High blood pressure: the problem may be more complicated than you think

According to the World Health Organisation, a third of South African adults have hypertension, better known as high blood pressure, with the consequent increase in the risk of heart attack, heart failure, kidney disease or stroke.  Mortality reduction should be the ultimate goal of antihypertensive treatment.

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ACE inhibitors (ACEIs) are one of the first line treatment options for uncomplicated primary hypertension.  Despite their positive impact on mortality reduction, ACEIs have been shown to reduce the levels of vitamin D₃ in the body.   Most South Africans are already compromised in terms of vitamin D₃ levels, despite living in a sunny country. 

Long-term use of ACEIs also results in the depletion of zinc, which may complicate the clinical features of atherosclerosis, amongst other effects.    Diseases such as diabetes, heart failure and hypertension might also enhance zinc deficiency.

Vitamin D and zinc play a role in the Renin Angiotensin System (RAS) system which regulates blood pressure.  Inappropriate stimulation of RAS has been associated with the pathogenesis of hypertension, heart attack, stroke and hypertrophy of the left ventricle and vascular smooth muscle cells.  This may increase risk of death from stroke, coronary heart disease and heart failure.

Awareness of the potential depletion of these nutrients, as a result of hypertension, or the treatment thereof, leads to the question of how to best handle this problem.  Exposure to sunlight and food sources such as oily fish, offer an option for the replacement of vitamin D₃ while oysters, red meat and poultry offer supplementation sources for zinc.

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