Hypertension Treatment Medical Nutrition Therapy Encourage weight loss

Hypertension Treatment Medical Nutrition Therapy • Encourage weight loss for all overweight individuals, even modest weight lose lowers blood pressure. o Physical activity and behavior modifications are important for weight loss and maintenance. • Adjust mix of carbohydrates, protein, and fat to meet metabolic goals and preferences; customize nutrition counseling based on Apo. E genotype. Is it time to begin restricting fructose in the diet? • Limit alcohol intake. • Promote smoking cessation. US Endocrine Review 2006; 1: 2 -5

Medical Nutrition Therapy Critically Based on Apo. E Genotype 1. Arterioscler Thromb Vasc Biol 2000; 20: 1990 -199 2. Am J Clin Nutr 2003; 77: 1098 -1111 3. J Nutr 2004; 134: 2517 -2522 4. Am J Clin Nutr 2001; 73: 736 -745

Dietary Fructose Intake ↑ Glu 5 Transporter Facilitating Fructose Absorption Int J Nephrol, Volume 2011, Article ID 392708, 8 pages

High Fructose Diet ↑ Sodium and Chloride Absorption -> Hypertension J Hypertens 2015; 33: 912– 920 NHE 3, sodium-hydrogen exchanger 3, PAT 1, putative anion transporter 1

High Fructose Diet Increases Sympathetic Nervous System Activations -> Hypertension J Hypertens 2015; 33: 912– 920

Sugar Not Salt Drives Hypertension. Are We Looking at the Wrong White Crystal! Open Heart 2014; 1: e 000167

High Salt Diet Stimulates Fructose Production in the Liver Glucose Ton. EBP* *Tonicity-responsive ↑ ↑ Increases Aldose Reductase ↑ Increases Serum Osmolarity ↑ ↑ High Salt Diet Fructose enhancer binding-protein