Hello, dear reader! Let’s get talking on something very crucial, and it has to do with Hypertension—what many of us call B.P. Like Peptic Ulcer Disease and diabetes mellitus, hypertension is a familiar non-communicable disease; it’s one of the most common worldwide diseases afflicting humans and is a major risk factor for stroke, myocardial infarction, vascular disease, and chronic kidney disease and so on.

The cause is not clearly known but established risk factors have been implicated in hypertension—I should get back to that soon.

Then, last week a young adult man, probably in his late 30s, was back at the clinic for routine check-up. He was diagnosed of hypertension about 2 years ago following some unclear events. He noted that one of his parents has the medical condition and before he was eventually diagnosed of it, his greatest nightmare in life was fear of developing hypertension, more so he never expected it to come that early in his life.
On taking his blood pressure reading, it read 120/70mmHg (120 millimetres of Mercury for the systolic reading that is on top and 70 millimetres of Mercury for the diastolic denominator). And the good news is, he has been on 120-125mmHg for systolic and 70-75mmHg for diastolic since he started DASH diet, few months ago.

Unfortunately, there is this other patient that has consistently being on 140/90mmHg while on drugs alone. He was diagnosed last year after losing his wife and daughter to road traffic accident. In our last meeting, I had taken a pretty good time to counsel him and started him on DASH program with the aim of achieving an additional drop of about 10 to 11mmHg for systolic and about 6 to 7mmHg for diastolic within the next 4 to 8weeks. Meaning when he returns for check-up in at least 4weeks time, we’d be hoping to have a B.P reading of 130/80mmHg or less while still using his medications and could even go on DASH alone afterward.

Hypertension has been classified based on the recommendation of the seventh report of the Joint National Committee on prevention, detection, evaluation and treatment of hypertension:

Hypertension classes
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Normal blood pressure : Systolic lower than 120 mm Hg, diastolic lower than 80 mm Hg Prehypertension: Systolic 120-139 mm Hg, diastolic 80-89 mm Hg Stage 1 Hypertension: Systolic 140-159 mm Hg, diastolic 90-99 mm Hg Stage 2 Hypertension: Systolic 160 mm Hg or greater, diastolic 100 mm Hg or greater

 

What Is A DASH?

Practicable DASH
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DASH stands for Dietary Approaches to Stop Hypertension.
It is a dietary pattern promoted by the U.S.-based National Heart, Lung, and Blood Institute (NHLBI) to prevent and control hypertension. DASH is adopted by many countries including Nigeria. The DASH diet is rich in fruits, vegetables, whole grains, and low-fat dairy foods; includes meat, fish, poultry, nuts, and beans.
However, DASH is limited in sugar-sweetened foods and beverages, red meat, and added fats, and sodium.

Who Needs DASH?
The general believe is that DASH is only useful in controlling Hypertension in hypertensive patients, apparently, that’s misconstrued! DASH is also useful for preventing hypertension in people at risk of developing hypertension.

Who Is At Risk Of Developing Hypertension?
1. If one or both of your parents or grandparents, uncle or aunt has hypertension.

2. If you are in your adulthood. The risk of high blood pressure increases as you age.

3. If you are of African decent. Well, it’s generally believed that hypertension is particularly common among blacks. Is somebody raising an eyebrow to that?

4. If you are obese or overweight. To know if you are obese, check your weight in kilograms and height in meters. Divide your weight (in kg) by the square of your height (in meters squared) to get your Body Mass Index (BMI). If your BMI is greater or equals to 30, your are obese!

If Less than 18.5—underweight
18.5 to 24—normal weight
24 to 29 – overweight
30—34 mild obesity
35—39 moderate obesity
40 and above – morbid obesity.

If you’re reading this, perhaps you could do the maths right away and oops! Bring on the outcome.

5. If you live a sedentary lifestyle. Lack of physical activities also increases the risk of being overweight.

6. If you take tobacco. The chemicals in tobacco can damage walls of your blood vessels, majorly your arteries. This can cause them to narrow, increasing resistance to flow of blood and subsequently increasing your blood pressure.

7. If you take plenty of salt. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.

8. If you are an alcoholic. Over time, heavy drinking can damage your heart.

9. If You are pregnant. Hypertension in pregnancy is one condition that is common among young pregnant woman. This is usually more seen in woman getting pregnant for the first time, reasons are not so clear but there are evidences implicating increase resistance in the placenta vascular bed, a site where blood, oxygen and nutrients are exchanged between the mother and the unborn baby.

10. If you are continuously Stressed. This leads to persistent release of stress hormones like cortisol which greatly contribute to increase blood pressure via many mechanisms.

11. Someone having kidney disease, diabetes and sleep apnoea is at risk of developing hypertension.
How Do I Make DASH Practicable?

DASH diet incorporate diet rich in fruits, vegetables, whole grains, and low-fat dairy foods; includes meat, fish, poultry, nuts, and beans.

Fruit and vegetables: not only replenish the body but also supply essential minerals and nutrients like potassium, magnesium and calcium. Good news is that, they also contain anti-oxidants which are thought to prevent stroke, heart diseases and kidney stones. Banana provides a significant amount of potassium for the body.

Grains and cereals: rice, maize, millet, guinea corn, wheat are important part of our diet and they are important part of DASH. Which ever way you choose to prepare yours, always remember how helpful they are in DASH.

Beans: well, can anyone do without this protein power house?

Non-red meat (meat in fish and poultry), nuts and other foods rich in fibres are all important add-ons to DASH.
On the other hand, DASH restricts the intake of red meat, sodium, sugar-sweetened foods and beverages and added fats, hence to comply effectively with this, have a list of your routine meals over a week and carefully strike out those that rich in

Red meat:
Limit red meat like cow meat, goat meat, ram and other sources of red meat. These meats can be replaced by fish (dry fish of high value), and poultry (chicken, turkey etc.). Dry fish and poultry are generally low in fat content, however, it’s expedient to avoid the fatty skin in poultry because it contains high cholesterol.

Sodium:

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Apart from table salt we add to meals we prepare at home, sodium is present in the form seasonings in many processed foods and snacks. In DASH, it’s recommended to limit sodium intake to about 1.5g ( a little more than half of tea spoon of table salt) a day.

With research carried out by NHLBI, the DASH-sodium results indicate that low sodium levels correlated with the largest reductions in blood pressure for participants at both pre-hypertensive and hypertensive levels, with the hypertensive participants showing the greatest reductions in blood pressure overall.

The question is, how can I do without salt and seasonings in my diet?
Well 1 teaspoon of salt weighs about 6 grams, it’s advised that you should limit salt intake to just about 70% (which is more than half) of 1 tea spoon per day, corresponding to about 4grams of salt in a day. The normal table salt is made up of sodium and chlorine, while sodium takes 40%, chlorine takes the remaining 60%, by taking just about 4grams or less of salt a day (a little more than half of tea spoon), you would be taking the recommended 1.5g of sodium per day.
The consequence of this is, the difficulty in balancing between your table salt use, seasonings use, and your intake of processed foods and junks in order not to exceed 1.5g of sodium a day!
The more logical solution is to result to preparing most of your meals and avoiding proceeded foods and junks as much as possible. With time, this would become a routine and need I remind you also that experiencing a drop in your blood pressure after going through this sacrifice would be an invaluable motivation for full adherence to DASH

Fatty foods:
Strike out fatty foods from your meals by limiting foods containing fat and oil. Your aim with fatty food would be to avoid those foods that are rich in low density lipoprotein ( bad cholesterol ) and replaced them with those rich in high density lipoprotein and triglycerides ( good cholesterol); Oil made from animals e.g. chicken and turkey oil should be replaced by vegetable oil (Groundnut or peanut oil, Soya beans oil, Cocoanut oil, Corn oil,
Cottonseed oil, Olive oil, Palm oil, Rapeseed oil, Safflower oil, Sesame oil,
Sunflower oil etc.)
Oil, including palm oil, that have been partially hydrogenated ( converted semi-solid) should be avoided because they now contain bad cholesterol.

Alcohol and caffeine: it’s advisable that this two products should be drastically reduced.
And In case you are hypertensive or at risk of hypertension and still taking alcohol or caffeine, it’s high time you DASHed them for good.

I do hope to have your comments and questions on how to effectively have a DASH diet.

Thanks for reading, and don’t forget to check out why only men are at risk of BPH!

References
1. Description of DASH Eating plan. The National Heart, Lung, and Blood Institute (NHLBI). September 16, 2015.

2. High Blood Pressure Fact Sheet, CDC. February 19, 2015.

3. Meena S Madhur. Hypertension; JNC 7 classification. Medscape App. V.3.3.2 . Last updated on July 9, 2016.

4. How Much Sodium You Eat per day? Authority Nutrition.com

5. Wikipedia. Hypertension. Last edited on 16th August, 2016.

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