in the dietary sodium intake in adults with hypertension than that in the control group over a 8-week period, as measured by the estimated 24-hour urinary sodium excretion from spot urine and FFQ. The intervention group did not show a significant difference from the control group in the self-confidence in following a low sodium diet and in the 24-hour urinary sodium excretion or dietary intake of sodium as measured by the 24-hour dietary recall. A larger clinical trial is warranted to further elucidate the effects of the LowSalt4Life intervention on sodium intake and blood pressure levels in adults with hypertension. CLINICALTRIAL ClinicalTrials.gov NCT03099343; https://clinicaltrials.gov/ct2/show/NCT03099343 INTERNATIONAL REGISTERED REPORT RR2-10.2196/11282

scholarly journals Report of the first AKI Round Table meeting: an initiative of the ESICM AKI Section

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
M. Ostermann ◽  
A. Schneider ◽  
T. Rimmele ◽  
I. Bobek ◽  
M. van Dam ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Critical Care ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Future Research ◽  
Knowledge Gaps ◽  
Blood Pressure Targets

Abstract Purpose Critical Care Nephrology is an emerging sub-specialty of Critical Care. Despite increasing awareness about the serious impact of acute kidney injury (AKI) and renal replacement therapy (RRT), important knowledge gaps persist. This report represents a summary of a 1-day meeting of the AKI section of the European Society of Intensive Care Medicine (ESICM) identifying priorities for future AKI research. Methods International Members of the AKI section of the ESICM were selected and allocated to one of three subgroups: “AKI diagnosis and evaluation”, “Medical management of AKI” and “Renal Replacement Therapy for AKI.” Using a modified Delphi methodology, each group identified knowledge gaps and developed potential proposals for future collaborative research. Results The following key research projects were developed: Systematic reviews: (a) epidemiology of AKI with stratification by patient cohorts and diagnostic criteria; (b) role of higher blood pressure targets in patients with hypertension admitted to the Intensive Care Unit, and (c) specific clearance characteristics of different modalities of continuous renal replacement therapy (CRRT). Observational studies: (a) epidemiology of critically ill patients according to AKI duration, and (b) current clinical practice of CRRT. Intervention studies:( a) Comparison of different blood pressure targets in critically ill patients with hypertension, and (b) comparison of clearance of solutes with various molecular weights between different CRRT modalities. Conclusion Consensus was reached on a future research agenda for the AKI section of the ESICM.

Sign in / Sign up

Export Citation Format

Share Document