Hypertension

Hypertension

Welcome to the Systematic Review on Medical Nutrition Therapy (MNT) 
for Adult Pre-hypertension and Hypertension
 
Hypertension is the most prevalent risk factor for cardiovascular disease (CVD) and accounted for nearly 11 million cardiovascular deaths globally in 2021 (Vaduganathan et al 2022). While approximately 50% of adults in the United States (US) are affected by high blood pressure (BP), it is well-controlled in only 1 of 4 individuals (Whelton et al 2018, Benjamin et al 2019). Multiple factors increase an individual’s risk for hypertension including genetics, environment, and the interaction of the two. Most environmental risk factors are modifiable and include lifestyle behaviors, including dietary intake (Benjamin et al. 2019). Estimated annual costs attributed to hypertension have been reported to be almost $56 billion US Dollars (Benjamin, Muntner et al. 2019). 
 
Dietary intake and MNT provided by a dietitian have demonstrated efficacy in improving outcomes in adults with pre-hypertension and hypertension. The objective of this systematic review was to examine the research question: In adults with pre-hypertension or hypertension, what is the effect of MNT provided by a dietitian compared to standard care or no intervention on blood pressure (BP), hypertension incidence, medication use, anthropometrics, and cardiovascular risk and events?
 
Key Findings:
  • MNT provided by a dietitian may reduce systolic and diastolic blood pressure, arterial stiffness, body weight and waist circumference. Certainty of evidence was low. 
  • MNT improved anti-hypertensive medication usage, risk of stroke and cardiovascular disease  risk score, and certainty of evidence was moderate. 
  • There was no significant difference in risk for myocardial infarction between groups. 
  • Very few studies evaluated changes in quality of life and mortality and therefore, no firm conclusions could be reached. 

Use the links on the left to view the results of the systematic review. 

References:

  • Benjamin EJ, Muntner P,  Alonso A, et al. Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation 2019 139(10): e56-e528.
  • Vaduganathan M, Mensah GA, Turco JV, et al. The Global Burden of Cardiovascular Diseases and Risk: A Compass for Future Health. J Am Coll Cardiol 2022 80(25): 2361-2371.
  • Whelton PK, Carey RM, Aronow WS, et al. 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. J Amer Coll Cardiol. 2018 71(19): e127-e248.
  • Pre-Hypertension and Hypertension Systematic Reivew Project Team and Disclosures (2022-24)

    The following individuals contributed their valuable time and expertise to this project:

    Content Advisors Members

    • Dianne DellaValle, PhD, RDN 
      Associate Professor/Program Director, King’s College, Wilkes-Barre, PA, USA
    • Shannon L. Lennon, PhD, RDN 
      Professor, University of Delaware, Newark, DE, USA

    Project Team

    • Lisa Moloney, PhD, RDN, Project Manager 
      Nutrition Researcher Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Mary Rozga, PhD, RDN, Project Manager 
      Nutrition Researcher Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Deepa Handu, PhD, RDN, Methodologist 
      Senior Scientific Director, Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Katelyn E. Senkus, PhD, RDN, Lead Analyst
      Postdoctoral Associate, University of Alabama (through 08/2023); Baylor College of Medicine (as of 09/2023), Houston, TX, USA
    • Josephine L. Dudzik, MS, RDN, CDN, Analyst 
      PhD candidate, New York University, New York, NY, USA
    • Amanda Wanner, MLS, AHIP, Information Specialist 
      Consultant, Saint John, NB, Canada

    Financial Contributors

    • Academy of Nutrition and Dietetics Foundation Evidence Analysis Library Research Endowment
    • Academy of Nutrition and Dietetics 

    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.

    • None
  • Hypertension Systematic Review and Guideline Project Team and Disclosures (2013-2015)

    The following individuals contributed their valuable time and expertise to this project:

    Workgroup Members

    • Diane DellaValle, PhD, RDN, Chair
    • Karen Corbin, PhD, RD (resigned 12/2014)
    • Denise Donaldson-Kaiser, MBA, MS, RD, CDN (resigned 1/2014)
    • Shannon Lennon-Edwards, PhD, RD
    • Brigid McVaugh, MS, RD/LD
    • Melissa Prest, MS, RD, LDN, CSR
    • Susan Rodder, MS, RD, LD (starting 2/2015)

    Project Managers

    • Tami Piemonte, MS, RDN/LDN (starting 11/2014)
    • Mujahed Khan*, MBA, RD (resigned 11/2014)

    Lead Analysts

    • Kathy Hoy, EdD, RD, LDN
    • Erica Gradwell, MS, RD (1/2015 - 2/2015)

    Evidence Analysts

    • Jennifer Aiyer, MS, RD
    • Lisa Davis, MS, RD
    • Alison Dvorak, MS, RDN, CDN
    • Roseline Jan, MS, RD
    • Renee Korczak, PhD, RD
    • Holly Larson, MS, RD
    • Nadia Marzella, MS, LDN
    • Nichole McGrath, LDN
    • Joan Pleuss, MS, CD
    • Helen Solomon, MBA, RD

    Guideline Reviewers

    • Sujata L. Archer, PhD, RD, LD
    • Carolyn Bradley-Guidry, MPAS, PA-C, BSN
    • Terrry Lynn Brown, MPH, MBA, RD, LD, CNSC
    • Brenda M. Davy, PhD, RD
    • Tatyana Yousef El-Kour, MS, RDN
    • A. Christine Hummell, MS, RD, LD, CNSD
    • Elvira Q. Johnson, MS, RD, CDE
    • Vijaya Juturu, PhD, FACN
    • Marilyn D. Schorin, PhD, RDN, LDN, CN, CNS, FAND
    • Bielca Soza, MS, RDN, LD
    • Rebecca J. Threlkeld, MS, RDN, LDN
    • Anna Q.Tourkakis, MPA/H, NDTR
    • Christine K. Weithman, MBA, RD, LDN

    Academy Staff

    • Paula Ziegler, PhD, RD

     * = Academy staff

    Financial Contributor

    • Academy of Nutrition and Dietetics


    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.

    • Karen Corbin - received a grant from the American Heart Association, NIH
  • Project Resources

    The following resources were developed from the 2007-2008 review:

    • Pre-Hypertension and Hypertension (2024) Systematic Review Presentation: this 23-slide MS Powerpoint presentation includes conclusions and grades for the systematic review. Ideal for meetings, in-service presentations, and classroom lectures (this product is not designed for the consumer). Download for free.
    • Hypertension 2015 Evidence-Based Nutrition Recommendations Pocket Guide - This practical quick-reference pocket guide contains the HTN2015 evidence-based graded recommendations. Available in print and digital format.
      • Print format:  4.25"x7.25" multifold. Learn more ...
      • Digital format: compatible with iPhone, iPad and Android products. Learn more ...