Discussion

Almost in all instances hypertension treatment guidelinesrecommend non-pharmacological measures (life style modification)to control hypertension, a major one being salt restriction in diet[12]. Life style modification is known to work better if tailored tothe individual or group cultural heritage, beliefs and norms [13,14].Salt taste threshold is known to be higher in hypertensives and theiroff springs [15,16]. Taste attitude is a very high predictor of addedsalt in food [17] and determines what individuals or groups use infood as seasoning. The tendency is that individuals at greater risk forhypertension would crave more table salt in food, further fuelling arise in their blood pressures. The above notwithstanding, it is possibleto achieve significant salt reduction in the population; and Adeyemohas shown the feasibility in Nigeria [18].

This study has found that commercially produced seasoningsused in cooking in our environment though better than table saltin sodium and potassium profile could add significantly to thesodium intake if used in addition to table salt in cooking. This ishighest for the seasoning powder. The traditional seasoning salt(kanwa) though with sodium in the same range as the commerciallyprepared seasonings has about double to triple their potassiumcontent; and hence better regarding sodium/potassium profile thanthe commercially prepared seasonings. The best turned out to be thetraditional seasoning powder (tooka) which has very low sodiumand high potassium contents resulting in the least sodium/potassiumratio. This makes it ideal for seasoning in hypertensives and thoseprone to the disease. It is known that high sodium/potassium ratioscontribute to hypertension and several cardiovascular diseases [19].Use of such plant based seasonings with low sodium/potassium ratiocould partly explain the lower prevalence of hypertension in the ruralareas where they are used more commonly than the commerciallyprepared seasonings.

Potassium intake all over the world is lower than desired [20].In the west improved intake is by recommended intake in fruits andvegetables [21]. Unfortunately this is low there [22] as well as in ourenvironment for reasons ranging from cost, lack of storage facilitiesand group food habits. Seasonings used for cooking would seem tobe a convenient way of increasing potassium intake since most ofthe sodium intake is via table salt used in food. Use of traditionalseasonings like “tooka” in this case should be encouraged in ourenvironment and the commercially produced ones discouragedin addition to table salt used for cooking. Where flavor becomes agreat issue, non salt containing seasonings like onion, garlic, curry pepper and nutmeg or various traditional plant based seasoningscould suffice, to prevent high sodium intake in diet with consequenthypertension. Such individual and population intervention in foodhabits would go a long way in keeping hypertension statistics low andby extension its attendant complications; especially in blacks wherea modest reduction in sodium intake is associated with significantdecreases in blood pressure [23]. Smith-Sprangler et al. [24] haveshown how efforts in the population to decrease sodium intake resultin decreased cardiovascular disease burden. The same applies to strokeas Gardener et al have also found that low dietary reduces incidenceof stroke [25].

Until large scale co-operation by the food industry is achieved inthis regard (especially in appropriate sodium labeling of products),our roles as clinicians should hinge on education of the publicregarding dietary choices towards decreasing dietary sodium intake.