This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hollenberg, N. K. Articles by Vicaria-Clement, M. Search for Related Content PubMed PubMed Citation Articles by Hollenberg, N. K. Articles by Vicaria-Clement, M. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Dietary Sodium High Blood Pressure Seniors' Health Hazardous Substances DB MAGNESIUM COMPOUNDS MAGNESIUM, ELEMENTAL POTASSIUM SODIUM

(Hypertension. 1997;29:171.)
© 1997 American Heart Association, Inc.

Scientific Contributions

Aging, Acculturation, Salt Intake, and Hypertension in the Kuna of Panama

Norman K. Hollenberg; Gregorio Martinez; Marji McCullough; Terri Meinking; Diane Passan; Mack Preston; Alicio Rivera; David Taplin; Maureen Vicaria-Clement

From Brigham and Women’s Hospital and Harvard Medical School (N.K.H., M.M., D.P.), Boston, Mass; The University of Miami (T.M., D.T., M.V.-C.), Miami, Fla; and the Panamanian Ministry of Health (G.M., M.P., A.R.), Panama City, Panama.

Reprint requests to Norman K. Hollenberg, MD, PhD, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115

The indigenous Kuna who live on islands in the Panamanian Caribbean were among the first communities described with little age-related rise in blood pressure or hypertension. Our goals in this study were to ascertain whether isolated island-dwelling Kuna continue to show this pattern, whether migration to Panama City and its environs changed the patterns, and whether the island-dwelling Kuna have maintained their normal blood pressure levels despite partial acculturation, reflected in an increased salt intake. We enrolled 316 Kuna participants who ranged in age from 18 to 82 years. In 50, homogeneity was confirmed by documentation of an O+ blood group. In 92 island dwellers, diastolic hypertension was not identified and blood pressure levels were as low in volunteers over 60 years of age as in those between 20 and 30 years of age. In Panama City, conversely, hypertension prevalence was 10.7% and exceeded 45% in those over 60 years of age (P<.01), blood pressure levels were higher in the elderly, and there was a statistically significant positive relationship between age and blood pressure (P<.01). In Kuna Nega, a Panama City suburb designed to maintain a traditional Kuna lifestyle but with access to the city, all findings were intermediate. Sodium intake and excretion assessed in 50 island-dwelling Kuna averaged 135±15 mEq/g creatinine per 24 hours, exceeding substantially other communities free of hypertension and an age-related rise in blood pressure. Despite partial acculturation, the island-dwelling Kuna Indians are protected from hypertension and thus provide an attractive population for examining alternative mechanisms.

Key Words: sodium • potassium • magnesium • calcium • body mass • obesity • aging

This article has been cited by other articles:

				I. J Brown, I. Tzoulaki, V. Candeias, and P. Elliott Salt intakes around the world: implications for public health Int. J. Epidemiol., June 1, 2009; 38(3): 791 - 813. [Abstract] [Full Text] [PDF]

				H. Niinikoski, A. Jula, J. Viikari, T. Ronnemaa, P. Heino, H. Lagstrom, E. Jokinen, and O. Simell Blood Pressure Is Lower in Children and Adolescents With a Low-Saturated-Fat Diet Since Infancy: The Special Turku Coronary Risk Factor Intervention Project Hypertension, June 1, 2009; 53(6): 918 - 924. [Abstract] [Full Text] [PDF]

				R. Corti, A. J. Flammer, N. K. Hollenberg, and T. F. Luscher Cocoa and Cardiovascular Health Circulation, March 17, 2009; 119(10): 1433 - 1441. [Abstract] [Full Text] [PDF]

				K. G. Yamazaki, D. Romero-Perez, M. Barraza-Hidalgo, M. Cruz, M. Rivas, B. Cortez-Gomez, G. Ceballos, and F. Villarreal Short- and long-term effects of (-)-epicatechin on myocardial ischemia-reperfusion injury Am J Physiol Heart Circ Physiol, August 1, 2008; 295(2): H761 - H767. [Abstract] [Full Text] [PDF]

				U. Campia and J. A. Panza Flavanol-rich cocoa a promising new dietary intervention to reduce cardiovascular risk in type 2 diabetes? J. Am. Coll. Cardiol., June 3, 2008; 51(22): 2150 - 2152. [Full Text] [PDF]

				R. R. Allen, L. Carson, C. Kwik-Uribe, E. M. Evans, and J. W. Erdman Jr Daily Consumption of a Dark Chocolate Containing Flavanols and Added Sterol Esters Affects Cardiovascular Risk Factors in a Normotensive Population with Elevated Cholesterol J. Nutr., April 1, 2008; 138(4): 725 - 731. [Abstract] [Full Text] [PDF]

				N. K. Hollenberg and N. D.L. Fisher Is It the Dark in Dark Chocolate? Circulation, November 20, 2007; 116(21): 2360 - 2362. [Full Text] [PDF]

				P. R. Conlin Eat Your Fruits and Vegetables But Hold the Salt Circulation, October 2, 2007; 116(14): 1530 - 1531. [Full Text] [PDF]

				B. D. Dickinson, S. Havas, and for the Council on Science and Public Health, Amer Reducing the Population Burden of Cardiovascular Disease by Reducing Sodium Intake: A Report of the Council on Science and Public Health Arch Intern Med, July 23, 2007; 167(14): 1460 - 1468. [Abstract] [Full Text] [PDF]

				N. K. Hollenberg The Influence of Dietary Sodium on Blood Pressure. J. Am. Coll. Nutr., June 1, 2006; 25(suppl_3): 240S - 246S. [Abstract] [Full Text] [PDF]

				P. R. Steffen, T. B. Smith, M. Larson, and L. Butler Acculturation to Western Society as a Risk Factor for High Blood Pressure: A Meta-Analytic Review Psychosom Med, May 1, 2006; 68(3): 386 - 397. [Abstract] [Full Text] [PDF]

				H. Schroeter, C. Heiss, J. Balzer, P. Kleinbongard, C. L. Keen, N. K. Hollenberg, H. Sies, C. Kwik-Uribe, H. H. Schmitz, and M. Kelm (-)-Epicatechin mediates beneficial effects of flavanol-rich cocoa on vascular function in humans PNAS, January 24, 2006; 103(4): 1024 - 1029. [Abstract] [Full Text] [PDF]

				A. Alonso, C. de la Fuente, J. J. Beunza, A. Sanchez-Villegas, M. A. Martinez-Gonzalez, A. Alonso, A. Sanchez-Villegas, D. Grassi, J. B. Blumberg, and C. Ferri Chocolate Consumption and Incidence of Hypertension Hypertension, December 1, 2005; 46(6): e21 - e22. [Full Text] [PDF]

				P. Meneton, X. Jeunemaitre, H. E. de Wardener, and G. A. Macgregor Links Between Dietary Salt Intake, Renal Salt Handling, Blood Pressure, and Cardiovascular Diseases Physiol Rev, April 1, 2005; 85(2): 679 - 715. [Abstract] [Full Text] [PDF]

				D. Grassi, C. Lippi, S. Necozione, G. Desideri, and C. Ferri Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons Am. J. Clinical Nutrition, March 1, 2005; 81(3): 611 - 614. [Abstract] [Full Text] [PDF]

				M. H. Alderman Dietary Sodium and Cardiovascular Health in Hypertensive Patients: The Case against Universal Sodium Restriction J. Am. Soc. Nephrol., January 1, 2004; 15(90010): S47 - 50. [Abstract] [Full Text]

				M. H Alderman Salt, blood pressure and health: a cautionary tale Int. J. Epidemiol., April 1, 2002; 31(2): 311 - 316. [Full Text] [PDF]

				G MacGregor and H. de Wardener Commentary: Salt, blood pressure and health Int. J. Epidemiol., April 1, 2002; 31(2): 320 - 327. [Full Text] [PDF]

				M. H. Weinberger More Spice on the Salt Debate Arch Intern Med, November 24, 1997; 157(21): 2407 - 2408. [Abstract] [PDF]