Hypertension

HTN: Medical Nutrition Therapy (2015)

• Intervention
  In persons with hypertension, how effective is Medical Nutrition Therapy provided by a registered dietitian nutritionist compared to no or other interventions on blood pressure?

  • Conclusion
    Medical nutrition therapy (MNT) provided by a registered dietitian nutritionist (RDN) using individual or group sessions reduces blood pressure (BP) in persons with hypertension or pre-hypertension. Six studies reported reductions in systolic blood pressure (SBP) up to 10mmHg and in diastolic blood pressure (DBP) up to 6.0mmHg after one to three months of MNT provided at least every other week for at least three sessions. Four studies reported similar significant reductions in BP from six to twelve months when MNT was provided at least monthly or with follow-up provided after five or more sessions. Five studies report sustained reductions for up to four years with MNT provided at least two to three times per year.
  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In persons with hypertension, how effective is Medical Nutrition Therapy provided by a registered dietitian nutritionist compared to no or other interventions on blood pressure?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Appel LJ, Espeland MA, Easter L, Wilson AC, Folmar S, Lacy CR. Effects of reduced sodium intake on hypertension control in older individuals:  results from the Trial of Nonpharmacologic Interventions in the Elderly (TONE). Arch Intern Med. 2001 Mar 12; 161 (5): 685-693.
      • Applegate WB, Miller ST, Elam JT, Cushman WC, El Derwi D, Brewer A, Graney MJ.  Nonpharmacologic intervention to reduce blood pressure in older patients with mild hypertension. Arch Intern Med. 1992; 152: 1162-1166.
      • Darne B, Nivarong M, Tugaye A, Safar M, Plouin PF, Guillanneuf MT, Cubeau J, Pannier B, Peguignot F, Cambien F. Hypocaloric diet and antihypertensive drug treatment. A randomized controlled clinical trial. Blood Press. 1993; 2(2): 130-135. 
      • Eriksson KM, Westborg CJ, Eliasson MCE. A randomized trial of lifestyle intervention in primary healthcare for the modification of cardiovascular risk factors. The Bjorknas study. Scand J Public Health. 2006; 34(5): 453-461. 
      • Ferrara AL, Pacioni D, Di  Fronzo V, Russo BF, Stalano L, Speranza E, Gente R, Gargiulo F, Ferrara F. Lifestyle educational program strongly increases compliance to nonpharmacologic intervention in hypertensive patients: A two-year follow-up study. J Clin Hypertens. 2012; 14(11): 767-772. 
      • Goertz CH, Grimm RH, Svendsen K, Grandits G. Treatment of Hypertension with Alternative Therapies (THAT) Study: A randomized clinical trial. Journal of Hypertension. 2002; 20(10); 2063-2068.
      • Huggins CE, Margerison C, Worsley A, Nowson CA. Influence of dietary modifcations on the blood pressure response to antihypertensive medication. Br J Nutr. 2011;105:248-255.
      • Koopman H, Spreeuwenberg C, Westerman RF, Donker AJM. Dietary treatment of patients with mild to moderate hypertension in a general practice: A pilot intervention study. (2) Beyond three months. Journal of Human Hypertension. 1990; 4: 372-374.
      • Koopman H, Spreeuwenberg C, Westerman RF, Donker AJM. Dietary treatment of patients with mild to moderate hypertension in a general practice: A pilot intervention study. (1) The first three months.  Journal of Human Hypertension. 1990; 4: 368-371.
      • Kumanyika SK, Cook NR, Cutler JA, Belden L, Brewer A, Cohen JD, Hebert PR, Lasser VI, Raines J, Raczynski J, Shepek L, Diller L, Whelton PK, Yamamoto M; Trials of Hypertension Prevention Collaborative Research Group. Sodium reduction for hypertension prevention in overweight adults: Further results from the Trials of Hypertension Prevention Phase II. J Hum Hypertens. 2005 Jan; 19(1): 33-45.
      • Noda K, Zhang B, Iwata A, Nishikawa H, Ogawa M, Nomiyama T, Miura S, Sako H, Matsuo K, Yahiro E, Yanase T, Saku K. Lifestyle changes through the use of delivered meals and dietary counseling in a single-blind study. Circ J. 2012; 76: 1335-1344.
      • Rankins JR, Sampson W, Brown B, Jenkins-Salley T. Dietary Approaches to Stop Hypertension (DASH) intervention reduces blood pressure among hypertensive African American patients in a neighborhood health care center. J Nutr Educ Behav. 2005; 37: 259-264.
      • Torres MRSG, Ferreira TS, Nogueira LP, Nascimento DCS, Sanjuliani AF. Dietary counseling on long-term weight loss in overweight hypertensive patients. Clinics. 2011; 66(10): 1,779-1,785.
      • Weinberger MH, Cohen SJ, Miller JZ, Luft FC, Grim CE, Fineberg NS. Dietary sodium restriction as adjunctive treatment of hypertension. JAMA 1988; 259 (17) : 2,561-2,565.
      • Welty FK, Nasca MM, Lew NS, Gregoire S, Ruan Y. Effect of onsite dietitian counseling on weight loss and lipid levels in an outpatient physician office. Am J Cardiol. 2007; 100(1): 73-75.
  • Search Plan and Results: HTN: MNT 2013