Many nutritional disorders are associated with the risk of developing hypertension, with increasing severity of hy- pertension and/or with refractoriness to pharmacologic management of hypertension. These nutritional factors include obesity, excessive energy intake, high dietary so- dium, and low potassium intake. There are multiple and complex mechanisms by which obesity and and excessi- ve energy intake increase blood pressure. Increased alco- hol may acutely elevate blood pressure. Higher intakes of potassium, polyunsaturated fatty acids, protein, exercise and possibly vitamin D may reduce blood pressure. Less conclusive studies suggest that certain amino acids, tea, green coffee bean extract, dark chocolate, and foods high in nitrates may reduce blood pressure. Moreover, interacti- ons between medicines and nutrient intake on blood pres- sure have been documented, where some nutrients may potentiate or impair the blood pressure-lowering effects of certain medicines. Of all of these factors, the nutrient inta- kes and nutritional disorders that have the most profound effects on increasing the risk or severity of elevated blood pressure or of raising the refractoriness of elevated blood pressure to medicinal therapy are obesity, excessive energy intake and high sodium diets. Reducing obesity and ener- gy and sodium intake will reduce blood pressure, probably especially in individuals with only mildly to moderately ele- vated blood pressure, or decrease the risk of developing hypertension. A number of dietary regimens may reduce blood pressure, most notably the DASH Low Sodium Diet. Other health enhancement activities also appear to lower blood pressure (e.g., regular exercise). Long term compli- ance with such dietary and lifestyle regimens remain diffi- cult for many people. This field is an active area of scientific investigation and may well reveal additional interactions between nutrient intake, nutritional status and increased blood pressure in the future.

Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center Los Angeles

9. mezinárodní nefrologické sympozium "Metabolické změny při chronickém selhání ledvin", Tatranská Lomnica, 21.10.2009