Do not pass the salt, please: A healthy Thanksgiving reminder

Do not pass the salt, please: A healthy Thanksgiving reminder
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For many, the holiday season is a time for good eating, home cooked meals, turkey, gravy, sauces and celebration. But think again before you pick up the salt shaker at your next festive meal. 

As a cardiologist, I see patients with various types of heart issues. The sicker patients I see in the Intensive Care Unit. Recently, I treated a 34-year-old African-American man who was admitted to the ICU with breathing problems.

His blood pressure was very high, about 220/120. This led to build-up of fluid in his lungs, so he was placed on the ventilator to help him breathe. His blood work showed he had kidney problems as well, later determined to be due to hypertension, which he already had for a long time.

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His heart was also affected and enlarged. We gave him IV medications to help him get rid of the water in his lungs, and after three days, he was off the ventilator and was able to breathe again on his own.

When he was fully awake and himself, we discussed what happened, how he could have died, and the bad effects of hypertension that he already had. We discussed that even at his young age, he could have had a stroke as well based on his high blood pressure.

This patient received hypertension education, and eventually left the hospital. He began exercising, lost weight, began eating a mostly healthy and low sodium diet, and began taking his blood pressure medications regularly.

His case unfortunately is not an anomaly. 

According to the American Heart Association, in 2016, more than 80,000 deaths in the United States were due to hypertension.

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African-Americans are known to develop hypertension (or high blood pressure) at a higher rate than whites; according to the Centers for Disease Control. The CDC reports  that more than 40 percent of) African-Americans have a diagnosis of hypertension through the course of their lifetime. 

A 2018 study published in the Journal of the American Heart Association notes that three in four black adults have hypertension by their mid-50s. This means that a good number of black adults have hypertension at younger ages; often developing as teenagers and in their early 20s. 

Additionally, African-Americans have higher risk of complications from hypertension such as stroke, heart attack, heart failure, kidney failure (eventually ending up on dialysis) than whites. African-Americans have up to four times higher rates of dialysis compared with whites. African-Americans also have up to six times higher risk of strokes compared with any other population in the United States.

Some of the factors contributing to hypertension in African-Americans include genetic and hereditary factors. One of the theories is that blacks tend to retain more sodium in their system, which leads to more water retention, which contributes to higher blood pressures. Some studies suggest that historically, blacks living in Africa had to retain sodium and water in order to survive the warmer climate and not die of dehydration. 

Historic records show blacks coming from Africa on slave ships to the United States died due to vomiting from seasickness, diarrhea, and profuse sweating – leading to dehydration. Those who survived this ordeal on the ships were those who had higher sodium and water retention; thus creating a generation of blacks in the U. S. with higher rates of hypertension. Indeed, the rate of hypertension in African-Americans is about twice that of blacks in Africa. 

My former ICU patient continues to have his blood pressure well-controlled a year later. Because of his current heathy habits, he has not been admitted to the hospital since I first met him. He no longer has shortness of breath with exertion like he used to have before that fateful day that he got admitted. This also means that his chances of stroke, heart failure, heart attack, dialysis, has gone down tremendously — because he is now maintaining healthy habits.  

Hypertension is the main problem leading to stroke, heart failure, heart attack, dialysis, and the main reason for death due to cardiovascular diseases in African-Americans. The fact that African-Americans are sensitive to salt, means that there is an easy solution to limiting and/or preventing the chronic deleterious effects of hypertension in African-Americans.  

As a black cardiologist who sees, takes care of and can identify with this population, I strongly urge both patients and other physicians to heed the note of caution this holiday season and always. 

Please do not pass the salt. 

Dr. Tochukwu (Tochi) Okwuosa is cardiologist and an associate professor of medicine at Rush University Medical Center and a Public Voices Fellow through The OpEd Project. Her clinical focus includes treating and managing hypertension.