Many patients with hypertension are sodium sensitive, meaning their blood pressure increases after they consume excessive amounts of sodium and decreases after they reduce their sodium intake. Such patients may be prescribed a sodiumrestricted diet, which usually limits sodium consumption to 2 grams a day.



If your patient must comply with such a diet, help him make the change. Along with his dietitian, provide nutritional counseling soon after his hypertension is diagnosed. Include the family or caregiver in your teaching, especially if she prepares the patient's food at home.

Sources of Sodium

Your patient must understand which foods and drugs contain sodium. Explain that the most common sources of sodium are table salt, processed foods, drugs, and softened water.

Table Salt

Advise your patient to avoid using table salt during food preparation and tell him not to add salt to his food. Common table salt consists of 40% sodium and 60% chloride, so if he takes in 6 grams of salt, he's actually consuming 2.4 grams of sodium.

Foods

Explain that some foods, such as beef and dairy products, naturally contain sodium. Other foods are processed with sodium to enhance the flavor or prolong the shelf life. Preserved or processed foods include pickles, canned vegetables, soups, and gravy. Tell him to be alert for products that list sodium ingredients such as sodium benzoate and sodium citrate.

Also, teach your hypertensive patient how to read food labels for sodium content. To reduce confusion and regulate what manufacturers put on food labels, the Food and Drug Administration has defined the terms used in sodium labeling:

* Sodium-Free : less than 5 mg of sodium per serving.

* Very Low Sodium: 35 mg or less per serving.

* Low Sodium: 140 mg or less per serving.

* Reduced Sodium: sodium content reduced by at least 25% of usual level.

* Light Sodium: sodium content reduced by at least 50% of usual level.

* Without Added Salt, Unsalted, or no Added Salt: foods once processed with salt and now processed without it. (These foods must list the amount of sodium per serving.)

Caution your patient about foods that claim to be low in sodium. If the sodium content is less than 5 mg per serving, he can eat the food without concern. If it's higher than 5 mg, he'll need to include the amount in his calculation of sodium intake for the day.

Drugs

Show your patient how to check labels for the sodium content of over-the-counter drugs such as antacids, cough syrups, and laxatives. For other drugs, advise him to check with his pharmacist. If necessary, he should ask his physician or pharmacist to recommend alternative drugs with little or no sodium.

Water

Natural and softened water can be high in sodium. A patient following a severely sodium-restricted diet should investigate the sodium content of his drinking water by contacting his water company or local public health department. Then he should discuss this information with his physician. Depending on how much sodium is in the water, he may be advised to drink and cook with distilled water.