Diet and lifestyle in hypertension: changing perspectives.

It is now recognized that dietary and other lifestyle or environmental factors are critical for the phenotypic expression of a genetic predisposition to blood pressure (BP) elevation. These environmental factors influence the entire frequency distribution of BPs in any given population, and hence affect the prevalence of hypertension using whatever arbitrary cutoff point is chosen to categorize patients in this way. "Dose-response" relationships with BP have been demonstrated with body fat, alcohol consumption, sodium intake, vegetarian vs. meat-related diets, and physical activity. Possible relationships between these and other "environmental" factors have not yet been fully clarified, although this is of considerable importance for primary prevention of hypertension as well as for specifying advice for individual patients. Knowledge of the extent to which varying dietary or other lifestyle factors operate in different patients is also likely to be necessary for those trying to resolve the nature of the pathophysiological and genetic mechanisms underlying high BP. Finally, several of the factors causing hypertension independently predispose to atherosclerosis, and have compounded the risk of cardiovascular disease in hypertensive patients.