HEY BROTHER, PUT DOWN THAT SALT SHAKER!

By Mikel Holt
In the time it takes you to read this magazine, an African American will die from a hypertension-related illness.
Hypertension, or high blood pressure, is a leading contributor to Black health disparities, and is directly linked to various aliments from kidney disease to heart attacks and strokes.
American Heart Association data reveals that one in three Americans have high blood pressure; 81% are aware of it; but 47.5% don’t have it controlled. 
Forty two percent of Black men and 47% of Black women have high blood pressure.
Alarmingly, those latter figures are expected to increase by seven percent by 2030.
Which means by that time, there will also be an increase in the percentage of African Americans who die from the malady.
In 2009, 61,762 deaths were directly related to high blood pressure. And that figure is dwarfed by deaths indirectly linked to hypertension, including heart attacks, strokes and kidney failure. According to various research, 69% of heart attack victims and 77% of stroke deaths can be linked to high blood pressure.
Despite medical advances and extensive research, the debate continues over the reasons for the disproportionate impact of hypertension in African Americans (Africans and Black Caribbeans are less likely to have high blood pressure).  Genetics, obesity, diet, environment and stress are factors, but do not offer a clearly defined path to predictions. There is, however, consensus about one contributing factor that seemingly separates African Americans from all other ethnic groups: most Black Americans are sensitive to salt intake, and sodium puts them at risk of high blood pressure.
Medical College of Wisconsin hypertension expert Dr. Theodore Kotchen recently authored an article for the New England Journal of Medicine that removes all doubt about the correlation between salt intake and hypertension.
Dr. Kotchen, who is considered an expert on hypertension in African Americans, has written more than 200 scholarly medical articles.  His latest, on salt as an undeniable contributing factor in high blood pressure, supports the causation between lowering salt intake and decreasing blood pressure. 
An associate dean for clinical research and professor of medicine at the Medical College of Wisconsin, Dr. Kotchen said in a recent interview that African Americans are particularly sensitive to salt.  The source of salt intake is generally evenly weighed between diets consisting of various processed goods (canned vegetables, TV dinners and other foods rich in sodium)/ traditional African American soul food diets, which are also generally high in salt content, and ‘extra’ salt oftentimes generously added to meals from the salt shaker.
Salt intake alone doesn’t fully explain why African Americans are more likely to have high blood pressure, Dr. Kotchen said.  Genetics, obesity and stress are also factors, although their respective weights may be different based on the individual and his or her environment.
And exactly why African Americans, unlike people of African descent living elsewhere, are so sensitive to salt is also not fully explained.
“We’re not sure why (African Americans are sensitive to salt),” he admitted.  “There are many theories.  But we do know how to lower the risk associated with (the disease), and lowering salt intake is a major component.”
Changing our diets, exercise and medication are important factors in lowering blood pressure, Kotchen said.  “Pay attention to your weight, stay physically active.  And take prescribed medicines.”
That latter point is extremely important, says noted cardiologist Elijah Saunders, who is advocating for a more aggressive medical standard for controlling hypertension in African Americans.
(Healthy Start didn’t get an opportunity to question Dr. Kotchen about Dr. Saunders’ position, but the two noted experts did agree in their support for the DASH diet as a factor in lowering high blood pressure.
DASH is an acronym for Dietary Approaches to Stop Hypertension. Dr. Kotchen explained that the diet is high in fruits, vegetables, and fiber. 
The hypertension expert said he didn’t want to mislead anyone into thinking human beings should not consume any salt.  Some salt is essential for life.’  But for African Americans, salt intake should be limited.
“And they should get their blood pressure checked on a regular basis.” 
If the reading is over 140/90 mm Hg., consult a doctor immediately.
For individuals without health insurance, there are numerous opportunities to obtain a free blood pressure reading from certified nurses and medical facilities, including walk-ins.  People can also find free blood pressure machines at Walgreen’s and Hayat Pharmacies.
Dr. Kotchen said it would not hurt to ask the pharmacist of clerk at either or those businesses when the machine had been most recently calibrated to insure they provide an accurate reading.
Doctors Kotchen and Saunders also agree that diuretics can play an important role in lowering blood pressure in African Americans.
“Diuretics (water pills) are inexpensive but effective,” Dr. Kotchen acknowledged, and “could play a significant role in lowering blood pressure in African Americans with sensitivities to salt. “
The noted physicians would not recommend diuretics as a stand alone medication as some physicians have suggested for individuals without insurance or the means to purchase other high blood pressure medication.  But he did say it could play a role in combination with other drugs.
“Blood pressure medication as prescribed by physicians is extremely important; the diuretic is generally added on because it helps wash out salt from the system.  But by itself it isn’t a cure-all. Just like any medication, it has potential consequences.  That’s why it’s important to see a doctor.  They will develop a comprehensive program. 
“You can control blood pressure.   Maybe we don’t know all the reasons why African Americans are (more predisposed) to have it, but we do know how to keep it under control.”

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