The previously published clinical guidelines to treat cardiovascular disease (CVD) were precisely approaches to treat this condition. Nowadays, the American Heart Association (AHA) and KDOQi gathered an interesting treatment approach to diminish the risk of developing chronic conditions. As new metabolic and inflammatory markers become critical control points to prevent and reverse disease, new dietary practices become essential to make the shift. Also, the efficacy and reliability of genetic testing can join the nutritional CVD treatment guidelines to tailor a better and personalized plan to our patient.
The dietary approaches to stop hypertension focus on reducing sodium ingestion to reduce high blood pressure (HBP). The underlying mechanism of this preventive factor ultimately lessens the extracellular water and prevents swelling of the lower limbs, and lowers BP. However, genetic testing goes upstream and can determine the enzymatic function modulating the renin-angiotensin-aldosterone system (RAAS).
ACE: ACE is the genetic code for the angiotensin-converting enzyme, a key player in the renin-angiotensin system. A deletion (D) or insertion (I) in this code directly reflects the body’s capacity to modulate blood pressure and fluids.
A study was published in the New England Journal of Medicine to detect SNPs on ACE in patients with left ventricular hypertrophy. This study found that patients with the DD genotype strongly associated with left ventricular hypertrophy in men. Also, the findings of this study suggested that left ventricular hypertrophy had a close association with genetic disposition.
AGT: AGT is the genetic code for angiotensinogen, a precursor molecule for angiotensin II, which modulates blood pressure and body fluids. Tissues like the brain, the kidneys, and adrenal glands depend on angiotensin to regulate blood pressure. Angiotensinogen contributes to blood pressure elevation by causing vasoconstriction. Therefore, high levels of this molecule could be found in patients with essential hypertension.
Three different polymorphisms in the encoding gene associate with the presence of essential hypertension:
A-20C and G-217 polymorphisms are linked to essential hypertension in Asians and Caucasians, but not A-6G. Extensive literature also links the CC genotype with an increased risk of hypertension.
Preventive effect of reduced sodium intake
Cardiovascular disease and hypertension are multifactorial conditions with a high prevalence in our population. We have discussed the genetic variants that can influence the tendency of developing these conditions. On the other hand, environmental factors, including exercise, lifestyle, dietary habits, and sodium intake, interact with our genetics. Those patients with a salt-sensitive (SS) genotype with a high sodium intake are prone to develop hypertension and CVD than those with a salt-resistant (SR) genotype.
The dietary approach to stop hypertension (DASH) is the nutritional standard of care for controlling high blood pressure. Indeed, this dietary approach can reduce systolic blood pressure by up to eight to 14 points. It mainly focuses on introducing 6 to 8 servings of whole wheat cereals, fresh fruits and vegetables, lean aminal origin products, dairy, legumes, healthy fats, nuts, and seeds. However, the main focus of this diet is to control sodium intake by limiting it to 2,300mg on the standard DASH diet or 1,500mg in the lower sodium DASH diet.
What foods to avoid to lower your sodium intake?
|High-sodium foods||Low-sodium foods|
Corn tortilla rice
Genetic testing is the easiest way to prevent chronic diseases in the long run. Imagine having a medical screening that provides you with a preventive strategy instead of fixing whatever you already have with a pill? Genetic testing offers a preventative approach while empowering clinicians and patients with a design to improve the patient’s wellbeing. In this particular case, reducing sodium intake can prevent or delay the appearance of CVD and hypertension. – Ana Paola Rodríguez Arciniega, MS.
Schunkert, H et al. “Association between a deletion polymorphism of the angiotensin-converting-enzyme gene and left ventricular hypertrophy.” The New England journal of medicine vol. 330,23 (1994): 1634-8. doi:10.1056/NEJM199406093302302
Xi, Bo, et al. “Association of polymorphisms in the AGT gene with essential hypertension in the Chinese population.” Journal of the Renin-Angiotensin-Aldosterone System 13.2 (2012): 282-288.
Sun, Jiahong, et al. “Polymorphisms of three genes (ACE, AGT, and CYP11B2) in the renin-angiotensin-aldosterone system are not associated with blood pressure salt sensitivity: A systematic meta-analysis.” Blood pressure 25.2 (2016): 117-122.
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Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
Licensed in Texas & New Mexico