Application of nutritional diet care in patients with hypertension

Nutritional dietary care is the core measure of non-drug intervention for hypertension. A standardized and implemented personalized dietary plan can reduce the systolic blood pressure of patients with first-level hypertension by 5~20mmHg and reduce the risk of adverse cardiovascular events by more than 20%. For patients with mild to moderate hypertension, it can even replace part of the dose of antihypertensive drugs. This is a consensus reached in the field of chronic disease management at home and abroad.

I have been working in community chronic disease management for almost 7 years, and I have met between 1,000 and 800 patients with high blood pressure. The most common misunderstanding is "I have already taken antihypertensive drugs, so what should I avoid?", and others who copy the "super antihypertensive recipes" from the Internet. In the end, they either break the habit within a week, or take them, which causes gastrointestinal discomfort and raises blood pressure.

Interestingly, there is currently no unified "gold standard" antihypertensive diet plan in the industry. There are two mainstream application directions, each with its own advantages and disadvantages. One is the DASH dietary pattern introduced from abroad, which focuses on high potassium, high calcium, high dietary fiber, low sodium, and low saturated fat. The evidence-based evidence is very sufficient. Foreign clinical data shows that if it is adhered to for more than 3 months, it can lower blood pressure by an average of 8 to 10 mmHg. However, this plan is often not adapted to the domestic environment. : It is required to drink 300ml of low-fat milk every day. Nearly 40% of the patients I have contacted are lactose intolerant and suffer from diarrhea after drinking it. They are also required to eat 100g of whole grains every day. Many elderly people with bad teeth cannot chew at all, but have no appetite for meals. If they cannot keep up with their nutritional intake, it will affect the stability of their blood pressure. The other is the "syndrome differentiation" program promoted by domestic traditional Chinese medicine nutrition in recent years. On the basis of controlling salt and oil, the formula is adjusted according to the patient's constitution. For example, patients with excessive liver yang and frequent dizziness and blushing should add more celery and chrysanthemum soaked in daily. Patients with heavy phlegm and dampness, abdominal obesity, and greasy tongue coating can eat more winter melon, barley, and adzuki beans to remove dampness. The adaptability is indeed stronger, but the disadvantage is that there is no unified quantitative standard and it relies heavily on the personal experience of nursing staff or nutritionists.

The 62-year-old Uncle Zhang who was in charge of me before is a typical example. After he was diagnosed with first-level hypertension, he heard others say that the DASH diet is good. He ate oatmeal and drank cold milk every day. He had diarrhea for half a month, but his blood pressure rose from 145/92mmHg to 158/97mmHg. Later, he was given He adjusted the plan: replacing oatmeal with easy-to-digest millet porridge, milk with warm Shuhua milk, and adding a small dish of fried celery every day without adding any oil. He felt comfortable eating, and his blood pressure stabilized at around 135/85mmHg in less than a month. He has been doing this for almost two years now, and has never taken antihypertensive drugs.

Don’t think that salt control is a cliché. It’s actually quite controversial. Nowadays, the public generally receives information that "hypertensive patients should not eat more than 5g of salt per day." However, the "Guidelines for the Diagnosis and Treatment of Hypertension in the Elderly" released last year also clearly mentioned that for elderly patients over 75 years old, with poor appetite or frequent diarrhea, excessive salt restriction will lead to hyponatremia, and the risk of falling will increase by 32%. We met an 82-year-old Grandma Li before. Her family strictly restricted salt for her, and the dishes she cooked every day were almost tasteless. She hid in secretly eating pickles, half a piece at a time, which directly sent her blood pressure to 180/110mmHg and sent her to the emergency room. Later, we discussed with her family that we didn’t have to stop eating it completely. We gave her a small piece of soybean curd every day, which was included in the total amount of salt. She was happy, and she didn’t have to eat it secretly, but her blood pressure was very stable.

To be honest, the most effective way to provide dietary care to patients is never to hand out thick diet manuals, but to follow them to the vegetable market and teach them how to choose at the vegetable stalls: replace pork belly with lean beef, pickles with fresh cold vegetables, and when buying noodles, turn over and look at the ingredient list. Don’t buy any noodles with a sodium content exceeding 300mg/100g. There used to be a 32-year-old programmer who said that he never eats out and cooks noodles at home every day without adding much salt. His blood pressure has been 150/95mmHg and cannot be lowered. Later, he discovered that the soba noodles he bought that are said to be "healthy" have 100 grams of soba noodles. There is only 1.2g of salt. He eats 200g in one meal, and the plain noodles have 2.4g of salt. Add the salt in fried eggs and light soy sauce, and the daily amount has long been exceeded. Later, he switched to sodium-free noodles. Within two months, his blood pressure dropped to 138/84mmHg, and he did not need to take medicine for the time being.

In fact, nutritional diet care is never about drawing a bunch of rules and regulations for patients, telling them not to eat this or that. After all, a plan that can be adhered to for a long time is effective. There is no need to force everyone to eat according to the same template. If you are lactose intolerant, don't drink milk. The same goes for eating tofu to supplement calcium. If your teeth don't like whole grains, eating more fresh vegetables to supplement dietary fiber will have the same effect. Even if you are craving for a piece of braised pork occasionally, it doesn't matter. You can make up for it by adding less oil and salt the next day. It's better than suppressing your appetite and eventually overeating. In the final analysis, the core of dietary care is not "control", but to help patients find a way to live peacefully with food and stabilize their blood pressure.