HTN: Dietary Protein 2008
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
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.
Risks/Harms of Implementing This Recommendation
No defined intake level at which potential adverse effects of protein has been identified.
Conditions of Application
No conditions specified.
Potential Costs Associated with Application
- Two cross-sectional studies (Liu et al, 2002; Iseki et al, 2003) and a meta-analysis (Liu et al, 2002) suggest an inverse relationship between protein intake and blood pressure, especially in men, while one cross-sectional study reported an inverse relationship between vegetable protein but not total protein intake and blood pressure (Elliott et al, 2006).
- Two randomized trials reported no differences in blood pressure between groups consuming high and low levels of dietary protein (Farnsworth et al, 2003; Brinkworth et al, 2004).
- However, one randomized trial identified small reductions in blood pressure in prehypertensive and hypertensive subjects consuming 25% of energy from protein, of which 50% was vegetable protein (Appel et al, 2005).
Recommendation Strength Rationale
- Conclusion Statement is Grade III
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
What is the relationship between protein intake and blood pressure in healthy and hypertensive adults?
Appel LJ, Sacks FM, Carey VJ, Obarzanek E, Swain JF, Miller ER, Conlin PR, Erlinger TP, Rosner BA, Laranjo NM, Charleston J, McCarron P, Bishop LM for the OmniHeart Collaborative Research Group. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA. 2005; 294: 2,455-2,464.
Brinkworth GD, Noakes M, Keogh JB, Luscombe ND, Wittert GA, Clifton PM. Long-term effects of a high-protein, low-carbohydrate diet on weight control and cardiovascular risk markers in obese hyperinsulinemic subjects. Int J Obes Relat Metab Disord, 2004; 28 (5): 661-670.
Elliott P, Stamler J, Dyer AR, Appel L, Dennis B, Kesteloot H, Ueshima H, Okayama A, Chan Q, Garside DB, Zhou B for the Intermap Research Group. Association between protein intake and blood pressure. Archives of Internal Medicine, 2006; 166: 79-87.
Farnsworth E, Luscombe ND, Noakes M, Wittert G, Argyiou E, Clifton PM. Effect of a high-protein, energy-restricted diet on body composition, glycemic control, and lipid concentrations in overweight and obese hyperinsulinemic men and women. American Journal of Clinical Nutrition. 2003; 78: 31-39.
Iseki K, Iseki C, Itoh K, Sanefuji M, Uezono K, Ikemiya Y, Fukiyama K, Kawasaki T. Estimated protein intake and blood pressure in a screened cohort in Okinawa, Japan. Hypertension Research. 2003; 26: 289-294.
Liu L, Ikeda K, Sullivan D, Ling W, Yamori Y. Epidemiological evidence of the association between dietary protein intake and blood pressure: a meta-analysis of published data. Hypertens Res. 2002; 25: 689-695.
Liu L, Ikeda K, Yamori Y. Inverse relationship between urinary markers of animal protein intake and blood pressure in Chinese: results from the WHO Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study. International Journal of Epidemiology, 2002; 31: 227-233.
References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process
The Dietary Reference Intakes (DRI) and Recommended Dietary Allowances (RDA) are issued by the Food and Nutrition Board of the Institute of Medicine, National Academy of Sciences.