Hypertension and DASH Diet: Evidence and Recommendations for Patients

This report delves into hypertension, also known as high blood pressure, and its implications for health, including the risks of heart disorders and stroke. It explains the pathophysiology of hypertension, emphasizing the role of the kidneys, genetics, and neuro-hormonal systems. The report also highlights the DASH diet, which is recommended for managing hypertension, and outlines dietary recommendations, including increased fruit and vegetable intake, low-fat dairy, and limiting sodium, saturated fats, and alcohol. It provides evidence supporting the DASH diet's effectiveness, such as the benefits of potassium, nuts, and low-fat dairy. The report references several studies to support the claims made and provides a comprehensive overview of hypertension and dietary approaches to manage it.

Hypertension:
Hypertension is another name for high blood pressure.
It can lead to various severe complications and
increase the risk of heart disorder, stroke and also
death. Blood pressure can be explained as the force
that is exerted by the blood against the walls of the
blood. The pressure mainly depends on the work
which is being done by the heart as well as the
resistance of the blood vessels. When such pressure
becomes high, it leads to many complications as well
as several chronic disorders (1).
Important facts about hypertension:
Acute cases of high blood pressure mainly include the
situations of stress. However, it can result from own or
can be the outcomes of severe underlying conditions like
that of kidney disorders.
Normal blood pressure requires to be 120 over 80 mm of
mercury but hypertension can only be sated when the
pressure is 130 over 80 mmHg (2)
Unmanaged situations of hypertension can lead to stroke,
heart attack as well as other problems
Pathophysiology of hypertension:
The pathophysiology of the disorder is highly complex and also multi-factorial. Studies opine that kidney is mainly the contributing factor as well as the target organ of the
hypertensive procedures. The disorder is seen to involve the interaction of the different multiple organs as well a numerous mechanism of the independent or the various
interdependent pathways (4). Factors that play a main role in the pathogenesis of hypertension are seen to include genetics as well as activation of the neuro-hormonal systems like
that of the sympathetic nervous systems as well as the angiotensin-aldosterone system. Even obesity and increased dietary salt can result in this disorder. Arterial hypertension can be
explained as the condition of the persistent elevation of that of the systemic blood pressure. It can be described as the product or that of the total peripheral vascular resistance and that
of the cardiac output (5). The different factors that are involved in short term as well as long term regulation of the blood pressure for sufficient amount of adequate tissue perfusion.
These are the humoral mediators, neural stimulation, cardiac output and cardiac blood volume as well as vascular caliber, elasticity, and reactivity.
Over the course of the natural history, essential hypertension can gets converted to that of the established hypertension. Studies are of the opinion that persistent hypertension
can result into complicated hypertension after about the long and invariable, asymptomatic period. In this situation, organ damage to that of the aorta as well as mall arteries and even
kidneys, heart, retina and central nervous systems become evident.
 Single gene mutations can result in the Mendelian forms of hypertension where ten genes have been identified that can result in the monogenic forms of hypertension. The
mutations can result in affecting the blood pressure by altering the renal salt-handling mechanism
 The autonomic nervous system can be seen to play important role in maintenance of cardiovascular homeostasis via that of the volume, pressure and chemoreceptor signals.
It mainly happens like this by regulation of the kidney function that in turn affects the cardiac output, vascular resistance, and fluid retention. Excessive activity of the
sympathetic nervous system can result in hypertension (6)
 Renin-angiotensin aldosterone system helps in maintaining the extracellular fluid volume, peripheral resistance, and when this system gets disturbed, it might laed to
development of hypertension.
 The endothelium of the blood vessels can help in producing extensive ranges of the substances which help in influencing of the blood flow and this in turn can be affected by
the changes in the blood as well as the pressure of the blood flow. An example may be the local nitric oxide as well as endothelin, these are secreted by structures like the
endothelium only. These are the major regulators of the blood pressure as well as the vascular tome.
Treatment procedure of hypertension
and ma
Hypertension and Dash diet

DASH diet:
The DASH diet is mainly recorded by healthcare professionals when patients suffer from high blood pressure,
the diet is quite simple and comprises of the following:
 Eating more fruits as well as vegetables and even low-fat dairy foods
 Cutting back on the foods that are high like those in saturated fat, cholesterol as well as trans fat
 Eating more whole-grain foods along with fish, poultry and nuts (7)
 Limiting the sodium as well as sweets and also sugary drinks and red meats
Evidences of DASH diet in reducing hypertension:
 Getting more fruits and vegetables: fruits and vegetables are the natural sources of potassium which had
been found by studies to be effective in lowering of the blood pressure. Many researches had already
revealed that low levels of potassium might result in hypertension and therefore, keeping a diet rich in
plant foods can help by providing enough potassium and also help in maintaining adequate levels.
 Getting more nuts in the diet: it has been found that more nuts are excellent sources of mono-saturated
fats and this helps in lowering the bad cholesterol thereby increasing the good cholesterol. They are also
found to be richer in antioxidants and nuts contain compounds that may help in reducing the damage to
the blood vessels. These compounds would also help in keeping the blood vessels healthy and would
result in unrestricted blood flow (8).
 Consumption of dairy with low fat content: studies have found that calcium is not only good for health
but is also necessary for blood pressure regulation. As the dairy foods are found to be richer in calcium,
they also have high-fat dairy contents that are not good for the health of the heart. Some of the non-
dairy sources of calcium can be soy beans, collard greens and calcium-fortified beverages such as
almond milk (9)
 Limiting saturated fat in diet: DASH diet is found to be low in saturated fat. Studies have revealed that a
diet low in the saturated fat can help in decreasing the risk of the heart disorders and hypertension. It
has been found that plant foods are great ways for getting nutrients that included protein without too
much saturated fat. Some of the excellent choices are beans, lentils and tofus.
 Being active and limiting alcohol: physical activity helps in promoting the health of heart and would
help in achieving overall fitness. Blood pressure can be reduced by aerobic exercises regularly that
would aim for about 60 minutes each day or most of the days or about 150 minutes every week (10).
Recommendations for patients and physicians:
The DASH diet eating plan should be made one of the key parts of
healthy lifestyle and should be combined with other healthy
behaviors and lifestyle choices like that of physical activities which
would help in controlling the blood pressure and other LDL
cholesterol for life. It is also important for limiting the daily
sodium levels to 2,300 mg, or 1,500 mg (11). For preventing and
controlling high blood pressure:
 Being physically active
 Maintaining a healthy weight
 Limiting the intake of alcohol (12)
 Managing and coping with stress
 Quitting to smoke completely
 Getting plenty of sleep
References:
1. Kim NH. Group 4 pulmonary hypertension: Chronic thromboembolic pulmonary
hypertension: epidemiology, pathophysiology, and treatment. Cardiology clinics.
2016 Aug;34(3):435-41.
2. Simonneau G, Torbicki A, Dorfmüller P, Kim N. The pathophysiology of chronic
thromboembolic pulmonary hypertension. European Respiratory Review. 2017 Mar
31;26(143):160112.
3. Qureshi AZ, Tulloh RM. Paediatric pulmonary hypertension: aetiology,
pathophysiology and treatment. Paediatrics and Child Health. 2017 Feb 1;27(2):50-7.
4. Guazzi M, Naeije R. Pulmonary hypertension in heart failure: pathophysiology,
pathobiology, and emerging clinical perspectives. Journal of the American College of
Cardiology. 2017 Mar 27;69(13):1718-34.
5. Fernandez M. Molecular pathophysiology of portal hypertension. Hepatology. 2015
Apr 1;61(4):1406-15.
6. Rai SK, Fung TT, Lu N, Keller SF, Curhan GC, Choi HK. The Dietary Approaches
to Stop Hypertension (DASH) diet, Western diet, and risk of gout in men: prospective
cohort study. bmj. 2017 May 9;357:j1794.
7. Siervo M, Lara J, Chowdhury S, Ashor A, Oggioni C, Mathers JC. Effects of the
Dietary Approach to Stop Hypertension (DASH) diet on cardiovascular risk factors: a
systematic review and meta-analysis. British Journal of Nutrition. 2015
Jan;113(1):1-5.
8. Cherian L, Wang Y, Holland T, Agarwal P, Aggarwal N, Morris MC. Dietary
Approaches to Stop Hypertension (DASH) Diet Associated with Lower Rates of
Depression (P2. 179).
9. Soltani S, Shirani F, Chitsazi MJ, Salehi‐Abargouei A. The effect of dietary
approaches to stop hypertension (DASH) diet on weight and body composition in
adults: a systematic review and meta‐analysis of randomized controlled clinical trials.
Obesity reviews. 2016 May;17(5):442-54.
10. Chiu S, Bergeron N, Williams PT, Bray GA, Sutherland B, Krauss RM. Comparison
of the DASH (Dietary Approaches to Stop Hypertension) diet and a higher-fat
DASH diet on blood pressure and lipids and lipoproteins: a randomized controlled
trial–3. The American journal of clinical nutrition. 2015 Dec 30;103(2):341-7.
11. Perez-Cornago A, Sanchez-Villegas A, Bes-Rastrollo M, Gea A, Molero P,
Lahortiga-Ramos F, Martinez-Gonzalez MÁ. Relationship between adherence to
Dietary Approaches to Stop Hypertension (DASH) diet indices and
incidence of depression during up to 8 years of follow-up. Public health
nutrition. 2017 Sep;20(13):2383-92.
12. Juraschek SP, White K, Tang O, Yeh HC, Cooper LA, Miller III ER.
Effects of a Dietary Approach to Stop Hypertension (DASH) Diet
Intervention on Serum Uric Acid in African Americans With
Hypertension. Arthritis care & research. 2018 Oct;70(10):1509-16.