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Recommendations Summary

HTN: Medical Nutrition Therapy 2015

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.


  • Recommendation(s)

    HTN: Effectiveness of Medical Nutrition Therapy (MNT)

    Medical nutrition therapy (MNT) provided by a registered dietitian nutritionist (RDN) is recommended to reduce blood pressure (BP) in adults with hypertension (HTN). A strong body of research indicates that MNT provided by an RDN using individual or group sessions reduces BP in persons with HTN or pre-hypertension.

    Rating: Strong
    Imperative

    HTN: Duration and Frequency of Medical Nutrition Therapy (MNT) Encounters

    To reduce BP in adults with HTN, the RDN should provide MTN encounters at least monthly for the first year. After the first year, the RDN should schedule follow up sessions at least two to three times per year to maintain reductions in BP. A strong body of research indicates that reductions in systolic blood pressure (SBP) up to 10mm Hg and in diastolic blood pressure (DBP) up to 6mm Hg were achieved in the first three months of MNT provided every other week for at least three sessions. Similar significant reductions in BP were reported at six to 12 months when MNT was provided at least monthly, or with follow-up provided after five or more sessions. Sustained reductions in BP for up to four years was reported when MNT was provided at least two to three times per year.

     

    Rating: Strong
    Imperative

    • Risks/Harms of Implementing This Recommendation

      There are no potential risks or harms associated with the application of this recommendation.

    • Conditions of Application

      There are no conditions that may limit the application of the recommendation.

    • Potential Costs Associated with Application

      Costs of MNT sessions vary; however, MNT sessions are essential for improved outcomes.

    • Recommendation Narrative

      A total of 15 studies (17 articles) were included in the evidence analysis supporting the recommendations:

      • Seven positive quality randomized controlled trials or crossover trials (Appel et al, 2001; Appel et al, 2003; Ferrara et al, 2012; Goertz et al, 2002; Kumanyika et al, 2005; Noda et al, 2012; Whelton et al, 1998)
      • Two positive quality non-randomized trials (Rankins et al, 2005; Weinberger et al, 1998)
      • One positive quality prospective cohort study (Torres et al, 2011)
      • Six neutral quality randomized controlled or crossover trials (Applegate et al, 1992; Darne et al, 1993; Eriksson et al, 2006; Huggins et al, 2011; Koopman et al, 1990; Koopman et al, 1990)
      • One neutral quality time study (Welty et al, 2007).
      Effectiveness, Duration and Frequency of MNT

      MNT provided by an RDN using individual or group sessions reduced BP in adults with HTN or pre-hypertension:
      • Patients received individual or group counseling on DASH diets (Appel et al, 2003; Huggins et al, 2011; Rankins et al, 2005; Torres et al, 2011; Welty et al, 2007), low-sodium diets (Appel et al, 2001; Applegate et al, 1992; Goertz et al, 2002; Huggins et al, 2011; Koopman et al, 1990; Koopman et al, 1990; Kumanyika et al, 2005; Noda et al, 2012; Torres et al, 2011; Weinberger et al, 1998; Whelton et al, 1998), weight control (Applegate et al, 1992; Darne et al, 1993; Noda et al, 2012; Torres et al, 2011; Welty et al, 2007; Whelton et al, 1998), national dietary recommendations (Eriksson et al, 2006) and the Mediterranean diet (Ferrara et al, 2012)
      • Six studies reported on the short-term effectiveness of MNT between one and six months (Goertz et al, 2002 ; Huggins et al, 2011; Koopman et al, 1990; Noda et al, 2012; Rankins et al, 2005; Weinberger et al, 1998) 
      • Five studies (six articles) reported on the effectiveness of MNT between six months and one year (Appel et al, 2003; Appel et al, 2011; Applegate et al, 1992; Darne et al 1993; Eriksson et al, 2006; Whelton et al, 1998)
      • Four studies (five articles) reported on the effectiveness of MNT beyond one year (Ferrara et al, 2012; Koopman et al, 1990; Kumanyika et al, 2005; Torres et al, 2011; Welty et al, 2007).

    • Recommendation Strength Rationale

      Conclusion statement is Grade I.
       

    • Minority Opinions

      None.