Medical Nutrition Therapy

MNT: Effectiveness of MNT for Hypertension (2009)

• Assessment
  What is the evidence to support effectiveness of MNT provided by a Registered Dietitian for hypertension in adults?

  • Conclusion

    Medical nutrition therapy (MNT) provided by a Registered Dietitian lowers blood pressure in adults with hypertension. Three studies regarding the effectiveness of medical nutrition therapy for under six months reported significant reductions in blood pressure of approximately five mm Hg for both systolic and diastolic blood pressure. Five studies regarding the effectiveness of MNT from six to twelve months reported similar significant reductions in blood pressure. Five studies report sustained reductions in blood pressure beyond one year. In these studies, both individual and group sessions were employed over an average of nine sessions.    

     

  • 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: Effectiveness of MNT provided by a Registered Dietitian for hypertension in adults
    • 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.
      • Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PJ, Stevens VJ, Vollmer WM, Lin PH, Svetkey LP, Stedman SW, Young DR; Writing Group of the PREMIER Collaborative Research Group. Effects of comprehensive lifestyle modification on blood pressure control: Main results of the PREMIER Clinical Trial. JAMA 2003 Apr 23-30; 289 (16): 2,083-2,093. 
      • 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. 
      • 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.
      • 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.
      • Nowson CA, Worsley A, Margerison C, Jorna MK, Godfrey SJ, Booth A. Blood pressure change with weight loss is affected by diet type in men. Am J Clin Nutr 2005;81:983-989.
      • Pritchard DA, Hyndman J, Taba F. Nutritional counselling in general practice: A cost effective analysis. J Epidemiol Community Health. 1999; 53: 311-316.
      • Ramsay LE, Ramsay MH, Hettiarachchi J, Davies DL, Winchester J. Weight reduction in a blood pressure clinic. British Medical Journal. 1978; 2: 244-245.
      • 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: Effectiveness of MNT for HTN in Adults 2008