This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.The NIH has recently distributed the results of a consensus conference, which urges that 'all Americans' consume low fat-high carbohydrate diets. Previous results from our research group have demonstrated that the ingestion of low fat-high carbohydrate diets by normal individuals or patients with non-insulin-dependent diabetes can lead to an increase in plasma concentrations of glucose, insulin, triglyceride (TG), as well as a fall in both plasma high density (HDL) and low density lipoprotein (LDL) concentrations. Since the risk of developing coronary artery disease (CAD) has been shown to be associated with all of these metabolic changes, questions can be raised as to the appropriateness of the advice that 'all Americans' eat low fat/high carbohydrate diets. Recent observations have shown that patients with untreated hypertension have higher than normal plasma glucose, insulin and TG concentrations. Institution of several forms of anti-hypersensitive drug therapies have been shown to accentuate these metabolic defects as well as lower plasma HDL-cholesterol concentration. Indeed, the presence of these metabolic abnormalities may explain why treatment of hypertension has not reduced the risk of CAD. Given the presence of the metabolic defects outlined above, and the fact that these same changes are aggravated by low fat/high carbohydrate diets, it is necessary to raise the possibility that the recommended dietary change may increase, not decrease, the risk of CAD in patients with hypertension.
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