Dietary management for high blood pressure (hypertension)

Objectives

• To maintain adequate nutrition.
• To reduce the sodium intake.
• To achieve a gradual weight loss in overweight individuals and maintain their weight slightly below normal weight.
• To restrict fat (if required) depending on the lipid (fat) profile.

Dietary modifications

Energy: Energy needs to be restricted in case of overweight individuals. Even normal weight individuals benefit with a slight reduction in energy. Therefore, the energy intake should be adjusted in such a way so as to bring about a weight loss and maintain slightly below the normal level.

Proteins: A normal protein intake is suggested. Excess amount of proteins should be avoided, as these foods are usually high in animal fat as well as sodium.

Fats: As low energy diets are essentially low fat diets, the quantity of fat should be reduced. Also, it is important to check the quality of fat. Fats should be of plant origin including soya oil, groundnut oil, sunflower oil and corn oil. Fats from animal origin such as ghee, butter etc. should be restricted.

Carbohydrates: Emphasis should be placed on including foods high in complex carbohydrates such as starches and dietary fibre rather than simple sugars.

Sodium: Sodium restriction along with weight reduction is effective in controlling mild to moderate hypertension. Therefore, use of salt for cooking and also for table purpose should be restricted.

Other minerals: Two other minerals, potassium and calcium, are important in relation to hypertension. An adequate potassium intake is an essential part of treatment. This can be done by including sufficient amounts of potassium rich foods such as milk, fruits and vegetables. Adequate amount of calcium intake is also beneficial in treating high blood pressure. Some of the calcium rich foods are milk, leafy vegetables etc.

Sodium restricted diets

Four levels of dietary sodium restriction are suggested:

       1. Mild sodium restriction (2 to 3 )

Salt may be used lightly in cooking but no more salt at the table is allowed. There is no restriction on the use of naturally occurring fresh foods. Processed or preserved foods in which salt has been used as a preservative or as a flavouring agent are to be omitted.

Do not use:

• Salt at the table (for salads or curds)
• Salt lightly in cooking.
• Salt preserved foods such as salted or smoked meat (ham, bacon, sausages, frankfurters, etc), salted or smoked fish.
• Highly salted foods such as crackers, potato chips, salted nuts, salted popcorns, salted snacks.
• Foods with sodium as preservative such as tomato ketchup, chilli sauce, soya sauce, garlic sauce, pickles and chutneys.
• Flavour enhancers such as mono sodium glutamate (ajinomoto) used in Chinese cookery.
• Processed cheese, salted butter.

        2. Moderate sodium restriction (1000 mg / 1 g)

In addition to the modifications required in case of mild sodium restriction, some control of natural foods is needed. The use of high sodium vegetables, baked products should be limited. No salt should be used for cooking.

Do not use:

• Canned vegetables in brine or canned vegetable juices.
• More than one serving of vegetables such as beetroots, carrots, beet greens, mustard greens, spinach, lotus stem and white turnip.
• Bread, bread rolls, crackers.
• Ready to eat breakfast cereals such as corn flakes, oats etc.
• Shell fishes such as shrimps, crabs, lobsters.
• Mayonnaise or other salad dressings.
• Baking powder, baking soda and anything containing these.

        3. Strict sodium restriction (500 mg)

Along with the modifications made in the mild and moderate sodium restriction diets, meat, eggs, and milk products are used in smaller quantities. Meat is limited to 2 cups, meat or chicken to 100 g and egg to one daily.

        4. Severe sodium restriction (200 mg)

This is used in rare cases, as it is too restrictive a level to be nutritionally adequate. In this type of a diet, milk is used in restricted amounts, meat and chicken is limited to 40 to 50 g per day and eggs to about 3 per week.

Sample diet plan

Meal	Menu
Early morning	Tea
Breakfast	Dalia porridge / milk / tea / coffee Besan chila / vegetable pan cake / stuffed chapatti / sprouts chat Apple / papaya / pear / water melon
Lunch	2 chapatti Whole moong dal / any dal preferably whole dal Ghia subzi/Dry karela Curd / vegetable raita
Evening tea	Tea / coffee Marie biscuits
Dinner	Tomato or vegetable soup 1 chapatti Paneer and vegetable subzi Salad Fruit custard

To remember

• Diet is more or less normal.
• Salt needs to be restricted.
• Food should be made in a way that it is palatable even with lesser amount of salt or even without salt.
• Variety of condiments (low in sodium) and flavouring agents such as lemon, vinegar, tamarind extract, onion, garlic, spices etc. can be used to improve the palatability of salt free food.
• Some foods rich in potassium but low in sodium are potatoes, banana, apricots and legumes, which can be included in the diet.
• Restrict fried and fatty foods.
• Restrict alcohol intake.