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Hypertension, not essential: an epidemic preventable by improved eating patterns

Journal of Human Hypertension volume 27, pages 581–582 (2013)Cite this article

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In most populations worldwide, blood pressure (BP) rises substantially with age from youth through middle age. The consequence is that adverse BP levels—prehypertensive and hypertensive—are epidemic, as are their adverse effects: morbidity, disability and premature death from major cardiovascular diseases (CVD; coronary heart disease, stroke, congestive heart failure and so on).

For decades, most persons with high BP were diagnosed as having essential hypertension.1, 2 The word essential in front of hypertension served physicians as a tidy way to signify ignorance of the causes of adverse BP, and to justify—in the era before effective antihypertensive medications—‘watchful waiting’ and ‘judicious neglect’. But in recent decades, the term has been used less, replaced by the alternative, primary hypertension—with good cause. We have learned a lot in recent decades about the multiple causes—especially the multiple dietary causes—of the common rise in BP with age, the consequent epidemic of prehypertension/hypertension and the rarity of favorable BP levels from early middle age on. We now know that none of these adverse aspects of human BP is essential; high BP and its complications can be prevented and controlled, by improved dietary patterns, and pharmacological treatment as indicated.1, 2, 3, 4 Thus, as the recent NICE guidelines also note,5 the term essential hypertension is now obsolete and counter-productive; it needs to be explicitly and deliberately retired to the museum of historical medical acronyms. An impressive body of evidence is now in hand on the influences of multiple lifestyle—particularly dietary—factors on BP. This evidence documents the judgment for internment, and for dietary guidelines for prevention/control of hypertension/prehypertension.3 The dietary factors include micro- and macronutrients, alcohol and caloric inbalance, resulting in overweight/obesity. Nutrients inversely (favorably) related to BP include: dietary calcium, magnesium, phosphorus, potassium, non-heme iron, omega-3 polyunsaturated fatty acids (PFAs; linolenic acid, long-chain PFAs from fatty fish), omega-6 PFAs (for example, linoleic acid), vegetable protein, glutamic acid; directly (adversely) related to BP: dietary sodium (salt), alcohol, sugars and caloric imbalance, resulting in overweight/obesity.1, 2, 3, 4 The affected BP variables encompass the gamut: population slope of BP with age from youth through middle-age, population average systolic blood pressure (SBP)/diastolic blood pressure (DBP), prevalence of prehypertension and hypertension. Estimates of the combined impact on population BP of these several dietary factors—lower habitual intake of protective factors, higher habitual intake of adverse factors—are SBP higher by about 8–10 mm Hg.2, 3 Conversely, as emphasized in published guidelines on improving nutrition to control hypertension,3 estimates of the combined impact on BP of favorable levels of all these dietary factors are population average SBP lower by a like amount, with an anticipated virtual elimination of the usual rise in BP with age from youth through middle age, and consequent elimination of epidemic prehypertension/hypertension.2, 3

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References

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  1. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    J Stamler

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Stamler, J. Hypertension, not essential: an epidemic preventable by improved eating patterns. J Hum Hypertens 27, 581–582 (2013). https://doi.org/10.1038/jhh.2013.25

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