Jeff, Questions about where to locate medical literature...

[KatyInAZ]

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[JeffN]

Hi Katy,

Where can I locate (and print) the medical literature (or studies) that indicate the risks of using antihypertensives.

There are several classes of hypertension medications so you will need to look at them all. This information is no secret and is usually also contained on the package inserts of the medications.

You can look them up by name here, and get info on side effects and toxicity

http://www.nlm.nih.gov/medlineplus/druginformation.html

And, you can search the Library of Medicine here

http://www.nlm.nih.gov/medlineplus/druginformation.html

If you enter the drug name and "side effects", you will get lots of results.

There are literally dozens of possible drugs they may want to use, so if you can be more specific of the ones they want to use, then I can help you further.

My son, who is 17, is just about at the point where the physicians are diagnosing him with essential hypertension. We've run all the tests (rule out pheo, kidney disease, echocardiogram) and all have come back normal. He has an appt with a cardiologist next just to make sure he's okay in that dept. I'm having everything done that I can, because I just don't believe that this can be essential hypertension.

I agree.

Often, we are told that many, if not most, cases of essential HTN will not respond to diet or salt reduction. Sometimes we are told anywhere from 50-90% will not respond. However, this is not true. The reason this is what is often seen is because the diet and sodium restriction they use is not adequate. It is very difficult to lower the sodium intake on people who continue to consume a typical American diet as over 77% of this sodium is hidden. In addition, many people do not know which foods have the most because the system they usually use for comparisons and food labels, is misleading and ineffective.

For instance, not many people realize that a serving (slice) of typical bread can have 2-3x the amount of sodium as a serving of potato chips.

He's not overweight, exercises, doesn't smoke, is on a 1500mg/day (more or less) of sodium. I'm not ready to put him on a lifetime of medications just yet. With his current diet, we can keep his BP around 140/85 or so, sometimes lower, sometimes higher. I know thats not ideal, but is it worth putting him on medications for the rest of his life? I'd like to be able to have the literature in my hands when I discuss the risks, benefits and complications of long-term antihypertensive drug therapy with his physician.

Any input or suggestions would be greatly appreciated. Oh, by the way, his labs were all normal.

Thanks, Kathy

The 1500 mgs is the upper end (not upper limit) of the recommendation from the Institute of Medicine for healthy people under the age of 50. However, if someone is sensitive, or if they are limiting their intake to 1500 mgs and still showing higher BP readings, they may have to lower it more. Sometimes, depending on the person, it may have to go to 1200, 1000, or even 750 or less.

I would be very hesitant to put my teenager on any medication that they would have to take for their rest of their life, without thoroughly investigating any other option.

It is great that all his other labs are normal.

What I would recommend is to see if he is willing to go along with and help with a very thorough look at his intake and attempt to really lower (or eliminate) the amount of added sodium from all sources and see how he responds. This may only take a few days to see a response or maybe 2-3 weeks. My experience is that children and teenagers usually respond much quicker than adults. Either way, it may well be worth the effort. Then, once he can see the side effects of the medication and also how he responds to a thorough attempt at salt restriction, he can decide how much effort he is going to put into this.

In the end, at 17, it will be up to him.

In Health
Jeff

[KatyInAZ]

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[JeffN]

Hi Katy

I've read that humans only require about 300mg per day anyway, is this true?

There is no RDA for sodium although the 10th edition of the Recommended Dietary Allowances states

"Thus, a minimum average requirement for adults can be estimated under conditions of maximal adaptation and without active sweating as no more than 5 mEq/day, which corresponds to 115 mg of sodium or approximately 300 mg of sodium chloride per day. In consideration of the wide variation of patterns of physical activity and climatic exposure, a safe minimum intake might be set at 500 mg/day. Such an intake is substantially exceeded by usual diets in the United States, even in the absence of added sodium chloride."

Recommended Dietary Allowances, 10th Edition, Subcommittee on the Tenth Edition of the RDAs, Food and Nutrition Board, Commission on Life Sciences, National Research Council, NATIONAL ACADEMY PRESS, Washington, D.C. 1989


The Yanomamo Indians of the tropical rain forest of South America have a sodium intake of less than 200 mg/day, and do not develop any problems related to a "low" intake (hyponatremia).

Oliver WJ, Cohen EL, Neel JV. Blood pressure, sodium intake, and sodium related hormones in the Yanomamo Indians, a "no-salt" culture. Circulation 1975;52:146-51.

In Health
Jeff

[KatyInAZ]

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[JeffN]

Hi Katy,

I've put Tyler on 500mg per day. It's actually a lot easier than people think and he's totally satisfied with the food I've made him. Once you make their own bread items, the rest is a piece of cake.

That is good to hear. I hope it is a "low sodium" piece of cake.

Why does it take so long for the body to adjust to the lower sodium level, but when he consumes a high sodium meal, his BP skyrockets immediately?

A day and half is fairly short to see a response, so do not give up, stick with it and keep an eye of the numbers.

I have seen some people's BP's fall dramatically and quickly when sodium is lowered, sometimes within 48-72 hours, and others whose fall slowly and may take weeks to reach the same level of reduction.

In Health
Jeff

[KatyInAZ]

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