Consult the medical resource doctors trust

UpToDate is one of the most respected medical information resources in the world, used by over 360,000 doctors and thousands of patients to find answers to medical questions.

  • Content written by a faculty of over 4,000 physicians from leading medical institutions
  • Unbiased: free of advertising or pharmaceutical funding
  • Evidence-based treatment recommendations
  • Continuously updated to incorporate new medical findings

Diet in the treatment and prevention of hypertension

INTRODUCTION

A variety of dietary modifications are beneficial in the treatment of hypertension, including reduction of sodium intake, moderation of alcohol, weight loss in the obese, and possibly increasing potassium and calcium intake, and ingestion of a vegetarian diet or fish oil supplements [1].

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 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 physician will try to modify all of the factors that may be contributing to the elevation in blood pressure, 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 blood pressure adequately [2]. 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 blood pressure. Once blood pressure 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 blood pressure.
To continue reading this article you need to subscribe.

Read the rest of this article and others like it

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use (click here) ©2010 UpToDate, Inc.
References Top
  1. Chobanian, AV, Bakris, GL, Black, HR, Cushman, WC. 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.
  2. Bavikati, VV, Sperling, LS, Salmon, RD, et al. Effect of comprehensive therapeutic lifestyle changes on prehypertension. Am J Cardiol 2008; 102:1677.
  3. 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.
  4. Neaton, JD, Grimm, RH Jr, Prineas, RJ, et al. Treatment of Mild Hypertension Study: Final results. JAMA 1993; 270:713.
  5. Appel, LJ, Moore, TJ, Obarzanek, E, et al. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med 1997; 336:1117.
  6. 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. N Engl J Med 2001; 344:3.
  7. 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.
  8. 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.
  9. Pickering, TG. Lifestyle modification and blood pressure control: is the glass half full or half empty?. JAMA 2003; 289:2131.
  10. 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.
  11. He, FJ, MacGregor, GA. Fortnightly review: Beneficial effects of potassium. BMJ 2001; 323:497.
  12. Kotchen, TA, McCarron, DA, for the Nutrition Committee. Dietary electrolytes and blood pressure. A statement for Healthcare Professionals from the American Heart Association Nutrition Committee. Circulation 1998; 98:613.
  13. 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.
  14. 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.
  15. 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.
  16. The Trials of Hypertension Prevention Collaborative Research Group. The effects of nonpharmacologic interventions on blood pressure of persons with high-normal levels. Results of the Trials of Hypertension Prevention, Phase 1. JAMA 1992; 267:1213.
  17. Bonaa, KH, Sjerve, KS, Straume, B, et al. Effect of eicosapentaenoic acid and docosahexaenoic acid on blood pressure in hypertension. A population-based intervention trial from the Tromso study. N Engl J Med 1990; 322:795.
  18. Kasim, SE, Stern, B, Khilani, 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.
  19. 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.
  20. 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.
  21. 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.
  22. Power, ML, Heaney, RP, Kalkwarf, HJ, Pitkin, RM. The role of calcium in health and disease. Am J Obstet Gynecol 1999; 181:1560.
  23. Griffith, LE, Guyatt, GH, Cook, RJ, et al. The influence of dietary and nondietary calcium supplementation on blood pressure. Am J Hypertens 1999; 12:84.
  24. Bostick, RM, Fosdick, L, Grandits, GA, Grambsch, P. Effect of calcium supplementation on serum cholesterol and blood pressure. A randomized, double-blind, placebo-controlled, clinical trial. Arch Fam Med 2000; 9:31.
  25. Sacks, FM, Willett, WC, Smith, A, et al. Effect on blood pressure of potassium, calcium, and magnesium in women with low habitual intake. Hypertension 1998; 31:131.
  26. Reid, IR, Horne, A, Mason, B, et al. Effects of calcium supplementation on body weight and blood pressure in normal older women: a randomized controlled trial. J Clin Endocrinol Metab 2005; 90:3824.
  27. Resnick, LM. Calcium metabolism in the pathophysiology and treatment of clinical hypertension. Am J Hypertens 1989; 2:179S.
  28. Margetts, BM, Beilin, LJ, Vandongen, R, Armstrong, BK. Vegetarian diet in mild hypertension: A randomised controlled trial. Br Med J 1986; 293:1468.
  29. 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.
  30. 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.
  31. Obarzanek, B, Velletri, PA, Cutler, JA. Dietary protein and blood pressure. JAMA 1996; 275:1598.
  32. 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.
  33. 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.
  34. Forman, JP, Rimm, EB, Stampfer, MJ, Curhan, GC. Folate intake and the risk of incident hypertension among US women. JAMA 2005; 293:320.
  35. Taubert, D, Roesen, R, Schomig, E. Effect of cocoa and tea intake on blood presure: A meta-analysis. Arch Intern Med 2007; 167:626.
  36. 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.
  37. 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). JAMA 1998; 279:839.
  38. Forman, JP, Stampfer, MJ, Curhan, GC. Diet and lifestyle risk factors associated with incident hypertension in women. JAMA 2009; 302:401.
  39. 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.
  40. 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.
  41. 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.
  42. 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.
white circle LOG IN
white circle DEMO