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Hypertensive Cardiovascular Disease High blood pressure is commonly seen in most people these days.

But do you know that it has a very close connection with cardiovascular diseases? Read on to learn about hypertensive cardiovascular disease.Hypertensive cardiovascular disease also known as hypertensive heart disease occurs due to the complication of hypertension or high blood pressure. In this condition the workload of the heart is increased manifold and with time this causes the heart muscles to thicken. The heart continues pumping blood against this increased pressure and over a period of time the left ventricle of the heart enlarges and this in turn causes the blood pumped by heart to reduce. If proper treatment is not taken at this stage then symptoms of congestive heart failure may be observed. High blood pressure or hypertension is among the top most factors associated with cardiovascular diseases. This can result in ischemic heart disease. High blood pressure is also a contributing factor to the eventual thickening of walls of blood vessels. This increases the possibility of heart attacks and strokes. Hypertensive cardiovascular disease is among the leading killers in present times. Around 7 people out of every 1000 suffer from this disease. Heredity is an important factor so far as people suffering from hypertension are concerned. Other factors include excessive consumption of salt and excessive stress. Symptoms It usually takes some time for the problem of high blood pressure to eventually lead to hypertensive cardiovascular disease and therefore high blood pressure is often called the silent killer. Eventually hypertensive heart disease can also lead to congestive heart failure. Some symptoms of hypertension and the eventual congestive heart failure include arrhythmias, shortness of breath, weakness and fatigue, swelling in lower extremities and greater frequency of urination during the night. Hypertensive cardiovascular disease may also result in ischemic heart condition and in this case there might be chest pain, sweating and dizziness, nausea and shortness of breath. Hypertrophic cardiomyopathy could also be a result of hypertensive heart disease. Tests Usually the first signal is elevated blood pressure together with a possibility of enlargement of the heart. Fluid within the lungs may also be found in preliminary examination by using the stethoscope and some abnormal heart sounds may also be detected. ECG is ordinarily done and this may show abnormal results in those who have possible hypertensive cardiovascular disease. Evidence of ischemia which is the lack of oxygen in the heart muscle may also be detected. Some other tests ordinarily conducted may include a chest X ray, a CT scan of the chest, echocardiogram and coronary angiogram. Treatment The primary aim of any treatment in hypertensive cardiovascular disease is reduction of blood pressure and then eventual control of the heart disease. The line of treatment will ordinarily depend on the condition such as whether there is angina or acute myocardial infarction. The line of treatment may include beta blockers, angiotensin converting enzyme inhibitors (ACE), calcium channel blockers, diuretics etc depending upon particulars of each individual case. The blood pressure is consistently

required to be checked and kept under control in this condition. Likewise people experiencing hypertensive cardiovascular disease have to make certain changes in their lifestyle and diet patters. These would ordinarily include weight loss where obesity is identified, moderate exercise as per directions of the medical professional and adjustments in the diet. These adjustments would include inake of healthy food including vegetables, fresh fruits and low fat dairy items. Smoking is also a contributing factor to hypertension and therefore these lifestyle changes would have to include the patient quitting smoking. Consumption of fish, whole grains are also recommended. In the long run the outcome largely depends on the possibility and extent of complications. In hypertensive cardiovascular disease the treatment will depend largely on the degree of enlargement of the left ventricle. However some medicines such as ACE inhibitors and others can reverse this enlargement and thereby help in improving the chances of survival in the patients in the long run.

Reducing Hypertensive Cardiovascular Disease Risk of African Americans with Diet: Focus on the Facts
Molly E. Reusser* and David A. McCarron,2

Hypertension is more common and more severe in African Americans than in other population groups in the United States, placing them at increased risk of cardiovascular disease, stroke, and end-stage renal disease. Whereas past efforts to reduce blood pressure (BP) via the diet centered on manipulating isolated nutrients, there are now conclusive data demonstrating that it is not single dietary components but the overall dietary pattern that has the greatest influence on BP. A nutritionally complete diet rich in fruits, vegetables, and low-fat dairy foods has been clearly proven to significantly lower BP in all population groups. This diet, commonly referred to as the Dietary Approaches to Stop Hypertension (DASH) diet, has been tested in randomized, controlled trials emphasizing African American populations and documented the greatest beneficial effects in hypertensive African Americans. Improving diet quality has been shown to be simply implemented without adverse effects such as symptoms of lactose maldigestion. It is also known to beneficially affect other cardiovascular risk factors and is in keeping with dietary recommendations for prevention of some cancers and osteoporosis. This paper reviews the current data relating dietary patterns to BP control, and advocates dietary recommendations that can accomplish their intended objective of enhancing the health of Americans by promoting safe, feasible, and proveneffective means of doing so. In the case of hypertension prevention and treatment, and thus the reduction of cardiovascular disease risk, overall diet quality should be the primary focus of nutritional recommendations. In search of the dietary culprit. Diet has long been known to participate in the development of high BP, and until recently, sodium had been considered the primary dietary cause of hypertension. Other dietary components have been implicated as well and, though not to the extent of sodium, have been studied extensively in efforts to assess the degree and the potential mechanisms of their influence (reviewed in 3). However, similar to sodium, these studies have yielded inconclusive and often conflicting results, consistent only in their inconsistency. One likely explanation for this is heterogeneity of BP responses, which is known to be a hallmark of single-nutrient interventions; although many individuals may experience favorable BP responses to a specific dietary manipulation such as increased calcium or decreased sodium, others may respond negatively and still others not at all (10,11). As a result, the available data are widely varied and often perplexing, as has been their selective use over the years in the development of national dietary recommendations for hypertension prevention and management. No single nutrient lowers blood pressure. Dietary nutrients are not ingested in isolation but as combined constituents of a complete diet and function interactively in the body and in their impact on BP regulation. Because nutrients express their physiologic actions through integrated pathways, it is unrealistic to expect a uniform benefit in terms of BP control from modifying the intake of a single nutrient. The concept that it is the adequate intake of multiple nutrients consumed in combination, rather than the intake of any single nutrient, that influences BP regulation exists throughout the nutrition literature. In 1984, based on our analysis of diet and BP from the first National Health and Nutrition Examination Survey database (2), we concluded that use of the diet for the management of high BP should emphasize consumption of a diet balanced in all the essential nutrients. More recently, in a cross-sectional assessment of the BP effects of various dietary micronutrients in 180 African American and Hispanic adolescents at high risk for hypertension, Falkner et al. (12) found lower BP in those with higher dietary intakes of multiple nutrients. Noting that there were no differences in sodium intake or weight between the study groups, these investigators concluded that diets rich in a

combination of nutrients derived from fruits, vegetables, and low-fat dairy products could contribute to primary prevention of hypertension when instituted at an early age. The DASH-sodium trial. A second DASH study, DASH-Sodium, was done to examine the BP effects of the DASH diet in combination with reduced sodium intake (17). Two diets were used in this study, the DASH diet, emphasizing fruits, vegetables, and low-fat dairy, and a typical American (control) diet, low in those foods and higher in fat, cholesterol, red meat, and sugars. Participants (n = 412) were randomly assigned to 1 of the 2 diets, and consumed them with sodium content at high (150 mmol/d), moderate (100 mmol/d), and low (50 mmol/d) levels for 30 d each. Compared to the high-sodium control diet, the lowsodium DASH diet resulted in decreases in systolic BP of 7.1 mm Hg in normotensive persons and 11.5 mm Hg in those with hypertension. In this study, persons regularly consuming diets of poor nutritional quality experienced BP reductions as seen in the first DASH study with lowered sodium intakes. Oddly, the authors and commentators argued that the combination of the DASH diet and severe salt restriction produced the optimal BP for all individuals regardless of BP status, ethnicity, age, etc. (17). However, once participants were consuming the nutritionally replete DASH diet, restricting dietary sodium levels contributed little or no additional benefit to BP in the vast majority (6). With the exception of older persons and African Americans with established hypertension, most study participants consuming the DASH diet alone realized optimal BP benefits. Thus, simply improving diet quality, with the daily consumption of 34 servings of dairy foods and 79 servings of fruits and vegetables, virtually eliminated any effect of salt on BP. This finding from the DASH-Sodium Trial is noteworthy because the study population was heavily skewed toward persons known to be more likely to express salt sensitivity. The study population comprised primarily African Americans, many of whom had hypertension and were significantly overweight, all factors that should have made the effects of salt on BP more evident. However, once on the DASH diet, just the reverse was observed: salt sensitivity was eliminated except in a very small percentage of participants. Thus, DASH-Sodium demonstrated that a diet containing the full complement of nutrients, including the mineral profile available primarily through dairy products (calcium, potassium, magnesium, phosphorus), can mitigate the negative effects of high salt intake on BP in salt-sensitive persons, including high-risk populations such as African Americans. Nearly 25 y of research, culminating in the striking results of the DASH trials, have confirmed the direct relationship between diet quality and BP management, and CVD risk. In addition to improvements in BP, high-quality diets have been shown to lower coronary heart disease and stroke incidence. Adoption of a nutrient-rich dietary pattern is associated with no side effects, can be practiced at reasonable cost and minimal complexity, and can effectively improve multiple medical conditions within a short time period and be sustained indefinitely. There is no single-nutrient manipulation that can confer this constellation of benefits. With their much higher burden in terms of hypertension and cardiovascular disease compared to whites, African Americans could likely realize the greatest gains from improved diet quality. Although other approaches may improve single conditions in certain individuals, emphasis on these cannot achieve what dietary guidelines are intended to achieve; rather, this misplaced emphasis serves only to divert time, effort, and money away from patients, healthcare providers, and taxpayers that could be directed toward proven practices with population-wide benefits. It is incumbent on nutrition policy makers in this country to base dietary recommendations on the strategies that have the greatest likelihood of accomplishing the purposes for which they exist. Because of its simplicity, feasibility, safety, and clearly proven and multiple health benefits, improved diet quality should be the focal point of lifestyle recommendations for BP management.