Hypertension is a major risk factor and a powerful predictor of cardio-vascular morbidity and mortality. Increasing production of  processed food, rapid urbanization, and changing lifestyles are transforming dietary patterns. The main thrust of primary prevention of HTN includes diet and lifestyle modification. The following Dietary changes are of paramount importance: 

EARLY PREVENTION:   Breastfeeding contributes to a lifetime of good health. Adults who were breastfed as babies often have lower blood pressure.

WEIGHT REDUCTION: The prevention and correction of obesity is a prudent way of reducing the risk of hypertension and indirectly coronary heart disease. A low-carb diet lowers insulin levels, which causes the kidneys to excrete excess sodium from the body. Positive results are seen with energy restriction alone. The goal, particularly in individuals with a family history of HTN, should be weight reduction to within 15% of desirable weight. 

REDUCING SALT INTAKE:  Salt is the primary source of sodium and increased consumption of sodium is associated with HTN and increased risk of heart disease and stroke.

Salt is mainly composed of two minerals, sodium and chloride, which have various functions in the body. The natural salt in food accounts for 10% of total intake, on average. The salt we add at the table or while cooking adds another 5-10%. About 75% of salt intake comes from salt added to processed foods, either because they are particularly high in salt (ready meals, cheese, salty snack foods, instant noodles etc.) or because they are consumed frequently in large amounts (bread and processed cereal products). 

Aim for 1500 mg – 2300 mg (½ tsp or 3g salt to 1 tsp or 6g salt) sodium/day.  Anything less than 1500 mg is impractical and may stimulate renin-angiotensin system to a degree that will limit the antihypertensive and potassium- sparing effects of the sodium restriction. The average intake of sodium is about 3400 mg. 

WHO recommends a reduction to less than 2 grams per day of sodium (5g salt) in adults. This can result in a decline in both systolic and diastolic blood pressure of >10 mmHg.  An estimated 2.5 million deaths could be prevented each year if global salt consumption were reduced to the recommended level. 

Tips for reducing sodium: 

•  Choose foods low in salt. Less obvious foods, such as bread also contain a lot.

• Limit the amount of salt added to food. 

• Do not add salt to foods at the table. Use herbs and spices and salt free seasonings.

• Read labels & look for foods with less than 400 mg sodium/serving. Look for “%DV”, foods listed as 5% or less for sodium are low in sodium. 

• Avoid sauces, papad, salted snacks etc. 

• Rinse canned foods.

It takes some time for taste buds to adjust, but once they get used to less salt, one is more likely to enjoy food and notice a broader range of flavours.

INCREASING POTASSIUM IN THE DIET:  Potassium and sodium fluctuate antagonistically - a decrease in potassium leads to sodium retention, whereas increase in potassium leads to sodium excretion. The recommended potassium intake for all adults may be achieved through adequate daily consumption of vegetables, fruits, dairy products, plain unsalted nuts & legumes.

INCREASE INTAKE OF FIBER: Various studies have been found to have an inverse association between blood pressure and fiber intake. Plant foods should be preferred as there is no fiber in meat, dairy, sugar or white foods (bread, rice, maida). Desirable level of dietary fiber intake is 30-40g/day

HEALTHY EATING -The DASH diet (Dietary Approaches to Stop Hypertension):DASH eating plan focuses on heart-healthy foods which are low in sodium, fat and cholesterol whereas rich in fiber, nutrients and protein, incorporating healthy fats in moderation. It consists mainly of fruits, vegetables, low-fat dairy products, whole grains, poultry, fish, beans, seeds and nuts while reducing the amount of red meat, sweets and sugar-containing beverages. Following such a diet reduces systolic blood pressure on average by 8 to 14 mm Hg and also has suitable effects on blood lipids.

LIMITING ALCOHOL CONSUMPTION: Alcohol raises blood pressure and also can harm vital organs like liver, brain and heart. 

 QUIT SMOKING: Smoking is a major risk factor leading to HTN and heart disease. In patients with coronary heart disease, smoking cessation is associated with a 36% reduction in the risk of all-cause mortality.

 PHYSICAL ACTIVITY: The role of physical activity for treatment of HTN is well known. Diet, Exercise and Weight loss Intervention Trial (DEW-IT) showed that exercise incorporated lifestyle intervention can result in significantly better BP control among patients taking Pharmacotherapy for HTN. 

STRESS MANAGEMENT:   Stress may temporarily increase blood pressure. People tend to eat high fat/ high salt foods, or engage in smoking or drinking alcohol to cope with stress. Learn to find healthy ways – 

•  Find time to walk each day. 

• Yoga is beneficial for a variety of psychological and medical conditions including HTN.  

• Meditation helps to calm the body and soul.

• Relaxation techniques such as massaging relieve stress. 

Bhagavan Sri Sathya Sai Baba has referred to food on many occasions. He says: “HURRY, WORRY and CURRY (rich, spicy food) are the causes of heart problems”

“Food having too much salt and spices is Rajasic and should be avoided”