Q. Important aspect of dietary management during hypertension?

Most important aspect of dietary management i.e. the intake of minerals and electrolytes, which are closely associated with the maintenance of blood volume. Hypervolemia as we know would cause greater pressure on the arteries.

Minerals and Electrolytes: Minerals and electrolytes of clinical significance include calcium, sodium and potassium. Let us read about them one by one.

• Calcium (Ca): Adequate calcium intake is an essential part of the treatment and this could be ensured through intakes of milk and milk products and green vegetable as well as adequate cereals and pulse intakes.

• Sodium: Studies have shown that sodium restriction along with weight reduction is effective in controlling mild to moderate hypertension (1-2 &day) along with diuretics recommended. Depending on the severity of hypertension, different levels of sodium intake can be recommended. These include:

- Mild Sodium restriction: 2-3 g sodium (2000-3000 mg). Salt may be used lightly in cooking, but no salt at the table is allowed. There is no restriction on naturally occurring fresh foods but processed foods should be avoided.

- Moderate Sodium restriction: 1 g sodium (1000 mg). In addition to the above restrictions, some control in naturally occurring fresh foods and no salt in cooking is added. Vegetables with high sodium content are limited in use, canned vegetables and baked products are avoided. Meat and milk products are used in moderate amounts.
 
- Strict Sodium restriction: 0.5 g sodium (500 mg). Apart from the restrictions stated above, meat, milk and eggs are allowed in small portions and vegetables with higher sodium content are avoided.

- Severe Sodium restriction: 0.25 g sodium (250 mg). This level is too restrictive and nutritionally inadequate and realistic to be used practically. In this, restricted quantities of meat and eggs are used only occasionally. Table 11.6 presents details on low sodium foods.

- Potassium: Increasing the potassium content in the diet lowers the blood pressure and improves hypertension. This could be done by increasing fruits and vegetables in the diet, which are rich in both potassium and fibre content.

Fluids: Fluid restriction is necessary only if oedema is present. Dehydration may be observed in some patients on diuretics. Thus, normal amount of fluids especially in the form of plain drinking water can be taken.