The indigenous Kuna who live on islands in the Panamanian Caribbean were among the first communities described with little age-related rise m 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 0+ blood group In 92 island dwellers, diastolic hypertension was not identified and blood pressure levels were as low m 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< Ol), blood pressure levels were higher in the elderly, and there was a statistically signrficant positive relationship between age and blood pressure (P< 01) In Kuna Nega, a Panama City suburb designed to mamtam a traditional Kuna lifestyle but with access to the city, all findmgs were Intermediate Sodmm mtake and excretion assessed m 50 islanddwelling Kuna averaged 135+ 15 mEq/g creatmme per 24 hours, exceedmg substantially other communities free of hypertension and an age-related rise m blood pressure Despite partial acculturation, the island-dwellmg Kuna Indians are protected from hypertension and thus provide an attractive populatton for exammmg alternative mechamsms (Hypertensron. 1997;29[part 21: 171-176.) Key Words l sodium l potassium l magnesmm l calcium l body mass l obesity l aging T he Kuna Indians who live in the isolated San BlasIsland cham off the Caribbean Coast of Panama were among the first commumttes described m which hypertension is rare. i In their recent review, James and Baker* cited 39 such populations m Africa, the Americas, Asia, and the Pacific Region In many of these communities, the primary evidence that the protective factor is environmental rather than genetic was the blood pressure rise following migration to an urban environment 2-1g Among the many lines of evidence suggestmg a role for salt intake m the pathogenesis of hypertension, particularly compellmg has been the rdentrficatton of these tsolated communities where salt intake 1s low, hypertension is rare, and blood pressure does not rise with age. By 1976, Page3 concluded that all low blood pressure populations have a low salt intake as part of their biology and probably as a maJor causal mechanism and supported that conclusion by citing nme earlier studies. Since that time, a number of confirmatory studies have been reported.a-'2 Salt intake m such "protected" commumtres generally provided less than 40 mBq of sodmm per day, and typrcally much less.Our goals m this study were to ascertain whether we could confirm the absence of hypertension and age-related rise m blood pressure m ...

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