Application of nutritional diet care in patients with hypertension

Nutritional dietary care is the core means of non-drug intervention for hypertension. Existing evidence-based medical data shows that long-term scientific dietary adjustment can increase the blood pressure compliance rate of patients with grade 1 (mild) hypertension to 72%, and nearly 40% of patients can maintain stable blood pressure without taking antihypertensive drugs.； Patients with moderate to severe hypertension can reduce the dosage of antihypertensive drugs by 20% to 35%, and the overall risk of cardiovascular and cerebrovascular complications can be reduced by about 30%.

Last week, I met 52-year-old Mr. Zhang at a community free clinic. He works as a project supervisor. His physical examination revealed grade 1 hypertension for half a year, and his systolic blood pressure has been hovering around 145~155mmHg. He was afraid that taking medicine would have side effects. He heard from relatives that he drank celery juice to reduce blood pressure, so he drank a large glass of it every morning on an empty stomach. After drinking it for three months, he had acid reflux and could not sleep. His blood pressure still did not drop. He came over with the physical examination report and asked me if I would have to take medicine for the rest of my life.

In fact, regarding the dietary care of hypertension, there have always been two different intervention ideas in the industry. In the early years, the mainstream view was the "sodium-only theory". As long as the daily sodium intake is controlled within 2g (equivalent to 5g of table salt), a good antihypertensive effect can be achieved. Many guidelines also put strict sodium restriction first. I managed a 72-year-old elderly patient in the past two years, and he followed this requirement to the extreme. Not only did he not add salt when cooking, but he also gave up all soy sauce, pickles, and even baking soda for baking dough. As a result, he fainted in the vegetable market due to hyponatremia in less than two months. When he was sent to the hospital, his blood sodium was only 121mmol/L, and he was hospitalized for a week.

In recent years, more and more clinical evidence has begun to support the idea of ​​"prioritizing the overall dietary pattern". It is believed that sodium restriction does not need to be used as the only hard indicator. As long as the overall dietary structure conforms to the principles of high potassium, high dietary fiber, and low saturated fat, even if the sodium intake is slightly relaxed to 6g/day, a good blood pressure lowering effect can be achieved. This is especially suitable for elderly patients with poor appetite and small food intake, as well as manual workers who work outdoors for a long time and sweat a lot. The amount of 5g of salt is prone to electrolyte imbalance.

Many patients said to me, "Why is my blood pressure still high even though I have eaten very lightly?" When I asked them, I found out that when calculating the amount of salt, they only counted the white salt used in cooking and did not include invisible sodium at all. Last month, there was a 28-year-old programmer who weighed 180 pounds and had a blood pressure of 150/100. He said that he usually used less salt when cooking at home. When I asked him, he would order a cup of full-sugar milk tea every afternoon and eat two packs of chicken feet with pickled peppers as a late-night snack when working overtime. The sodium content of these two items alone was more than 6g, which was equivalent to eating too much salt for the whole day. How could his blood pressure be lowered? To be honest, the sodium in the bread, biscuits, plums, and even the sports drinks you usually eat must be included in the total amount. Don’t just focus on the salt in the cooking spoon.

The DASH eating pattern, which is now internationally recognized as suitable for patients with hypertension, is not that mysterious to put it bluntly. You don’t need to weigh and eat according to the recipe every time. Just have a little snack in your daily meals: for example, replace the white porridge and white steamed buns with unsweetened oatmeal for breakfast, and drink a cup of low-fat milk.； When cooking at noon, add less half a spoonful of oyster sauce and half a spoonful of sauce, and add two more handfuls of dark green spinach and lettuce. ； After dinner in the evening, instead of eating salted melon seeds and salt-baked peanuts, eat a small apple or a handful of blueberries. These small adjustments are much more effective than drinking celery juice and nibbling onions every day.

As for the currently hotly debated issue of "can patients with high blood pressure drink alcohol?", there was a previous view that drinking a small amount of red wine can soften blood vessels and be good for blood pressure. In the past two years, the Lancet study also said that as long as alcohol is consumed, blood pressure will rise, and there is no so-called "safe amount." Our clinical practice generally does not give patients one-size-fits-all requirements. Of course, it is best not to drink alcohol if you are originally a teetotaler. If you insist on an old man who has been drinking for thirty or forty years and drinks two taels of white wine every time, and you insist on giving up all at once, he will be more likely to be irritable, have trouble sleeping, and his blood pressure will rise even higher. Instead, it is better to reduce it slowly. Drink no more than one tael of white wine each time, and drink no more than three times a week, which is more suitable for their physical condition.

When I give dietary guidance to patients, I never give them densely packed recipes. No one can stick to it, so I teach three easy-to-operate tips: The first is to buy a 2g salt-limiting spoon. One person can put one spoon on a meal, and a family of three can put three spoons on it. There is no need to calculate.； The second is when going out for a dinner, first pour a bowl of warm water, put the vegetables in and rinse them twice before eating. This can filter out at least half of the excess oil and salt. ； Third, don’t believe in “foods that are effective in lowering blood pressure,” such as celery, black garlic, or okra. None of these foods can directly lower blood pressure. They are all the result of long-term overall dietary adjustments. Don’t waste your money on health care products.

In fact, after so many years of chronic disease care, my biggest feeling is that nutritional diet care is never about making a "fasting list" for patients, not telling them not to eat or touch this or that, but to help them find small eating habits that they can stick to for a lifetime. After all, adjustments that can be implemented for a long time are the ones that really have a good effect on blood pressure.