Hypertension Relationships to Coronary Heart Disease and Stroke

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Hypertension is positively correlated with CHD and stroke mortality, and is generally accepted as one of the major risk factors for eventual CHD mortality. The term 'risk factor' generally indicates an associated occurrence, but it does not automatically mean that reducing a risk factor will be beneficial, as it would be for a causal risk factor. Although hypertension has a logical causal relationship to hemorrhagic stroke, its relationship to thrombotic or ischemic events remains to be established. Both CHD and hypertension might independently be made worse by some processes initiated by some common dietary causes. By now, scientists can see that neither CHD nor hypertension is likely to be due to dietary cholesterol. However, both disorders may relate to an unbalanced dietary intake of «6 over «3 PUFAs that causes unbalanced signaling from «6 over «3 eicosanoids. A meta-analysis of 36 clinical trials involving 2,114 subjects showed that supplementing with high intakes of fish oil gave lower blood pressures, especially for older and hypertensive subjects [Geleijnse et al., 2002]. However, the observed antihypertensive effect of fish oil is marginal (1.5-1.7 mm Hg reduction in double-blind trials), hence fish oil is likely to exert preventive effects on CHD mainly through other mechanisms (chap. 6).

A relationship of dietary «6 and «3 fats with the prevalence of ST-T changes in ECG and medication for hypertension was evident among hundreds of Japanese in Brazil and Japan [Mizushima et al., 1997]. This study suggests a possible association between fish intake and reduced cardiovascular risk, through the beneficial effects of taurine and «3 PUFA and a habitual low intake of calories and fat. Taurine is probably a surrogate marker of seafood intake because its reported cholesterol-lowering activity is significant only in huge amounts (2% of diet) in animal experiments, which is nearly impractical in human nutrition.

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