In the last several months, I’ve been trying to convince our medical colleagues here and in other countries that there appears to be a better way to bring down high blood pressure of our patients in Asia.
The overall incidence of cardiovascular disease (CVD) will also likely go down, as will the number of people dying yearly due to CVD.
In the Philippines, the number of CVD deaths is like one fully loaded commercial jumbo jet plane crashing four to five times a week.
The ideal medicine we should use don’t conform with some of the treatment guidelines recommended by our European and other colleagues. But there are some ethnic idiosyncracies that make Filipinos and other Asians behave differently from our Caucasian counterparts.
One of these traits is how our body handles excess salt or sodium. Some individuals don’t develop hypertension even if they ingest a lot of salt because their kidneys can handle it. They simply get rid of the excess salt through the urine. They’re called salt-resistant.
Others, however, have no such innate capability, and the excess sodium gets stored in the body and attracts water, causing edema, weight gain, elevated blood pressure and even heart failure. These are the salt-sensitive (SS) phenotype of individuals.
Salt-sensitive
I believe that Filipinos and Asians in general are salt-sensitive. If one is diabetic, elderly and overweight, or obese, those factors further increase the risk of being salt-sensitive.
Salt sensitivity not only increases blood pressure, it also triggers a complicated cascade of events that can cause strokes, kidney failure, heart attack and heart failure. It has been described as the silent but major contributor to the CVD epidemic in the region.
We know too much salt is bad, but somehow we’ve treated the problem with kid gloves and have not addressed it seriously despite the clear lessons learned by other countries in the region.
Japan, which has gradually reduced its salt consumption in the past decades, has seen a
reduction of stroke risks among citizens by 80 percent. Thailand, too, has its own salt-
reduction program, and the prevalence of high BP there has been decreasing.
A friend of a newly elected senator recently asked for suggestions on legislation that can impact public health significantly. I recommended to focus on salt reduction in processed foods.
Not from condiments
Contrary to belief, the greatest amount of salt we ingest does not come from the condiments we use, although it contributes to the salt load. The biggest source is processed foods, which include canned goods, salty snacks, frozen meals, instant noodles, margarine, ketchup, even dried fruits. Eat these in moderation.
Medical organizations and health advocates have been trying to convince snack food makers to reduce their products’ salt content up to 50 percent, which will still make the food palatable. But I think it has fallen on deaf ears.
We need legislation to “convince” them. Perhaps products with high-salt content should be imposed “sin taxes,” like cigarettes and alcohol. The data stares us in the eyes—they’re just as harmful as these other “sinful” products. They’re killing us slowly (and softly), and we don’t even realize it.
I’ve also been trying to convince colleagues that we should consider the problem of salt sensitivity when we treat hypertensive and diabetic patients. Ignoring this is treating them inadequately. Although we should strongly counsel them on salt reduction, realistically, around half of them will still exceed the safe salt limits.
Low-dose diuretics
Since the kidneys of SS patients do not excrete excess salt naturally, we have to assist the kidneys with low-dose diuretics, which facilitate sodium excretion in the kidney tubules. The mechanism may be similar to giving laxatives to the chronically constipated.
Diuretics are among the oldest drugs in cardiovascular medicine, introduced in the 1950s. But they remain the most effective, so far, to eliminate excess salt from the body. It has some side effects, but these are manageable. And the inconvenience of these side effects is much less, compared to the drugs’ benefits.
There are newer diuretics which have fewer side effects, are more long-acting, and have been shown to have additional benefits beyond sodium elimination.
I think our doctors should disabuse their minds of the belief that diuretics are inferior to the so-called modern drugs used to treat hypertension and heart diseases.
A doctor in the province told a patient of mine that the drug (a diuretic) I prescribed is antiquated. I called up the doctor and gave him a 10-minute refresher on the use of rational and appropriate drugs, and not only “modern” ones.
When we treat the root cause of any medical problem, and not just the observed symptom or clinical manifestation such as high BP or elevated blood sugar, our patients will be much better off. That’s the beauty of the art and science of medicine.