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A succinct overview of the nutritional management of hypertension, past, present, and future is presented. Prior to 1945, the low sodium diet and the rice-fruit diet were shown to be effective in reducing the blood pressure to normal levels in 35-40% of hypertensive patients. Between 1945 and the present, many studies were made on the effects of alcohol, water hardness, obesity, moderate restriction of sodium with increased potassium intake, increased dietary calcium, low animal and high unsaturated fat intake, and increased amounts of fiber in the diet. Criticisms are made of the very small magnitude, even if statistically significant, of blood pressure decreases and the too-short control periods in many instances, and also concerning the assumption of use of 24-h urinary sodium as an accurate index of the sodium intake, and of urinary creatinine as a physiological reference standard against the excretion of sodium. The author mentions, for possible future research, long-term studies of the effects of diets moderately restricted in sodium and high in potassium, of reducing weight and increasing physical activity in obese hypertensives, and of low animal and high polyunsaturated fat diets in patients with mild essential hypertension.
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PMID:Nutritional management of hypertension: past, present, and future. 375 39

Meteneprost potassium, a PGE2 analogue, was evaluated in thirty non-pregnant women for use as a prospective cervical dilator and softening agent. No significant change in cervical dilation was noted. A significant relationship between obesity and side effects was observed.
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PMID:Evaluation of meteneprost potassium (a PGE2 analogue) for cervical dilation and side effects in nonpregnant women. 376 45

In a blood pressure screening program involving 6589 high school students, 180 male (4.7%) and 17 female (0.6%) students were identified as borderline hypertensive. The 174 hypertensive male adolescents studied further showed pathophysiological features such as a significantly higher frequency of obesity, higher 24-hour urinary sodium excretion, higher hematocrit value, higher sodium and lower potassium concentration in red blood cells, and higher ouabain-sensitive sodium efflux compared with the control group (231 male students; p less than 0.05). When used alone, the ordinary 10-week period of counseling about a low salt diet failed to significantly reduce the blood pressure of hypertensive students. However, when education and counseling efforts were combined with self-monitoring of salt (chloride) excretion in overnight urine samples using a new salt titrator tape developed in our laboratory, 24-hour urinary sodium excretion, weight, and blood pressure decreased significantly over 10 weeks (mean reduction: 52 mEq/day for 24-hour urinary sodium excretion, 1.7 kg for weight, 12/7 mm Hg for blood pressure). These results indicate that blood pressure of borderline hypertensive adolescents could be effectively reduced with this nonpharmacological method of dietary education. Such systematic management might be of importance for the prevention of essential hypertension.
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PMID:Management of hypertension in high school students by using new salt titrator tape. 379 98

Hypertension is the most important known risk factor for stroke. Clinical, experimental, and epidemiologic evidence suggests that a high dietary intake of potassium is associated with lower blood pressure. In hypertensive rats, a high intake of potassium is reported to protect against stroke, even though blood pressure is not affected. We examined the relation between the 24-hour dietary potassium intake at base line and subsequent stroke-associated mortality in a population-based cohort of 859 men and women (aged 50 to 79 years) in Southern California. After 12 years, 24 stroke-associated deaths had occurred. The relative risks of stroke-associated mortality in the lowest tertile of potassium intake, as compared with that in the top two tertiles combined, were 2.6 (P = 0.16) in men and 4.8 (P = 0.01) in women. In multivariate analyses, a 10-mmol increase in daily potassium intake was associated with a 40 percent reduction in the risk of stroke-associated mortality (P less than 0.001). This effect was independent of other dietary variables, including the intake of calories, fat, protein, fiber, calcium, magnesium, and alcohol. The effect was also apparently independent of known cardiovascular risk factors, including age, sex, blood pressure, blood cholesterol level, obesity, fasting blood glucose level, and cigarette smoking. These findings support the hypothesis that a high intake of potassium from food sources may protect against stroke-associated death.
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PMID:Dietary potassium and stroke-associated mortality. A 12-year prospective population study. 379 1

A nutrition curriculum for 48 students age eight-18 years with high blood pressure was implemented in Franklinton, La., as part of A Dietary/Exercise Alteration Program Trial (ADAPT), a model promoting reduced sodium (Na+) and energy intake and increased potassium (K+) intake. A teacher guide listed basic concepts, teacher and student activities, materials, behavioral outcomes, and evaluation for 12 lessons at three age levels. Games were used to present new information and increase student involvement. Taste-tests promoted attitude change regarding acceptable snacks. Decision-making and assertiveness topics facilitated independent food choices and coping with peers. Self-monitoring of intakes encouraged personal responsibility for eating behavior. Results of paired t-tests showed knowledge increased 8.7% in the spring (p less than 0.01), 4.9% in the summer (N.S.), and 7.3% in the fall (p less than 0.0001). No significant differences in increase in posttest scores by age were found. Comparisons of curriculum compliance with medication use and blood pressure change showed no relationship. A multiple regression analysis of sodium-creatinine (Na+/Cr) ratios on class attendance and posttest scores showed that children with the highest test scores had lower Na+/Cr ratios. This program increased information and skills for those motivated to change lifestyle to control obesity and blood pressure.
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PMID:A nutrition curriculum for families with high blood pressure. 384 57

Pubertal juvenile dyspituitarism (PJD) is one of the common types of obesity in adolescents. Literature data on the involvement of the renin-angiotensin-aldosterone, hypophysis-adrenal cortex system in the formation of this syndrome are of controversial nature, and the pathogenesis of the development of arterial hypertension in PJD is obscure in many respects. The purpose of the study was to investigate the activity of plasma renin, potassium and sodium in the blood serum as well as the excretion of potassium and sodium with daily urine in PJD patients. A total of 148 PJD patients aged 14 to 21 were examined, of them 22 had exogenous constitutional obesity. The control group was composed of 54 healthy persons of the same sex and age. Electrolyte metabolic derangement, an increase in the ACTH level and hyperaldosteronemia were shown to play a certain role in the development of arterial hypertension in PJD. The above changes developed in the presence of disordered interrelationships in the hypophysis-adrenal cortex, renin-angiotensin-aldosterone system.
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PMID:[Pathogenesis of arterial hypertension in puberal juvenile dyspituitarism]. 390 40

A multiple regression analysis was performed on statistically independent factors derived from blood pressure measurements and possible predictive variables in 618 Utah adults. Nine blood pressure factors obtained in a previous study composed the dependent variables; 35 anthropometric, questionnaire, and biochemical variables were reduced by factor analysis to 10 factors and used as independent variables. Body size and obesity had significant independent effects on different types of blood pressure: body size correlated most highly with systolic blood pressure, while obesity correlated most highly with sitting diastolic blood pressure measurements. Smoking did not correlate with sitting blood pressure but did show a significant positive correlation (after controlling for obesity) with tilt and supine diastolic pressure. Alcohol consumption correlated positively with sitting diastolic pressure when the effects of body size and obesity were controlled. No correlations were found between urinary potassium or sodium excretion and any blood pressure factors, but a significant positive correlation was seen between plasma sodium concentration and several different types of diastolic blood pressure measurements. Psychological stress showed a significant independent positive correlation with systolic blood pressure measurements that was strongest in adults over 35 years of age. The multiple correlation values for the multiple regression equations ranged from 0.19 to 0.52.
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PMID:Factor analysis suggesting contrasting determinants for different blood pressure measurements. 394 76

A prospective study has been carried out to determine the causes of death and risk factors for survival in 4994 patients referred with a diagnosis of hypertension to hospital specialist clinics and 457 patients treated by their general practitioners for this condition. At the time of entering the prospective study, 69% of the patients were already being treated for hypertension. Four hundred and eleven patients have died, and their causes of death and death rates have been compared with the rates for the population of England and Wales. Ischaemic heart disease accounted for over one-third of the deaths and stroke for one-fifth. The death rates for these conditions were two to five times those expected for men and women aged 50-59 years and up to twice the rate expected for the age group 60-69 years. Survival in these selected patients was impaired by the following independent risk indicators: cigarette smoking, previous history of myocardial infarction or stroke, diagnosis of angina, impaired renal function and raised blood sugar. The following factors were not independent positive risk factors: smoking a pipe or cigars, obesity, a low plasma potassium and an elevated serum uric acid.
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PMID:The survival of treated hypertensive patients and their causes of death: a report from the DHSS hypertensive care computing project (DHCCP). 395 86

Data from the first Health and Nutrition Examination Survey were analyzed with multivariate statistical techniques to determine whether there was evidence for a contributory role of alcohol in hypertension and to provide a suitable perspective on the importance of nutrient variables compared with other established risk factors for hypertension. The results of these analyses reaffirm the importance of alcohol and sodium intakes on blood pressures among US adults. Potassium (inversely) and phosphorus (directly) were also identified as important nutrient predictors of higher systolic blood pressure. Calcium intake was significantly related to systolic blood pressure only among nonwhite men and was not a significant predictor of systolic pressure overall. In addition, the results of the study reemphasized the paramount importance of age, race, and obesity in determining hypertension. Current nutrient intakes, by comparison, are relatively less important.
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PMID:Alcohol, nutrient intake, and hypertension in US adults. 397 35

A weight-height index of adiposity should indicate the relative fatness of subjects of differing height unless obesity is itself correlated with height. The average body fat among adult women attending a hospital outpatient clinic for obesity was 40.5 percent of body weight. The height of an unselected series of 286 of these outpatients was found to be similar to that of the general population of women of similar age, which indicates that obesity in adult women is not significantly related to height. Body composition was measured by body density, body water and body potassium in a series of 104 female and 24 male subjects aged 14-60 years. In both sexes density, water and potassium gave progressively higher estimates of body fat (kg), and there was a significant difference between the values by different methods. The average of the estimates by these three methods was taken to be the 'true' value for each individual (F kg). Regression of F/H2 on W/H2 (Quetelet's index) gave a correlation coefficient of 0.955 for women and 0.943 for men. The deviation of the body fat estimated from Quetelet's formula from the 'true' value was not much greater than that when density, water or potassium were used as a basis for estimating body fat. It is concluded that Quetelet's formula is both a convenient and reliable indicator of obesity.
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PMID:Quetelet's index (W/H2) as a measure of fatness. 403 Jan 99


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