ABSTRACT
Hypertension is a common condition in older persons with potentially devastating consequences if left untreated. It is a major risk factor for atherosclerotic vascular disease and may affect up to 70% of individuals over the age of 65.1,2 In the elderly, as in younger adults, essential hypertension, that is, high blood pressure without an identifiable cause, is by far the most common type of hypertension. To some extent, hypertension is an affliction of modern society. Until recent history, humans employed the hunter-gatherer lifestyle for survival. Such “primitive” peoples experienced vigorous daily physical activity and a diet rich in potassium and fiber and low in fat and sodium. Patterns of nature led to periods of diminished food intake, and obesity and high blood pressure were virtually unheard of in those communities. Modern-day populations who enjoy relatively low incidences of hypertension tend to practice daily routines that mimic the primitive lifestyle of old, particularly in relation to nutrition and physical activity. Furthermore, blood pressure does not rise with age in these populations, suggesting that this condition is not an inevitable consequence of aging.1,3
The blood pressure profiles of immigrants from such regions, however, may change over the course of a few generations to resemble that of the host community. The overabundance of foods rich in sodium, calories, and fat in Westernized societies without doubt contributes to the epidemic of hypertension. Data from the third
National Health and Nutrition Examination Survey (NHANES III) indicate that dietary intake of potassium, calcium, and magnesium is below the Recommended Daily Allowances (RDAs) for adults over the age of 50, whereas intake of sodium and fat (saturated and total) exceeds the RDAs.4 Despite the multiple anatomical and physiological age-associated changes responsible for the increasing prevalence of hypertension with age, much can be done by way of lifestyle modification to retard, if not arrest, the progression of hypertension. With the abundance of effective medications available for treatment of hypertension, nonpharmacologic strategies have received far less attention than they deserve at the clinical level. This is, in part, due to the burden and high rate of discontinuation of lifestyle modification.
