Application of nutritional diet care in patients with hypertension

Nutritional dietary care is the most cost-effective and least adverse reaction core method among non-drug intervention programs for hypertension. Domestic and foreign evidence-based medicine data show that patients with essential hypertension who strictly adhere to scientific dietary adjustments will have first-grade hypertension (systolic blood pressure 140-159mmHg, comfortable). People with systolic blood pressure of 90-99mmHg can achieve a 4-8mmHg reduction in systolic blood pressure. More than 70% of mild patients can be weaned from drug treatment. Patients with grade two and above hypertension can also reduce the dosage of 1-2 antihypertensive drugs, while reducing the risk of cardiovascular and cerebrovascular complications.

I have been working at a community chronic disease management center for almost 8 years. The one who impressed me the most was Aunt Zhang, 58 years old, who came to see a doctor last year. She felt dizzy while dancing and went to have her blood pressure measured, which was 152/96mmHg. She was afraid that taking medicine would damage her liver and kidneys, so she refused to take antihypertensive medicines at any cost. We made a tailor-made diet adjustment plan for her, but she didn’t let her go. She completely avoided eating her favorite pickled pork belly, but only reduced the amount per serving from half a catty to 100 grams, eating it once a week at most, using a salt-limited spoon for cooking, and replacing the usual pickles with fresh cold cucumbers. When she checked again after 3 months, her blood pressure was stable at 138/84mmHg, and even the dizziness she often suffered before did not appear again.

Many people’s first impression of a high blood pressure diet is to add less salt. This is true, but there are too many ways to do it in practice. For example, the low-sodium salt debate has been fierce in the past two years. One group says that low-sodium salt can reduce sodium intake while replenishing potassium, and the blood pressure-lowering effect is much better than ordinary salt. The other group says that low-sodium salt contains high potassium, and eating it will cause hyperkalemia, which is dangerous. In fact, both statements are correct, but the applicable groups are different - patients with normal kidney function and no risk of high potassium can completely replace ordinary table salt with low sodium salt, and the blood pressure lowering effect can be increased by 2-3mmHg. However, if you have chronic kidney disease or are taking regular meals Patients taking steroid and sartan antihypertensive drugs must not take low-sodium salts. Previously, we had an old patient at our station, Uncle Li, whose kidney function was slightly abnormal. He heard from his neighbor that low-sodium salts were good, so he switched to low-sodium salts. After taking it for 3 months, his blood potassium was nearly 1 unit above the normal value, which shocked him greatly.

Moreover, most patients think that salt restriction means adding less salt to cooking. In fact, the invisible salt you eat unknowingly every day is the hardest hit area when your blood pressure cannot be lowered. These invisible salts are like blood pressure killers hiding in the dark. If you don't notice them, they secretly raise your blood pressure. Last month, a 29-year-old programmer came to see a doctor. He said that he used a salt-limited spoon when cooking at home every day and strictly added 3 grams of salt. After eating for more than half a year, his blood pressure was still stable at 150/100mmHg, and he could not get it down no matter what. When I asked him about his daily diet, he drank two cups of 3-sugar pearl milk tea every day at work, and ordered a pack of braised duck wings as a snack in the afternoon. The sodium content of these two items alone exceeded the daily recommended 2,000 mg (that is, 5 grams of salt), so the salt added to cooking was nothing. The stuffed buns, sausages, plums, and even the candied fruits in the chrysanthemum tea you usually eat are all hiding places for invisible salt. If you only focus on the salt shaker for cooking, it is like picking up the sesame seeds and losing the watermelon.

Let’s talk about what everyone often said before: “You can’t eat red meat if you have high blood pressure.” This is also an old misunderstanding. Nutritional guidelines in previous years did require patients with high blood pressure to strictly limit their intake of saturated fat, and it is best not to eat pork, beef, and mutton at all. However, new research in the past two years has found that as long as the total amount is controlled, eating lean red meat appropriately will not increase blood pressure, but can prevent patients from developing iron deficiency anemia due to a complete vegetarian diet. When we make a plan for patients now, we will clearly say that they can eat lean pork or beef twice a week, about 100 grams each time. Compared with the previous requirement to be completely vegetarian, the patient's compliance is more than twice as high. After all, no one wants to eat cabbage every day. Only a plan that can be eaten is effective.

The current industry-recognized antihypertensive dietary pattern is the DASH diet, which means eating more whole grains, fresh fruits and vegetables, and low-fat dairy products, and eating less sweets, red meat, and high-fat foods. However, you don’t have to copy it completely. I often tell patients that they don’t have to eat things they don’t like to meet the requirements of DASH. For example, for patients with gastric ulcers, if their stomach hurts after eating raw cold fruits and vegetables, they can switch to steamed pumpkins or boiled tomatoes. Even if the nutrients are lost a little, it doesn't matter. It's better than having a stomachache and never wanting to touch it again. There are also elderly patients with bad teeth who can't chew raw celery, so they can make celery stir-fried and dried, and the effect is not much different.

I have been doing chronic disease care for so many years, and my biggest feeling is that many patients cannot do well in dietary care. It is not because they don’t understand the truth, but because they pursue perfection too much. For example, today I couldn't help but go out for a hot pot meal with my friends. I ate two more mouthfuls of tripe and drank half a glass of iced Coke. I felt that all my efforts had been wasted, so I just broke the pot and ate hazelnuts for the next half month. It was completely unnecessary. An occasional overdose will not have much impact on blood pressure at all, as long as you control it a little in the next few days, compliance is always more important than perfect execution.

In the final analysis, nutritional dietary care is never about making a cold "fasting list" for patients with high blood pressure, nor is it asking everyone to eat according to the same template. It is about adjusting each person's taste preferences, basic diseases, and living habits to adjust a diet plan that he can stick to for a long time. After all, lowering blood pressure is a lifelong thing. You can’t not eat what you like for decades, right? Care that can be sustained comfortably is good care that can really help patients.