Best Ways to Cut Hypertension Differ for Westerners, Asians

Fran Lowry

January 17, 2014

OSAKA, Japan — A new review should serve as a reminder to physicians that lifestyle modifications are the cornerstone of hypertension prevention, but not all changes work for all populations. Because of differences in genes, diet, and lifestyle, the contributions of blood pressure to stroke are different for Westerners and East Asians, writes Dr Yoshihiro Kokubo (National Cerebral and Cardiovascular Center, Osaka, Japan)[1].

“The guidelines put out by the United States, Europe, China, and Japan for lifestyle modifications for prevention of hypertension are similar,” Yoshihiro writes. “Namely, salt restriction, high consumption of vegetables and fruits, increased intake of fish and reduced content of saturated/total fat, appropriate weight control, regular physical exercise, moderate alcohol consumption, and quitting smoking.”

These factors are also considered important for stroke prevention, Kokubo adds in his review published online January 13, 2014 in Hypertension.

Given how different these populations are, Kokubo decided to compare findings from lifestyle status in Westerners vs East Asians with regard to these hypertension guidelines.

“Even in East Asians, for example, fish consumption is different between Chinese and Japanese,” he told heartwire . “I wanted to review lifestyles according to the lifestyle modifications that appear in different guidelines, because I thought that this would lead to a beginning of improvement of both lifestyle changes and effects on blood pressure."

Salt Restriction

Many studies have shown that reduced salt intake is directly related to decreased blood pressure, including the Dietary Approaches to Stop Hypertension (DASH), International Study of Salt and Blood Pressure (INTERSALT), and International Study of Macro-Micronutrients and Blood Pressure (INTERMAP).

However, salt intake of Northern Japanese is among the highest in East Asia due to a high consumption of tsukemono (pickled vegetables), soy sauce, and miso soup. Consumption of carbohydrate in the form of rice and lower intakes of saturated fat and animal protein are believed to be the link with an increased risk of intracerebral hemorrhage in this population, Kokubo notes.

Also, Asians have a genetically higher salt sensitivity, and salt sensitivity in general is different among different populations, which indicates that the blood pressure response to sodium varies among ethnic groups.

Because of these factors, East Asians need to have more counseling about salt consumption, Kokubo says.

More of This, Less of That

Other findings of Kokubo's review include:

  • Westerners consume more meat and saturated fat, and therefore diets that restrict these foods will result in greater benefit regarding blood pressure control and atherosclerotic disease in this population.

  • Japanese, on the other hand, have high fish and soy intake, which may contribute to their having the lowest coronary heart disease mortality in the world.

  • Obesity and overweight are increasing worldwide, but men and women from East Asia are generally less heavy, potentially reducing their risk. However, increased body-mass index in male Japanese office workers has been shown to be a strong risk factor for hypertension.

  • Regular physical exercise is important for reducing hypertension in both Westerners and East Asians.

  • Japanese men have the highest consumption of alcohol, higher than American and British men. On the other hand, Western women consume more alcohol than Asian women. A campaign to reduce alcohol intake among Japanese men may be particularly beneficial in reducing their blood pressure.

  • East Asian men continue to smoke more than Westerners. Smoking rates of 40% to 60% among East Asian men are among the highest in the world. Smoking cessation efforts would have a greater impact in East Asian than Western countries.

Different Strokes for Different Folks

In his conclusion, Kokubo writes that a high consumption of fruits and vegetables, regular physical exercise, and maintaining appropriate body weight are all beneficial for blood pressure control in both Western and East Asian populations.

East Asians have the benefit of diets higher in fruits, vegetables, and fish, and a lower incidence of obesity, but they have a genetically higher salt sensitivity and greater salt intake than Westerners.

Also, excessive alcohol intake contributes to increased blood pressure in Japanese men, which is especially dangerous given their high rate of aldehyde dehydrogenase deficiency, a risk factor for hypertension, Kokubo writes.

By contrast, “Westerners need to pay attention to weight control, including regular exercise, and consider replacing dietary meat high in saturated fat with fish,” he said.

“Further comprehensive prospective studies are anticipated to show how each factor contributes to blood pressure control and a reduced risk of CVD in Westerners and East Asians,” Kokubo concludes.

Kokubo reports no relevant financial relationships. The study was supported by the Ministry of Health, Labor, and Welfare of Japan; Intramural Research Fund, National Cerebral and Cardiovascular Center; and Ministry of Education, Science, and Culture of Japan.

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