Hypertension, often referred to as high blood pressure, is a global public health concern. It is a major risk factor for heart disease and stroke, which are leading causes of death among adults in the U.S. and worldwide. Louisiana ranks among the highest state levels nationwide, with approximately 40% of adults diagnosed with hypertension (America’s Health Rankings Report, 2022). Louisiana also has one of the highest rates of heart disease and stroke (Louisiana Department of Health Report, 2022).

Hypertension often has no symptoms, but if untreated, it can damage blood vessels in the eyes, kidney, brain and heart. Family history, race or ethnicity, age and gender are risk factors that cannot be controlled. However, other risk factors, including diet, obesity, physical inactivity, stress, smoking and alcohol consumption, can be. Therefore, changes in diet and lifestyle are an effective approach to preventing onset of high blood pressure and improving disease management among those who are affected.

The LSU AgCenter developed a hypertension management program called Break Up With Salt (BUWS). This program was initiated in 2020 to meet the need for simple, practical and research-based strategies to direct lifestyle modification for adults. BUWS was built around the Dietary Approaches to Stop Hypertension (DASH) eating plan for which the Pennington Biomedical Research Center, a division of the LSU System, was a key contributor. The program teaches skills in meal planning, grocery shopping, reading nutrition fact labels and cooking as well as strategies for applying these skills in daily routines. The goal of BUWS is to help prevent and/or manage high blood pressure. The program is delivered virtually or in-person and consists of four sessions. Typically, a follow-up session is also included three to four months later.

Statewide successes include the BUWS program delivered in-person by an LSU AgCenter nutrition and community health (NCH) agent in partnership with the New Orleans Council on Aging (NOCOA). A group of 21 adults at one NOCOA site participated in the program in 2023. Each session included an informational presentation, a Q&A and dialogue, goal-setting activities, healthy recipes and handouts to reinforce the topics.

Session one, Hypertension, Setting Goals and Making Changes, focused on facts about hypertension including risk factors, symptoms and blood pressure categories. Participants learned simple lifestyle changes associated with healthy eating, physical activity and stress reduction. They also practiced goal setting, cueing and habit formation techniques to make and maintain these lifestyle changes.

In session two, DASH Diet and Nutrition Facts Label, participants were introduced to the evidence-based DASH diet. The diet recommends servings and sources of foods low in sodium and high in fiber, such as fruits, vegetables, whole grains, nuts, seeds and legumes, as well as choosing low-fat or fat-free dairy options and limiting high-fat meats. Participants were given resources to guide sodium reduction. These included general tips, food packages to practice reading nutrition fact labels, worksheets to track daily sodium intake, lists of high-sodium foods and facts about salt substitutes.

In session three, DASH in for Groceries, participants experienced a virtual grocery store tour interspersed with activities for practicing how to select foods low in salt and avoid added sugars and unhealthy fats. Tips on making the most of food dollars were also included. Participants exchanged tips as they began to understand and apply the knowledge and skills.

In the fourth session, Mastering Meals with Flavor, participants learned how to prepare lower-sodium meals and use herbs and spices instead of salt to enhance flavor. They also received a general introduction on pairing herbs and spices with specific foods. To support healthy food selections when eating out, participants were taught to associate certain menu words and terms, such as pickled, barbecued or au jus, with high sodium content.

At the follow-up session, the NCH agent gave a presentation on the Mediterranean Diet, which works well with the DASH eating plan.

To evaluate program effectiveness, participants completed surveys before and after the program. With 82% program completion, participants reported a 20% increase (68% to 88%) in their ability to use nutrition fact labels when grocery shopping. Other reported increases included learning to follow the DASH eating plan, to prepare food that tastes good without salt and to make lower sodium choices when eating out. These key improvements suggest that BUWS has the potential to help participants reduce long-term salt/sodium consumption and their risk for hypertension.

In Louisiana, maintaining a DASH eating plan can be achieved using locally grown foods. With their reach through local connections, partnerships and nutrition education programs such as BUWS, LSU AgCenter NCH agents can promote behavior change for better health outcomes in Louisiana.

Emelia Clement is a nutrition and community health agent in Orleans Parish and delivers BUWS programming. Elizabeth Gollub is an assistant professor in the School of Nutrition and Food Sciences.

This article appears in the fall 2024 edition of Louisiana Agriculture.

Tips To Reduce Sodium (Salt) in Your Diet

Elizabeth Gollub

• Choose low- or reduced-sodium, or no-salt-added versions of foods and condiments when available.
• Limit intake of smoked/cured and processed meats, poultry and fish.
• Look for and select ready-to-eat breakfast cereals that are lower in sodium.
• Limit your intake of foods packed in brine (e.g., pickles, pickled vegetables, olives and sauerkraut) and condiments (e.g., mustard, horseradish, ketchup, barbecue sauce, and soy and teriyaki sauce) — even lower sodium versions.
• Cook or prepare rice, pasta and hot cereals without added salt.
• If convenience items are a must, choose lower-sodium versions, especially when choosing frozen dinners, mixed dishes, pizzas, packaged mixes, canned soups or broths, and salad dressings.
• Rinse canned vegetables and meats to help remove the salt.
• Use herbs and spices, lemon, lime or vinegar in place of salt. Start by using half the amount of salt you currently add to your foods.

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