|Year : 2018 | Volume
| Issue : 3 | Page : 70-72
Management of Hypertension
Renal Dietician, Department of Nephrology, Dr. Kirplani's Kidney and Blood Pressure Clinic
|Date of Web Publication||23-Apr-2019|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sahigara S. Management of Hypertension. J Renal Nutr Metab 2018;4:70-2
| Role of Salt Restriction|| |
- Salt plays an important role in hypertension and that hypertension is associated with proteinuria and more rapid progression of chronic kidney disease (CKD)
- Salt intake also contributed to edema seen in many patients with proteinuric kidney disease
- Dietary salt should be restricted in those with hypertension and/or edema
- The recommendation is to restrict salt to about 4 g/day.
| Who Guidelines for Hypertension|| |
- High sodium consumption (>2 g/day, equivalent to 5 g salt/day) and insufficient potassium intake (<3.5 g/day) contribute to high blood pressure and increase the risk of heart disease and stroke
- The main source of sodium in our diet is salt although it can come from sodium glutamate, which is used as a condiment in many parts of the world
- Most people consume too much salt – on average 9–12 g/day or around twice the recommended maximum level of intake
- Salt intake of <5 g/day for adults helps to reduce blood pressure and risk of cardiovascular disease, stroke, and coronary heart attack. The principal benefit of lowering salt intake is a corresponding reduction in high blood pressure
- The WHO Member States have agreed to reduce the global population's intake of salt by a relative 30% by 2025
- Reducing salt intake has been identified as one of the most cost-effective measures countries can take to improve population health outcomes. Key salt reduction measures will generate an extra year of healthy life for a cost that falls below the average annual income or gross domestic product per person
- An estimated 2.5 million deaths could be prevented each year if global salt consumption was reduced to the recommended level.
| Recommendations for Salt Reduction|| |
- For adults: The WHO recommends that adults consume <5 g (just under a teaspoon) of salt per day
- For children: The WHO recommends that the recommended maximum intake of salt for adults should be adjusted downward for children aged 2–15 years based on their energy requirements relative to those of adults. This recommendation for children does not address the period of exclusive breastfeeding (0–6 months) or the period of complementary feeding with continued breastfeeding (6–24 months)
- All salt that is consumed should be iodized or “fortified” with iodine, which is essential for healthy brain development in the fetus and young child and optimizing people's mental function in general.
| Sodium|| |
- There is an urgent need to reduce salt intake in India. There are >50 studies connecting salt intake and blood pressure and the benefit of reducing salt intake
- It should be made clear salt or sodium added to the foods which include sodium bicarbonate, monosodium glutamate, and sodium lactate besides sodium chloride (table salt)
- Breads, biscuits, and all other processed foods may have salt sometimes more than a packet of wafers
- The food safety and standards authority of India FSSAI, which makes it mandatory for packaged goods to display nutritional facts, does not insist on information of salt. Few products that list salt imply sodium per 100 gm. “if there is 5 g of sodium in 100 g of food, multiply it by 2.5 to understand the salt in it
- It should be understood 1-g salt = 400-mg sodium.
| How to Reduce Salt in Diets|| |
- Patients should be explained how much is 4 g of salt, salt spoons can be given, or salt sachets can be used
- They should be told to cook food without salt and add salt after cooking that way the salt intake can be controlled
- get used to low salt to allow the taste buds to recover
- eat fresh food when possible
- not to add extra salt on the table (a special problem in India since salt is served in the food plate as a routine and salt shakers for soups)
- It is essential to target the young college and school students and educate them about the ill effects of processed food
- It is a myth that Indians require more salt due to the weather and sweating
- The maximum salt lost is in urine (that's why 24-h urine sodium is measured to calculate a person's salt intake). Sweat once acclimatized has very low sodium. Increased sweating requires more water intake and not salt.
| Salt Adjuncts|| |
Patients should be advised various recipes to enhance the taste in low-sodium foods. Adjuncts such as
- Amchur powder
- Spring onions
- Vinegar can be used
- Low-salt chutneys can be made as a side dish to make the meal look more palatable.
- Ready to use idli, dosa, dhokla, and cake batter have a lot of added sodium in various forms, patients should be explained this, and the recipes for the same should be shared without addition of it.
| Idli|| |
- Urad dal – 1 katori (soaked for 3–4 h)
- ½-katori cooked rice
- 3-katori idli rava.
- Grind the soaked urad dal with ½-katori cooked rice
- Take the idli rava and mix it with the batter
- Ferment it overnight and this batter can be used to make idlis.
| Dosas|| |
- 2-k rice flour
- ¾-k rava
- Mix and make a batter which can be used to make dosas.
| Rava Idli|| |
- 3-cup sooji/rava (semolina)
- 1-cup curd and 2-tbsp whole-wheat flour
- 4-tbsp poha (powdered using a mixer)
- 1/4th-tsp mustard seeds
- 2-tbsp oil
- Pinch of hing (asafoetida) and 2 sprigs of curry leaves
- Salt as required.
Method of preparation
- Soak rava in curd, adding enough water so that it resembles a typical idli batter. The consistency has to be neither too thick nor too thin. A semi-pouring consistency would be ideal
- Allow the batter to ferment for over 8 h. (Fermentation makes the batter lighter and releases good bacteria, which is good for the human gut.)
- After the batter is fermented, add whole-wheat flour (aata) and powdered poha to the batter. Aata helps to bind the sooji and poha adds texture. In case you do not have poha, you can add powdered kurmura. Heat oil in a pan, add mustard seeds, hing, broken cashew nut pieces, and curry leaves and let it crackle
- Pour the tempering/tadka over the batter. You can even add boiled vegetable puree to your batter. Boiled carrot puree, palak puree, and beetroot puree will make your idlis look colorful and attractive. Add very little salt to the batter
- Steam the idlis
- After the idlis are steamed, allow them to cool a little before demolding
- Serve hot.
| Sponge Cake|| |
- 4 eggs
- 100-g sugar
- 100-g self-rising flour (maida)
- ½-tsp vanilla essence.
- Beat eggs and sugar till thick like custard
- Add maida and mix well by fold method
- Bake in a greased dish in a preheated oven at 180°C–200°C for 20–25 min.
| Role of Albumin|| |
If the patient is leaking proteins, the serum albumin also needs to be monitored and low albumin levels should be corrected; low albumin levels can sometimes cause hypotension.
| Fluid Restriction|| |
Fluid restriction may be required to those patients who are edematous or have a low urine output. It is very important to explain to the patients that fl uid restriction does not mean just restricting water, it implies everything that is fl uid at room temperature.
| Summary|| |
- Dietary protein restriction retards the progression of CKD. However, it should be used only in those who are nutritionally adequate. It should not induce malnutrition
- Restricting protein intake below 0.6 g/kg/day is possible by supplementing essential amino acid or their keto acid (KA)
- By restricting nitrogen intake, there is reduced generation of uremic toxins and thus improvement in symptoms.
- When closely monitored, nutritional status can be maintained.
- In patients without active underlying disease, KA-supplemented diets significantly delay the need for renal replacement therapy.