Nutrition • 16 Dec 2020
Dietary Interventions to Reduce Hypertension
By Amanda R. Brown-Tortorici, PhD, MS, RD, CSCS – SSIHI Nutrition Counseling and Elizabeth Dineen, DO – SSIHI Integrative Cardiology
The cardiovascular system, consisting of the heart and circulatory system, functions to provide blood to the body’s organs, cells, and tissues. Blood pressure exists within the arteries to deliver blood from the heart to the rest of the body, and a normal blood pressure number is below 120/80 mmHg.1 Certain conditions and lifestyle behaviors can increase the risk of developing high blood pressure, also known as hypertension. These may include overweight and obesity, lack of physical activity, and inadequate intake of healthful nutrients.1 Uncontrolled high blood pressure increases the risk of developing conditions such as heart failure, a heart attack, a stroke, and chronic kidney disease.2 In 2018, almost half a million people died with hypertension as the primary or contributing cause of death in the United States.3
If you are monitoring your blood pressure at home, it is important to know the right way to measure it. This video by the American Medical Association and Johns Hopkins University demonstrates proper blood pressure monitoring technique and common errors in measurement:
It’s also important to use a validated device to measure blood pressure at home. A current list of independently validated devices can be found here: https://www.validatebp.org/.
The Dietary Approaches to Stop Hypertension (DASH) eating plan is an evidenced-based intervention for reducing high blood pressure.4 In a clinical trial testing the effects of the DASH diet on 133 hypertensive adults, it was found that following the DASH diet for 8 weeks produced significant reductions in systolic and diastolic pressure.5 In the follow-up DASH-Sodium clinical trial, the DASH diet in conjunction with reductions in sodium was shown to significantly lower blood pressure in a diverse cohort of 412 adults.6 A combination of the DASH diet and lifestyle modifications was found to significantly reduce blood pressure among 810 participants over 6 months in the PREMIER clinical trial.7
Highlights of the DASH eating plan include eating foods that are rich in fiber, protein, calcium, potassium, and magnesium. To accomplish this, the following foods are recommended as part of a daily eating plan:
- Whole grains are a major source of protein and calcium. Examples include oatmeal, quinoa, bulgur, and brown rice.
- Vegetables are rich sources of fiber, magnesium, and potassium. Examples include broccoli, kale, bell peppers, and sweet potatoes.
- Fruits are major sources of magnesium, potassium, and fiber. Examples include strawberries, oranges, bananas, mangoes, and peaches.
- Fat-free or low-fat dairy products are rich sources of protein and calcium. Examples include fat-free milk; fat-free or low-fat cheese; fat-free or low-fat yogurt. Dairy substitutes with similar nutrient profiles may be used as necessary.8
- Lean meats, poultry, and fish provide protein and magnesium. Choose lean cuts, trim visible fat, and remove skin from poultry.
- Nuts, seeds, and legumes are rich sources of protein, magnesium, energy, and fiber. Examples include almonds and walnuts (nuts); sunflower seeds and flax seeds; lentils and black beans (legumes).
- Fats and oils are excellent sources of mono- and poly-unsaturated fats. Examples include extra virgin olive oil and avocado.
The DASH eating plan also emphasizes reducing intake of the following:
- Sodium: Recommended intake is less than 2,300 mg per day. Tips for reducing sodium intake includes reading Nutrition Facts labels to identify sodium content, choosing fresh or frozen vegetables versus canned, using less salt in food preparation, and asking for foods to be prepared without salt at restaurants.
- Alcohol: Maximum daily alcohol intake is 2 for men and 1 for women of standard drinks (e.g., 12 oz. of regular beer, 5 oz. of wine, and 1.5 oz. of distilled spirits).
- Saturated and trans fats: Limit foods containing saturated fats such as fatty meats and full-fat dairy products. Avoid foods with the term “partially hydrogenated oils” in the ingredients list.
- Sweets and added sugars: Using a 2,000 calorie diet as a reference, sweets should be limited to 5 servings or less per week.
More information about the DASH eating plan can be found here (https://www.nhlbi.nih.gov/health-topics/dash-eating-plan).
In addition to the DASH diet, an integrative approach for the prevention and treatment of high blood pressure may include conventional medications, supplements, and other evidenced-based modalities. Consult with your healthcare provider to discuss an individualized plan to reduce your risk of high blood pressure.
- Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Himmelfarb, C. D., … & MacLaughlin, E. J. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 71(19), e127-e248.
- National Center for Chronic Disease Prevention and Health Promotion, Division of Heart Disease and Stroke Prevention. (2020, May 19). High Blood Pressure Symptoms and Causes. https://www.cdc.gov/bloodpressure/about.htm
- Centers for Disease Control and Prevention. Underlying Cause of Death, 1999–2018. CDC WONDER Online Database. Atlanta, GA: Centers for Disease Control and Prevention; 2018. http://wonder.cdc.gov/ucd-icd10.html. Accessed November 8, 2020.
- National Heart, Lung, and Blood Institute. (n.d.). DASH Eating Plan. https://www.nhlbi.nih.gov/health-topics/dash-eating-plan
- Conlin, P. R., Chow, D., Miller, E. R., Svetkey, L. P., Lin, P. H., Harsha, D. W., … & Appel, L. J. (2000). The effect of dietary patterns on blood pressure control in hypertensive patients: results from the Dietary Approaches to Stop Hypertension (DASH) trial. American journal of hypertension, 13(9), 949-955.
- Vollmer, W. M., Sacks, F. M., Ard, J., Appel, L. J., Bray, G. A., Simons-Morton, D. G., … & Karanja, N. (2001). Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial. Annals of internal medicine, 135(12), 1019-1028.
- Appel, L. J., Champagne, C. M., Harsha, D. W., Cooper, L. S., Obarzanek, E., Elmer, P. J., Stevens, V. J., Vollmer, W. M., Lin, P.-H., Svetkey, L. P., Young, D. R., & Writing Group of the PREMIER Collaborative Research Group. (2003). Effects of comprehensive lifestyle modification on blood pressure control: Main results of the PREMIER clinical trial. JAMA: Journal of the American Medical Association, 289(16), 2083–2093. https://doi.org/10.1001/jama.289.16.2083
- Tyson, C. C., Nwankwo, C., Lin, P. H., & Svetkey, L. P. (2012). The Dietary Approaches to Stop Hypertension (DASH) eating pattern in special populations. Current hypertension reports, 14(5), 388-396.