Good for heart, great for earth: Managing hypertension while safeguarding the planet
What if our food choices can reduce blood pressure and protect the environment?
Photo by Omar Belattar / Unsplash
Hypertension has now become so prevalent that over 1.2 billion adults globally are affected by it. Findings from the most recent Indonesian Health Survey reveal that hypertension continues to be a significant public health issue in Indonesia, with a prevalence rate of 30.8% in 2023. It has become a major cause of disability among individuals aged 18-59 years.
Hypertension or high blood pressure (BP) stands as the primary and most significant risk factor for various health complications, such as stroke, heart attack, heart failure, kidney damage, and numerous health problems, making it a common life-threatening condition with major public health implications.
World Hypertension Day (WHD), observed annually on May 17, is critical in raising awareness and promoting healthy lifestyle changes to combat hypertension. With the theme "Measure Your Blood Pressure Accurately, Control It, Live Longer", 2024 WHD aims to enhance public understanding of hypertension. This article goes beyond solely tackling hypertension, as we will explore a dual-faceted approach to combat this disease by adopting dietary patterns that help control blood pressure while contributing to environmental sustainability.
Understanding hypertension
Technically, hypertension occurs when the pressure in the blood vessels is higher than the normal range. Blood pressure consists of two numbers: The initial number (systolic) indicates the pressure in blood vessels during heart contractions, while the second number (diastolic) shows the pressure in the vessels when the heart is at rest between beats. According to major guidelines, hypertension is diagnosed when a person’s systolic blood pressure (SBP) is ≥140 mmHg and/or diastolic blood pressure (DBP) is ≥90 mmHg after repeated measurements.
Out of numerous risk factors for hypertension, most of them are related to lifestyle, including smoking, alcohol consumption, a sedentary lifestyle, being overweight or obese, and unhealthy dietary patterns. In most cases, these risk factors are present concurrently with other cardiovascular risk factors, namely diabetes, lipid profile disorder, and metabolic syndrome.
Most individuals with this condition do not experience any symptoms unless they have extremely high blood pressure (typically 180/120 or above). The silent nature of hypertension often results in it going undiagnosed and/or untreated, which consequently leads to many complications. Therefore, regular monitoring of blood pressure is crucial for the early detection and prompt treatment of hypertension.
Hypertension and food
Diet is central to cardiovascular risk development, including raised blood pressure. It is widely known that unhealthy consumption patterns characterized by excessive salt consumption, high saturated fats and trans fats, and low fruit and vegetable intake, are related to a higher risk of hypertension. Therefore, shifting dietary patterns into a healthier diet is the cornerstone for hypertension prevention and management.
Studies have been done on the effect of different nutrients and foods on blood pressure. However, many of these studies tend to overlook the interplay between different dietary components. Given the synergistic effects of food, the overall composition of diets is what matters and thus the dietary pattern approach can help in giving guidance in the context of preventing high blood pressure.
One dietary pattern frequently mentioned in managing hypertension is the DASH (Dietary Approaches to Stop Hypertension) diet, which is specifically developed to lower blood pressure levels. The DASH diet is rich in fruits, vegetables, whole grains, nuts, and low-fat dairy products, delivering complete opposite options of the unhealthy consumption patterns mentioned above. This diet also limits the intake of total and saturated fat, as well as red and processed meats, sugary beverages, and sweet treats. Through a clinical randomized trial, the DASH diet has been demonstrated to effectively lower blood pressure levels in individuals with both normal and high blood pressure. They found that implementing the dietary intervention could reduce SBD by approximately 6 to 11 mmHg.
Another familiar dietary pattern related to cardiovascular health is the Mediterranean diet. Adapted from the traditional diet of countries bordering the Mediterranean Sea, this dietary pattern is characterized by a high intake of fruits, vegetables, whole grains, pulses, fish, unsaturated fatty acids (especially olive oil), moderate alcohol consumption, and low consumption of meat (especially red and processed), dairy, and saturated fatty acids. A review of the Mediterranean diet and its impact on blood pressure revealed that adhering to this dietary pattern may have positive outcomes in lowering blood pressure levels in individuals with hypertension or those who are healthy. However, further investigation is required to determine the extent of this effect.
Diets for blood pressure and the planet
Now, what is the connection between our heart and the health of our earth? It is safe to say that food is one key ingredient and the main wedge between the two.
It is widely known that the food produced by our modern food system is affecting our health and is also related to multifaceted environmental impacts. Current food production systems contribute to a significant proportion of global greenhouse gas emissions (GHGE), biodiversity loss, water withdrawals for irrigation, and land use through deforestation. Consequently, addressing environmental issues poses a significant challenge for food systems, particularly in light of the projected increase in the world's population. Transformation in food systems, from production to consumption, urgently needs to be done to decrease the environmental impacts of our current consumption patterns.
If we take a look at the aforementioned heart-healthy dietary patterns, both the DASH and the Mediterranean diets share a common characteristic of being rich in plant-based foods, such as whole grains, fruits, vegetables, and pulses while being low in animal-based foods. The recommended food groups are recognized for their low environmental impact compared to our current diet. The traditional Mediterranean diet also takes into account the specific circumstances of Mediterranean countries, including food availability and eating habits, which is an important aspect from a sustainability point of view.
Various types of food have different impacts on the environment. The environmental impact of animal-based foods is generally higher in terms of GHGE than plant-based foods. Dairy products and red meat (especially beef) are notable for their significant and disproportionate impact, whereas foods or food groups promoted in a heart-healthy diet fall under the category of having a low environmental impact. Thus, shifting towards a more balanced diet with more plant-sourced foods provide beneficial outcomes in preventing hypertension while also reducing the food systems’ negative environmental impacts.
There is no silver bullet to address hypertension and planetary health; however, taking control of hypertension while ensuring environmental sustainability can begin with small manageable changes to our diets.
Choose more whole foods any day. Perhaps start snacking on fruits and vegetables up to 2-3 servings (200 grams) per day. This is equivalent to approximately having a piece of banana, a piece of mango, and a plate of sayur pecel on one day.
Incorporate more whole grain products to help increase fiber intake to 30-45 grams a day. This means leveraging Indonesian rich food cultures and getting to know other carbohydrate sources than white rice, such as brown rice, black rice, corn, sorghum, and millet.
It is not necessary to completely exclude animal-source foods, but consuming them within the recommended range (ie, three portions per week of red meat) are beneficial for both our health and the planet. Maybe it’s time to explore more variations in fish?
Cut back on salt intake to under 5 grams or one teaspoon a day and consume as little saturated and trans fat as possible by limiting the consumption of ultra-processed foods, processed red meat, and fried foods. Reducing sodium intake will not only benefit our health but also decrease the demand for resource-intensive food production.
Managing hypertension while preserving our planet can simply be achieved through mindful dietary choices. Let this year's World Hypertension Day be a call for all of us to start making small, meaningful changes to favor more sustainable healthy dietary patterns, and inspire those in our vicinity to follow suit.
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