Diet in the treatment and prevention of hypertension
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
- John P Forman, MD, MSc
John P Forman, MD, MSc
- Deputy Editor — Nephrology
- Assistant Professor of Medicine
- Harvard Medical School
A variety of dietary modifications are beneficial in the treatment of hypertension, including reduction of sodium intake, moderation of alcohol, weight loss in the overweight or obese, and a diet rich in fruits, vegetables, legumes, and low-fat dairy products and low in snacks, sweets, meat, and saturated fat. Individual dietary factors may also reduce blood pressure (BP) .
Nondietary modalities of lifestyle modification should also be considered, including cessation of smoking and institution of an aerobic exercise regimen. (See "Smoking and hypertension" and "Exercise in the treatment and prevention of hypertension".)
Most of the studies on nonpharmacologic therapy evaluated only a single factor to prove its efficacy (eg, weight reduction without sodium restriction). In making recommendations to the individual patient, however, the clinician will try to modify all of the factors that may be contributing to the elevation in BP, although it is uncertain if the effects of different modifications are additive.
In those with prehypertension or stage 1 hypertension, lifestyle changes may control the BP adequately . However, in those with either higher BP or additional risk (eg, diabetes or chronic kidney disease), drug therapies should first be used to more quickly and effectively control the BP. Once BP is well controlled, lifestyle changes should be strongly advised. If these are successfully achieved, reduction of medications may be possible.
This topic will review the effect of comprehensive dietary modification, as well as the effects of individual dietary interventions on BP.
- Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289:2560.
- Bavikati VV, Sperling LS, Salmon RD, et al. Effect of comprehensive therapeutic lifestyle changes on prehypertension. Am J Cardiol 2008; 102:1677.
- Sacks FM, Campos H. Dietary therapy in hypertension. N Engl J Med 2010; 362:2102.
- Stamler R, Stamler J, Grimm R, et al. Nutritional therapy for high blood pressure. Final report of a four-year randomized controlled trial--the Hypertension Control Program. JAMA 1987; 257:1484.
- Neaton JD, Grimm RH Jr, Prineas RJ, et al. Treatment of Mild Hypertension Study. Final results. Treatment of Mild Hypertension Study Research Group. JAMA 1993; 270:713.
- Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 1997; 336:1117.
- Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001; 344:3.
- Appel LJ, Champagne CM, Harsha DW, et al. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA 2003; 289:2083.
- Elmer PJ, Obarzanek E, Vollmer WM, et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med 2006; 144:485.
- Pickering TG. Lifestyle modification and blood pressure control: is the glass half full or half empty? JAMA 2003; 289:2131.
- Nicolson DJ, Dickinson HO, Campbell F, Mason JM. Lifestyle interventions or drugs for patients with essential hypertension: a systematic review. J Hypertens 2004; 22:2043.
- He FJ, MacGregor GA. Fortnightly review: Beneficial effects of potassium. BMJ 2001; 323:497.
- Kotchen TA, McCarron DA. Dietary electrolytes and blood pressure: a statement for healthcare professionals from the American Heart Association Nutrition Committee. Circulation 1998; 98:613.
- John JH, Ziebland S, Yudkin P, et al. Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood pressure: a randomised controlled trial. Lancet 2002; 359:1969.
- Stamler J, Liu K, Ruth KJ, et al. Eight-year blood pressure change in middle-aged men: relationship to multiple nutrients. Hypertension 2002; 39:1000.
- Yokoyama Y, Nishimura K, Barnard ND, et al. Vegetarian diets and blood pressure: a meta-analysis. JAMA Intern Med 2014; 174:577.
- Joosten MM, Gansevoort RT, Mukamal KJ, et al. Urinary magnesium excretion and risk of hypertension: the prevention of renal and vascular end-stage disease study. Hypertension 2013; 61:1161.
- Kass L, Weekes J, Carpenter L. Effect of magnesium supplementation on blood pressure: a meta-analysis. Eur J Clin Nutr 2012; 66:411.
- Knapp HR, FitzGerald GA. The antihypertensive effects of fish oil. A controlled study of polyunsaturated fatty acid supplements in essential hypertension. N Engl J Med 1989; 320:1037.
- The effects of nonpharmacologic interventions on blood pressure of persons with high normal levels. Results of the Trials of Hypertension Prevention, Phase I. JAMA 1992; 267:1213.
- Bønaa KH, Bjerve KS, Straume B, et al. Effect of eicosapentaenoic and docosahexaenoic acids on blood pressure in hypertension. A population-based intervention trial from the Tromsø study. N Engl J Med 1990; 322:795.
- Kasim SE, Stern B, Khilnani S, et al. Effects of omega-3 fish oils on lipid metabolism, glycemic control, and blood pressure in type II diabetic patients. J Clin Endocrinol Metab 1988; 67:1.
- Geleijnse JM, Giltay EJ, Grobbee DE, et al. Blood pressure response to fish oil supplementation: metaregression analysis of randomized trials. J Hypertens 2002; 20:1493.
- Mori TA, Burke V, Puddey IB, et al. Effect of fish diets and weight loss on serum leptin concentration in overweight, treated-hypertensive subjects. J Hypertens 2004; 22:1983.
- Bao DQ, Mori TA, Burke V, et al. Effects of dietary fish and weight reduction on ambulatory blood pressure in overweight hypertensives. Hypertension 1998; 32:710.
- Power ML, Heaney RP, Kalkwarf HJ, et al. The role of calcium in health and disease. Am J Obstet Gynecol 1999; 181:1560.
- Griffith LE, Guyatt GH, Cook RJ, et al. The influence of dietary and nondietary calcium supplementation on blood pressure: an updated metaanalysis of randomized controlled trials. Am J Hypertens 1999; 12:84.
- Michaëlsson K, Melhus H, Warensjö Lemming E, et al. Long term calcium intake and rates of all cause and cardiovascular mortality: community based prospective longitudinal cohort study. BMJ 2013; 346:f228.
- Streppel MT, Arends LR, van 't Veer P, et al. Dietary fiber and blood pressure: a meta-analysis of randomized placebo-controlled trials. Arch Intern Med 2005; 165:150.
- Whelton SP, Hyre AD, Pedersen B, et al. Effect of dietary fiber intake on blood pressure: a meta-analysis of randomized, controlled clinical trials. J Hypertens 2005; 23:475.
- Rodriguez-Leyva D, Weighell W, Edel AL, et al. Potent antihypertensive action of dietary flaxseed in hypertensive patients. Hypertension 2013; 62:1081.
- Appel LJ, Sacks FM, Carey VJ, et al. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA 2005; 294:2455.
- Washburn S, Burke GL, Morgan T, Anthony M. Effect of soy protein supplementation on serum lipoproteins, blood pressure, and menopausal symptoms in perimenopausal women. Menopause 1999; 6:7.
- He J, Gu D, Wu X, et al. Effect of soybean protein on blood pressure: a randomized, controlled trial. Ann Intern Med 2005; 143:1.
- He J, Wofford MR, Reynolds K, et al. Effect of dietary protein supplementation on blood pressure: a randomized, controlled trial. Circulation 2011; 124:589.
- Teunissen-Beekman KF, Dopheide J, Geleijnse JM, et al. Protein supplementation lowers blood pressure in overweight adults: effect of dietary proteins on blood pressure (PROPRES), a randomized trial. Am J Clin Nutr 2012; 95:966.
- Rebholz CM, Friedman EE, Powers LJ, et al. Dietary protein intake and blood pressure: a meta-analysis of randomized controlled trials. Am J Epidemiol 2012; 176 Suppl 7:S27.
- Forman JP, Rimm EB, Stampfer MJ, Curhan GC. Folate intake and the risk of incident hypertension among US women. JAMA 2005; 293:320.
- Xun P, Liu K, Loria CM, et al. Folate intake and incidence of hypertension among American young adults: a 20-y follow-up study. Am J Clin Nutr 2012; 95:1023.
- van Dijk RA, Rauwerda JA, Steyn M, et al. Long-term homocysteine-lowering treatment with folic acid plus pyridoxine is associated with decreased blood pressure but not with improved brachial artery endothelium-dependent vasodilation or carotid artery stiffness: a 2-year, randomized, placebo-controlled trial. Arterioscler Thromb Vasc Biol 2001; 21:2072.
- Mangoni AA, Sherwood RA, Swift CG, Jackson SH. Folic acid enhances endothelial function and reduces blood pressure in smokers: a randomized controlled trial. J Intern Med 2002; 252:497.
- McRae MP. High-dose folic acid supplementation effects on endothelial function and blood pressure in hypertensive patients: a meta-analysis of randomized controlled clinical trials. J Chiropr Med 2009; 8:15.
- Ried K, Sullivan TR, Fakler P, et al. Effect of cocoa on blood pressure. Cochrane Database Syst Rev 2012; :CD008893.
- Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The Trials of Hypertension Prevention, phase II. The Trials of Hypertension Prevention Collaborative Research Group. Arch Intern Med 1997; 157:657.
- Whelton PK, Appel LJ, Espeland MA, et al. Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group. JAMA 1998; 279:839.
- Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension in women. JAMA 2009; 302:401.
- He J, Whelton PK, Appel LJ, et al. Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension. Hypertension 2000; 35:544.
- Stamler R, Stamler J, Gosch FC, et al. Primary prevention of hypertension by nutritional-hygienic means. Final report of a randomized, controlled trial. JAMA 1989; 262:1801.
- Takahashi Y, Sasaki S, Okubo S, et al. Blood pressure change in a free-living population-based dietary modification study in Japan. J Hypertens 2006; 24:451.
- Whelton PK, He J, Appel LJ, et al. Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. JAMA 2002; 288:1882.
- COMPREHENSIVE DIETARY MODIFICATION
- Treatment of Mild Hypertension Study
- Dietary Approaches to Stop Hypertension trial
- Low-sodium DASH
- PREMIER trial
- Diet versus antihypertensive agents
- SALT RESTRICTION AND WEIGHT REDUCTION
- OTHER DIETARY INTERVENTIONS
- Fish oil
- - Fish intake
- High-fiber diet
- Protein intake
- INFORMATION FOR PATIENTS