Effectiveness of DASH Diet to Diminish Hypertension in Hispanic Population
Arterial hypertension is probably the most studied disease. There is sufficient evidence about its etiology, pathogenesis, manifestations, and methods of treatment. Nevertheless, hypertension is extremely prevalent. The work of the healthcare community is directed at decreasing the prevalence of hypertension and its complications. All doctors strongly recommend analyzing and changing lifestyle regardless of the severity of hypertension and the risk group. This paper discusses the prevalence rate of hypertension in the United States and different cultural groups, the main causes of high blood pressure in people aged above 40 years, treatment methods, and the usefulness of the DASH diet.
Fryar, Ostchega, Hales, Zhang, and Kruszon-Moran (2017) analyzed the prevalence of hypertension in the US in 2015-2016. They defined the prevalence of the disease, which was 29%, and its correlation to age. According to Fryar et al. (2017), 33% of individuals age 40-59 and 63.1% of people above the age of 60 suffer from the disease in the US. The prevalence of hypertension among men and women was almost equal, 30.2% and 27.7% respectively.
|Age group (years)||Total (%)||Men (%)||Women (%)|
|18 and over||29,0||30,2||27,7|
|60 and over||63,1||58,5||66,8|
According to Fryar et al. (2017), in the US, every third person above the age of 18 has hypertension, which is equally common among men and women. The risk of the disease increases with age. Thus, at the age of 18 to 39, men and women have similar prevalence. However, it rises among men at the age 40-59 and among women aged 60 and more.
America’s Health Rankings (2017) reported about high blood pressure in the US in 2017. According to this research, the percentage of hypertensive individuals aged 18 and over did not change significantly from 2012-2017. Men had a higher frequency of hypertension than women (33.7% and 30.2% respectively). The authors also studied the prevalence of high blood pressure in different age groups. The prevalence was 13.5% in people aged 18-44; 40.1% in those aged 45-64, and 61.6% in patients older than 65. Additionally, it is remarkable that the prevalence of high blood pressure increased from 22.2% in 1996 to 30.9% in 2017.
According to this data, since 2012, the number of individuals with high blood pressure has not changed significantly. Men are more frequently diagnosed with hypertension than women. Almost half of people aged 45 and over have high blood pressure. In the last 11 years, the frequency of hypertension increased by 8.7%.
Analyzing these sources, every third person aged 18 and over has hypertension in the United States. This tendency persists since 2012. Men suffer from high blood pressure more frequently than women. Although women usually develop hypertension at the age of 60 and over, the prevalence of hypertension increases with age in both sexes.
Additionally, scholars describe the prevalence rate of hypertension within different cultural groups. For instance, Fryar et al. (2017) examined the frequency of high blood pressure among non-Hispanic black, non-Hispanic white, non-Hispanic Asian, and Hispanic adults. It was 40.3%, 27.8%, 25.0%, and 27.8% respectively. In addition, the rate of hypertension ranged depending on the sex. Thus, according to the study, the disease affected 40.6% of non-Hispanic black adult men, 29.7% non-Hispanic white men, 28.7% non-Hispanic Asian men, and 27.3% Hispanic men – 27.3%. In females, the frequency was 39.9% among non-Hispanic black, 25.6% non-Hispanic white, 21.9% non-Hispanic Asian, and 28.0% Hispanic adults.
According to this research, hypertension is more frequent among non-Hispanic black individuals. Its prevalence is almost twice higher than in other cultural groups. There is no significant difference in the prevalence of hypertension among male and female US Hispanic people. Non-Hispanic black men are diagnosed with hypertension more often than other cultural and sex groups. The disease was also more common in non-Hispanic black women compared to other cultural groups. Non-Hispanic Asian women had the lowest rate of high blood pressure.
The authors of the annual report by America’s Health Rankings (2017) described the prevalence of high blood pressure among a wide range of cultural groups. Thus, hypertension affects 35.4% of Americans Indian, 20.6% of Asians, 40.5% of Black, 27.4% of Hawaiian/Pacific Islanders, 23.2% of Hispanic, and 33.4% of White adults. The results of this research match with the previous source. The prevalence of hypertension is the highest among non-Hispanic black and the least among non-Hispanic Asian people.
Kaiser Permanente (2018) published their research describing ethnic differences in the frequency of high blood pressure. They studied over 4 million people in the US. In the research, hypertension was diagnosed in 46.0% of African-Americans, 44.7% Native Hawaiians, 40.4% Asians, 37.3% American Indians, 34.9% non-Hispanic whites, and 34.3% Hispanics.
The highest prevalence of hypertension in both resources had people of African-American origin. Its prevalence among individuals of Asian origin was different in Kaiser Permanente’s (2018) study and America’s Health Rankings report (2017) (40.4% and 20.6% respectively). There is also a significant difference between the prevalence of high blood pressure among Asian adults: 44.7% in Kaiser Permanente compared to 27.4% in America’s Health Rankings report.
The development of arterial hypertension in individuals above the age of 40 years is a multistage process. It is characterized by impaired neurohumoral regulation of blood circulation and metabolism. Hypertension occurs most often in people who live in highly developed countries. Mayo Clinic Staff (2018) studied the main causes of high blood pressure. Age and sex are the key factors in the development of hypertension among individuals aged 40 years and above. Additionally, increased psycho-emotional stress is one of the main causes of high blood pressure in this age group. Prolonged negative emotions are the leading factor predisposing people to hypertension. A hereditary factor is also very important. It is proven that people with a family history of hypertension have a greater risk of getting high blood pressure. Moreover, high salt content in food influences the level of blood pressure. Frequent use of alcohol and smoking increases blood pressure as well. Excessive weight and low physical activity increase the risk of hypertension in adults at any age. Finally, kidney and thyroid diseases can also become the cause of hypertension.
Maas and Franke (2009) determined the risk of getting hypertension in women in menopause. Estrogen has many positive effects on the neurohumoral factors that regulate the function of the cardiovascular system. This hormone has a direct vasodilating effect on the arteries, including the coronary ones. Estrogen positively affects some pathological processes of the vascular wall. It decreases collagen synthesis, migration and proliferation of smooth muscle cells, migration of monocytes, and the level of inflammatory factors. The authors claimed that in premenopause and menopause, women are more likely to present with the progression of atherosclerosis (Maas & Franke, 2009). It is a consequence of the lack of estrogen. Estrogen also inhibits endothelial cell apoptosis and forms insulin resistance. Insulin resistance is a key factor in the formation of disorders of carbohydrate, lipid, and purine metabolism and hemostasis system. Neurohumoral changes associated with menopause contribute to the development of salt-sensitive hypertension.
Everett and Zajacova (2015) studied the gender factor as a key factor in hypertension. They said that in people younger than 50 years old, high blood pressure rate is higher among men compared to women. However, women are more frequently diagnosed with arterial hypertension at the age of 50 and over. In people under 50 years old, behavioral risk factors play a key role in the development of high blood pressure. At this stage, men have a higher prevalence of the disease than women. However, the situation changes after women reach menopause.
The main causes of hypertension include gender and age, race, lifestyle, family history of heart diseases, alcohol and nicotine consumption, and kidney and thyroid diseases. Analyzing these sources, the behavioral risk factors are the basic reasons for high blood pressure at the age of 40. They include overweight, low physical activity, and bad habits. Although, for individuals over 40, age and gender are the main factors in the development of hypertension. Summarizing information from the analyzed sources, it is clear that non-Hispanic black females the age 50 and over have the highest risk of high blood pressure.
Non- pharmacological treatment methods include lifestyle modification, which is prescribed to all patients with arterial hypertension regardless of its degree and medications taken. A healthy lifestyle can reduce blood pressure and the number of medicines. A healthy lifestyle includes eating balanced and regular (at least 4 times a day) meals, weight reduction, physical exercises, decrease in salt, saturated fat, and total fat intake, increase in fruit and vegetable intake, and giving up smoking, drinking alcohol and coffee. Reduced salt intake is one of the key steps to control blood pressure.
Lionakis, Mendrinos, Sanidas, Favatas, and Georgopoulou (2012) described different pharmacological groups of medicines to manage hypertension. Thus, the main classes of drugs used include β-blockers, thiazide diuretics, calcium antagonists, direct renin inhibitors, angiotensin-converting-enzyme inhibitors (ACEI), α-adrenergic blocking agents, and angiotensin receptor blockers (ARBs). ACEIs belong to the number one drug for the treatment of essential and secondary hypertension mainly due to their protective effect on kidney blood vessels. β-blockers block adrenergic receptors, which are responsible for the realization of the sympathoadrenal system. This pharmacological group decreases not only blood pressure but also heart rate. Diuretics reduce fluid retention in the body, thereby lowering blood pressure.
Antihypertensive therapy starts with prescribing a minimum dose of one drug with its subsequent increase. The advantage of monotherapy lies in the ability to change the class of the drug or increase the dose of the previously taken drug in case of ineffectiveness of treatment at the initial stage (Lionakis et al., 2012). It also allows choosing a medicine individually for each patient. A combination of drugs should be used to increase their effectiveness and reduce side effects. It is necessary to use long-acting drugs (12-24 hours with a single dose).
According to Maas and Franke (2009), women in perimenopause should follow non-pharmacological methods of blood pressure control and hormone replacement therapy. However, hormone therapy should not be prescribed to women with a high risk of coronary heart disease or a history of stroke. Doctors have to be careful in prescribing hormone therapy to smoking women and those who have diabetes and metabolic syndrome. Gynecologists recommend using combined hormone therapy containing drospirenone as a progestin component.
The usefulness of the DASH diet was described by Mugavero, Gunn, Dunet, and Bowman (2014). These scientists established that a high sodium intake increases the risk of cardiovascular diseases and its complications in nearly 67 million Americans. In 2003-2008, 90% of US adults consumed 3,300 mg of sodium per day, while it is recommended to consume less than 2,300 mg per day. The authors argue that decreasing salt intake will reduce the frequency of hypertension and the risk of developing it. Consumption of no more than 2,300 mg of sodium could avert 11 million cases of hypertension annually (Mugavero et al., 2014). They also believe that the DASH diet will have a positive impact on the health of the population and lower blood pressure levels.
American adults consume 43% more salt than recommended. An excessive intake of sodium results in a big number of new manifestations of hypertension. Lowering sodium intake may further decrease the prevalence of high blood pressure in the US population.
The Royal Australian College of General Practitioners (RACGP) (2018) demonstrated that the DASH diet decreases systolic blood pressure by 6 mmHg and diastolic blood pressure by 3 mmHg in 2-4 weeks. The DASH diet can also lower BMI, cholesterol, and low density lipoproteins, which are the key factors of cardiovascular diseaselow-densityerolsis, and metabolic disorders. Thus, according to the 10-year Framingham research, RACGP (2018) discovered the reduction of heart diseases by 13% in patients using the diet. Therefore, a can be concluded that the DASH diet may further lower the following conditions.
According to Rocha-Goldberg et al. (2010), the Hispanic population was the largest ethnic group in the United States in 2008. One in four Hispanic adults has hypertension. The group of authors studied the effectiveness of the DASH diet among the Hispanic population. They observed systolic blood pressure, weight, BMI, and physical activity. The outcome of the 6-week research produced amasing results. The indicators of systolic blood pressure were lowered by 10.4 ± amazing Hg, weight indicators – by 1.5 ± 3.2 lbs, and BMI – by 0.3 ± 0.5. The DASH diet has positive results on high blood pressure control. Nevertheless, it is hard to determine whether the diet could completely replace pharmacological treatment.
Similar research was conducted by Garcia, Talavera, Keir, Falcon, and Castaneda (2017). The scholars studied different indicators of hypertension in Hispanic adults with low income. The study lasted 16 weeks, during which the subjects were observed in San Ysdiro Health Center. The outcomes did not present a decrease in systolic and diastolic blood pressure, and BMI. However, the subjects showed a reduction in total cholesterol, Low-Density Lipoprotein (LDL), High-Density Lipoprotein (HDL), and triglycerides indicators. They also stated of health improvement and an interest in controlling blood pressure and counting pharmacological therapy.
The research results are quite promising. It can be concluded that the DASH diet lowers the risk of cardiovascular diseases. It is the first step in non-pharmacological treatment of high blood pressure. The prevalence of hyperthetension depends on behavioral risk factors in adults aged under 40 and on gender and age factor in adults older than 40. The frequency of hypertension also depends on the ethnic group. The causes of hypertension do not change for men above the age of 40 years, while the main reason of hypertension for women older than 40 is menopause. At the moment, the DASHforiet cannot completely replace pharmacological therapy in Hispanic people. However, it is the subject for further investigations.