Introduction

High blood pressure (hypertension) is a chronic medical condition in which normal force of

blood additionally pressures walls of the arteries. Additional force of blood occurs as a

consequence of either higher blood volume or reduced arterial lumen. Both factors may be

caused by hormonal or kidney disorders as well as numerous lifestyle factors such as stress,

obesity, lack of exercise, alcohol, smoking and diet. Considering the abovementioned, I chose to

follow the Dietary Approach to Stop Hypertension DASH diet in order to structure a diet plan

to prevent hypertension, mainly because of the mechanisms behind the food promoted by the

DASH diet.

Sodium Intake

Two DASH diets are available, one which limits consumption of sodium to less than 2300 mg a

day and another that limits sodium intake to 1500mg. I was indecisive which type to follow, as

the research papers are controversial. A study by Stolarz - Szkrzyp et al (2012) mentioned that in

the case of optimal kidney function, sodium is not a threat in terms of causing hypertension.

Despite that, evidence in research done by Feng et al (2012) contribute to the claim that dietary

sodium intake directly increases blood pressure, regardless of the kidney function. Their study

suggests the additional reduction of sodium to 1200 mg -1600 mg (Feng et al 2012). With

respect to another study done by Frizoli et al (2011), which explains that the reason for increased

blood pressure, when considering lifestyle factors, is not necessarily sodium intake only, I

decided to go for the standard DASH diet that includes 2300 mg of sodium per day. The standard

DASH diet allowed me to have a greater choice of groceries, and helped me structure a more

acceptable menu. It is worth mentioning that none of the studies is neglecting the chemical

relation which links sodium and water retention. Positively charged sodium attracts polar water

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molecules, which causes water retention. Furthermore, retained water causes higher blood

volume and thus raises the blood pressure. According to Stolarz- Szkrzyp et al (2012), in the case

of optimal kidney function, the blood pressure is increased only temporarily. In spite of the fact

that I chose the standard DASH diet, I tried to keep the sodium intake as low as possible. On the

other hand, I made an effort to structure a tasteful menu. Therefore, I added spices like parsley,

garlic and olive oil in order to replace table salt. A mayor limitation that I found following the

DASH diet is that it does not specify the use of spices. People are most likely to use high sodium

spices and if this is left to the patient, I would stress it as a huge limitation of the diet.

Garlic itself has the ability to decrease the blood pressure over couple of well-established

mechanisms. One mechanism includes anti-inflammatory abilities of garlic by modulating

cytokines in human blood. Another mechanism involves derivates of organic polysulfides which

are converted by erythrocytes into hydrogen sulfide - a powerful vasodilator (Ginter & Simko

2010). Finally, garlic has the ability to stimulate the nitric oxide generation in endothelial cells.

Nitric Oxide

Nitric oxide improves blood flow reducing the blood pressure by widening the blood vessels.

Lean et al (2012) recently showed that the DASH diet contributes to the bioavailability of nitric

oxide. Increased nitric oxide production may be a consequence of increased antioxidants. In the

case of high concentration of antioxidants, more nitric oxide produced would be oxidised to

nitrite rather than peroxynitrite and nitrate; this mechanism was established in study of Kojsova

et al (2006), and lately showed by Lean et al (2012). The DASH diet boosts antioxidant intake as

it recommends 4-5 portions of fruits, and the same amount of vegetables a day. I included the

required amount of fresh fruits and vegetables in the diet plan, but my biggest problem

structuring a menu plan was how to add all required fruits and vegetables in the menu and avoid

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a large number of snacks. Considering the fact that my patient is not an obese person I had a fear

that the number of meals would scare him, adding too many obligations to his diet. In addition to

that, I added fresh apple and banana in yoghurt as a part of homemade muesli, despite being

aware that some people may experience bloating feeling after mixing fructose with other food

(Friedman 1989). However, fruits could be eaten separately either before or at least two hours

after a meal that contains nutrients with longer digestion time.

Proteins

Structuring a one-day menu I used animal, vegetable and milk protein sources. Recent study by

He et al (2011) shows beneficial use of all protein sources and suggests replacing carbohydrate

sources with proteins in a treatment of hypertension. Beneficial effect of proteins might be due to

the high L-arginine content. L-arginine is a precursor of nitric oxide and therefore another

contributor in lowering the blood pressure (Gokce 2004). In addition to that, I added more rich

sources of L-arginine: chicken, sunflower seeds, pumpkin seeds and almonds.

Saturated and Trans Fats

Using only lean meat, poultry and fish, the DASH diet significantly reduces saturated and trans

fats. Lower saturated and trans fats contribute to reduction in the blood pressure indirectly by

reducing obesity and Low Density Lipoprotein (LDL) level. Obesity results in increased cardiac

output and blood volume which, consequently, further increases the blood pressure (Lavie et al

2009). Saturated and trans fats directly increase serum LDL level, which is a main contributor of

fatty plugs. Fatty plugs narrow arterial walls contributing to hypertension. On the other hand,

omega 3 fatty acids reduce blood viscosity, enhancing vasodilation and reducing aggregation of

thrombocytes (Iso et al 2006). I added seabass and flex seeds as rich sources of omega 3 fatty

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acids and strictly avoided any sources of red or processed meat. Next to the beneficial omega 3

fatty acids seabass is also high in magnesium. A study done by Swaminanthan (2003) showed

that magnesium deficiency increases aggregation of thrombocytes, contributing to blood

viscosity. Blood viscosity increases with respect to the increased amount of fibrinogen in the

blood. Fibrinogen is a strong indicator of blood coagulation. Viscous or thicker blood is more

resistant to flow and directly contributes to higher pressure of the blood against the walls of

arteries (Coban et al 2004). A study done by Azadbakth et al (2011) states that there was a

reduction in plasma fibrinogen level after implementing the DASH diet for 8 weeks. The

mechanism by which the DASH diet reduces fibrinogen is probably lower saturated, trans fat

intake as well as higher omega 3 fatty acids and magnesium intake.

Minerals and Blood Pressure

Apart from antioxidants, whole grains, fruits and vegetables bring one more strong contributor in

lowering the blood pressure - potassium. The abovementioned study by Lean et al (2012)

observed but did not spot the clear evidence of potassium benefits. However, a study done by Commented [E1]: Ne razumem bas ovaj glagol na ovom mestu
(observe but did not spot)?

Tayo et al (2012), which has done research on 2704 individuals, showed a positive effect of

potassium regulating hypertension. Their study shows that potassium promotes natriuresis,

excessive excretion of sodium in the urine. Taking into account the small group that was

observed in the first study, I decided to go for potassium-rich food while structuring one-day

menu plan. Taking into consideration the fact that potassium/sodium balance is important in

regulating the blood pressure, another reason for adding more of potassium-rich food was a

consequence of my first decision to go for the standard DASH diet, with a higher amount of

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sodium. In addition to that, I chose parsley, banana, spinach, pineapple, pumpkin seeds and

yoghurt.

Diary Intake

Yoghurt has multiple benefits in lowering the blood pressure. Apart from the abovementioned

potassium content, Lactobacillus helveticus found in fermented milk has a positive effect in

regulating fluid balance (Yamamoto et al 1994). Lactobacillus helveticus inhibits Angiotensin

Converting Enzyme (ACE). ACE has a pivotal role in Renin-Angiotensin system (RAS), a

hormonal system that regulates fluid balance and therefore the blood pressure. Angiotensin I is

able to be converted into angiotensin II; this conversion occurs in the liver only in the presence

of ACE. Angiotensin II is a strong vasoconstrictor and it affects the release of aldosterone.

Aldosterone further increases absorption of sodium and water, which leads to increased blood

volume and thus elevated blood pressure. Other diary proteins are also beneficial in lowering the

blood pressure, due to the opioid-like effect on the arteries. . The DASH diet recommends 2-3

portions of low fat or non fat diary daily. Taking everything into consideration, I decided to go

for three servings of diary per day.

Next to the diary intake, when treating hypertension, calcium intake should also be considered. Commented [E2]: Ne razumem sta bi ovo trebalo da znaci

There are some conflicting opinions about calcium intake in hypertensive individuals. Dickinson

et al (2006) show beneficial effect of calcium in reducing the blood pressure, while Blacher et al

(2001) claim that additional calcium contributes to calcification, a process in which calcium salts

build up in the soft tissue leading to hardening of the arterial walls, and contributing to the

increase in the blood pressure.

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Conclusion

Considering the fact that lifestyle has a great impact on the reduction of the blood pressure, a

number of recent researches urge medical professionals to promote lifestyle changes rather than

medications when preventing or curing hypertension in its early stages. Dietary Approach to

Stop Hypertension is a powerful method in regulating the blood pressure. Current instructions

certainly contribute to lowering the blood pressure; however, more specific instructions in the

direction of spices, type of fruits and vegetables, would definitely contribute to even more

efficient results.