ENVIRONMENTAL FACTORS in HYPERTENSION Evidence from various sources and studies, suggests that the environment plays an important

role in the genesis of age-related increases in blood pressure and in the occurrence of hypertension. An unhealthy diet including an excessive sodium intake, insufficient potassium intake, High fat content, insufficient fruits and vegetables and alcohol consumption are the leading causes of hypertension.

Dietary Patterns A predominantly vegetarian dietary pattern is often present to those cultures that have low blood pressure. Epidemiological studies suggest a variety of possible dietary changes to reduce blood pressure. The strongest evidence is for fruits and vegetables. Salt Intake Epidemiological data suggest a threshold relation between sodium intake and hypertension: those who ingest less than the amount required for a hypertensionogenic effect of sodium do not develop hypertension. Those who ingest more than the threshold amount will develop hypertension if they have the requisite genetic make up or they are exposed to other interacting, adverse environmental factors. Once above the threshold the relationship tends to be linear. Yet the threshold may be different for different populations . Those who tend to be salt sensitive like the elderly, overweight type II diabetics or those of African descent, tend to have lower renin levels and a lesser pressor response to sodium to deprivation.

Potassium, Calcium and Magnesium Cross-sectional studies in many countries have identified an inverse relationship between blood pressure and various measures of potassium intake. Epidemiological studies also support the suggestion that potassium deficiency may play a special role in the high incidence and prevalence of hypertension in blacks and in the elderly. In many clinical studies, increased potassium intake reduces both systolic and diastolic blood pressure. According to a meta-analysis on the effect of potassium on blood pressure (2069 participants) the net decrease in systolic blood pressure and diastolic blood pressure were 3.11 and 1.97 mmHg respectively comparing the potassium supplementation and control groups. The median dosage of potassium was 75 mmol/day. A meta-analysis sowed that there is an inverse association between blood pressure and dietary calcium intake. It has also been suggested that calcium supplementation reduces systolic blood pressure but not diastolic blood pressure.

It has been hypothesized that in the presence of magnesium depletion, intracellular calcium rises and leads to a contraction of smooth muscles and skeletal muscles, along with a rise in blood pressure. However, the body of evidence implicating magnesium as a major determinant of blood pressure is limited and inconsistent.

ALCOHOL Alcohol consumption is one of the most consistently observed epidemiological factors associated with hypertension among the known potentially modifiable risk factors. Above an average intake of two alcoholic drinks per day, the higher the intake, the higher the blood pressure. This relationship persists as an independent effect even when age, body mass, sodium and potassium excretion or intake, cigarette smoking and education are controlled for and has been demonstrated in whites, blacks and Asians.

Reference: ENVIRONMENTAL FAACTORS AND HYPERTENSION A Clinical Review Tai Chung Lam, Bernar My Cheung Medical Progress November 2001