Hypertension

HTN: Executive Summary of Recommendations (2008)

Hypertension (2008) Evidence-Based Nutrition Practice Guideline

Executive Summary of Recommendations

Below are the major recommendations and ratings for the Hypertension (2008) Evidence-Based Nutrition Practice Guideline.  More detail (including the evidence analysis supporting these recommendations) is available on this website to Academy members and subscribers under Major Recommendations.

To see a description of the Academy Recommendation Rating Scheme (Strong, Fair, Weak, Consensus, Insufficient Evidence), click here.

HTN: Classification of Blood Pressure 2008

HTN: Blood Pressure Measurement in Assessment

Blood pressure measurement should be used to classify blood pressure as Normal, Prehypertension, or Hypertension (Stage 1 or Stage 2), to estimate risk for disease, and to identify treatment options. Elevated blood pressure is associated with risk of damage to the heart (LVH, angina, MI, coronary artery disease, heart failure), brain (TIA, stroke, dementia), kidney (CKD), peripheral arteries, and eyes (retinopathy).

Consensus, Imperative

HTN: Blood Pressure Measurement in Monitoring and Evaluation

Blood pressure measurement should be used to monitor and evaluate the effectiveness of therapy. Elevated blood pressure is associated with risk of damage to the heart (LVH, angina, MI, coronary artery disease, heart failure), brain (TIA, stroke, dementia), kidney (CKD), peripheral arteries, and eyes (retinopathy).

Consensus, Imperative

  

Assessment

  HTN: Food/Nutrient-Medication Interactions 2008

HTN: Food/Nutrient and Medication Interaction Assessment

Dietitians should assess food/nutrient-medication interactions in patients that are on pharmacologic therapy for hypertension, as many antihypertensive medications interact with food and nutrients.

Consensus, Imperative

Intervention

 HTN: Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern 2008

HTN: DASH Diet

Individuals should adopt the Dietary Approaches to Stop Hypertension (DASH) dietary pattern which is rich in fruits, vegetables, low-fat dairy, and nuts; low in sodium, total fat, and saturated fat; and adequate in calories for weight management. The DASH dietary pattern reduces systolic blood pressure by 8-14 mmHg.

Consensus, Imperative

 HTN: Physical Activity 2008

Physical Activity

Dietitians should encourage individuals to engage in aerobic physical activity for at least 30 minutes per day on most days of the week, as it reduces systolic blood pressure by approximately 4 - 9 mmHg.

Consensus, Imperative

HTN: Dietary Sodium 2008

HTN: Sodium Intake

Dietary sodium intake should be limited to no more than 2300 mg sodium (100 mmol) per day. Reduction of dietary sodium to recommended levels lowers systolic blood pressure by approximately 2 - 8 mmHg.

Strong, Imperative

HTN: Sodium Intake Monitoring and Evaluation

If the patient demonstrates adherence to a 2300 mg sodium diet but has not achieved the treatment goal, then the dietitian should recommend the DASH dietary pattern and/or reduction in sodium to 1600 mg to further reduce blood pressure.

Strong, Conditional

HTN: Weight Management 2008

Weight Management

Optimal body weight should be achieved and maintained (BMI 18.5 - 24.9) to reduce blood pressure. Weight reduction lowers systolic blood pressure by 5 - 20 mmHg per 22 lbs (10 kg) body weight loss.

Consensus, Imperative

HTN: Omega-3 Fatty Acids 2008

Omega-3 Fatty Acids

Advise that the consumption of omega-3 fatty acids may not be beneficial for the management of hypertension, since their consumption does not appear to lower blood pressure.

Fair, Imperative

HTN: Dietary Protein 2008

Dietary Protein

Advise that the consumption of protein may or may not be beneficial for the reduction of blood pressure, since the effect of increased protein intake on blood pressure is unclear.

Weak, Imperative

 HTN: Soluble Fiber 2008

Soluble Fiber

Advise that the consumption of soluble fiber may or may not be beneficial for the reduction of blood pressure, since the effect of increased soluble fiber intake on blood pressure is unclear.

Weak, Imperative

 HTN: Potassium 2008

Potassium

Dietitians should advise individuals to consume adequate food sources of potassium as part of Medical Nutrition Therapy to reduce blood pressure. Research suggests that potassium intake lower than recommended levels (DRI) is associated with increased blood pressure.

Fair, Imperative

 

 HTN: Vitamins 2008

Vitamin C

Advise that the consumption of vitamin C may or may not be beneficial for the reduction of blood pressure, since the effect of increased vitamin C intake on blood pressure is unclear.

Weak, Imperative

Vitamin E

Advise that the consumption of vitamin E may or may not be beneficial for the reduction of blood pressure, since the effect of increased vitamin E intake on blood pressure is unclear.

Weak, Imperative

HTN: Dietary Magnesium 2008

Dietary Magnesium

 

If magnesium is proposed as a therapy to reduce blood pressure, advise that the effect of magnesium as a single nutrient on blood pressure in healthy or hypertensive adults is unknown. The effect of dietary patterns with magnesium intake above the DRI on blood pressure in healthy or hypertensive adults is minimal. However, some dietary patterns that contain magnesium lower than recommended levels (DRI) may be associated with elevated blood pressure.

Fair, Conditional

 HTN: Calcium 2008

Calcium

If calcium is proposed as a therapy to reduce blood pressure, advise that the effect of calcium as a single nutrient on blood pressure in healthy or hypertensive adults is unclear. Epidemiological studies report that dietary patterns containing calcium lower than recommended levels (DRI) may be associated with elevated blood pressure. The effect of dietary patterns with calcium intake above the DRI on blood pressure in healthy or hypertensive adults is minimal.

Fair, Conditional

HTN: Fruits and Vegetables 2008

Fruits and Vegetables

Advise the consumption of at least five to ten servings of fruits and vegetables per day, based on research reporting significant reductions in blood pressure after consumption of either the DASH dietary pattern or a diet rich in fruits and vegetables.

Strong, Imperative

 HTN: Soy Foods 2008

 Soy Foods

Advise that the consumption of soy foods may or may not be beneficial for the reduction of blood pressure, since the effect of increased soy food intake on blood pressure is unclear.

Weak, Imperative

HTN: Garlic 2008

Garlic

Consumption of garlic may or may not be beneficial for the reduction of blood pressure, since the current evidence is inconclusive regarding its effect on blood pressure.

Weak, Imperative

HTN: Cocoa and Chocolate 2008

 Cocoa and Chocolate

Consumption of cocoa or chocolate may or may not be beneficial for the reduction of blood pressure, since the current evidence is inconclusive regarding its effect on blood pressure.

Weak, Imperative

 HTN: Caffeine 2008

 HTN: Caffeine Intake

For those who consume caffeine, advise blood pressure monitoring; while acute intake of caffeine increases blood pressure, the effect of chronic caffeine intake is unclear.

Weak, Conditional

 HTN: Alcohol Consumption 2008

Alcohol Consumption

For individuals who can safely consume alcohol, consumption should be limited to no more than 2 drinks (24 oz beer, 10 oz wine, or 3 oz of 80-proof liquor) per day in most men and to no more than 1 drink per day in women.  A reduction in alcohol consumption may reduce systolic blood pressure by approximately 2 - 4 mmHg.

Consensus, Conditional 

 HTN: Management of Blood Pressure 2008

HTN: Comprehensive Program for Blood Pressure Management

Management of elevated blood pressure should be based on a comprehensive program including lifestyle modification (weight reduction, medical nutrition therapy and physical activity) and pharmacologic therapy. Research indicates that a comprehensive program can prevent target organ damage and improve cardiovascular outcomes.

Consensus, Imperative

Monitoring & Evaluation

HTN: Goals of Therapy 2008

HTN: Blood Pressure Treatment Goal

 

A treatment goal of <140/90 mmHg is recommended for individuals without comorbidities. This level is associated with preventing target organ damage and decreasing cardiovascular risk factors and complications.

Consensus, Imperative 

 

HTN: Goals of Therapy 2008

HTN: Blood Pressure Treatment Goal for Individuals with Diabetes or Renal Disease

 

For individuals with hypertension and diabetes or renal disease, a treatment goal of <130/80 mmHg is recommended. These individuals are at an increased risk for cardiovascular and renal morbidity and mortality.

Consensus, Conditional