Hypertension

HTN: Diet Patterns (2015)

• Intervention
  What is the effect of the DASH diet pattern on blood pressure in adults with hypertension?

  • Conclusion
    The Dietary Approaches to Stop Hypertension (DASH) diet with a sodium range of 1,500mg to 2,400mg, reduced systolic blood pressure (SBP) by 2.0mmHg to 11mmHg and diastolic blood pressure (DBP) by 0.0mmHg to 9.0mmHg in overweight or obese adults with hypertension (HTN) regardless of anti-hypertensive medications. DASH plus weight loss resulted in reductions in SBP of 11mmHg to 16mmHg and DBP of 6.0mmHg to 10mmHg. There were no studies that met the search inclusion criteria for normal weight adults with HTN.
  • 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: What is the effect of the DASH diet pattern on blood pressure in adults with hypertension?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Al-Solaiman Y, Jesri A, Mountford WK, Lackland T, Ahao Y, Egan BM. DASH lowers blood pressure in obese hypertensives beyond potassium, magnesium and fiber. J Hum Hypertens. 2010: 24 (4): 237-246.
      • Blumenthal JA, Babyak JA, Sherwood A, Craighead L, Pao-HWa L, Johnson J, Watkins LL, Wang JT, Kuhn C, Feinglos M, Hinderliter A. The effects of the dash diet alone and in combination with exercise and caloric restriction on insulin sensitivity and lipids. Hypertension. 2010; 55(5): 1,199-1,205.  
      • Elmer PJ, Obarzanek E, Vollmer WM, Simons-Morton D, Stevens VJ, Young DR, Pao-Hwa L, Champagne C, Harsha DW, Svetkey LP, Ard J, Brantley PJ, Proschan MA, Erlinger TP, Appel LJ. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: Eighteen-month results of a randomized trial. Ann Intern Med. 2006; 144: 485-495. 
      • Epstein DE, Sherwood A, Smith PJ, Craighead L, Caccia C, Lin PH, Babyak MA, Johnson JJ, Hinderliter A, Blumenthal JA. Determinants and consequences of adherence to the dietary approaches to Stop Hypertension Diet in African-American and white adults with high blood pressure: Results from the ENCORE trial. J Acad Nutr Diet. 2012; 112(11): 1,763-1,773.
      • 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.
      • Kirpizidis H, Stavrati A, Geleris P. Assessment of quality of life in a randomized clinical trial of candesartan only or in combination with DASH diet for hypertensive patients. J Cardiol. 2005; 46(5): 177-182.
  • Search Plan and Results: HTN: Diet Patterns (DASH) 2014
     
  What is the effect of the Mediterranean diet pattern on blood pressure in adults with hypertension?

  • Conclusion
    Limited evidence from one randomized controlled trial reports that hypertensive adults who followed a Mediterranean diet, supplemented with either extra virgin olive oil (up to one liter per week) or nuts (30g per day) had reductions in diastolic blood pressure up 1.5mmHg greater than those following a low-fat diet.
  • Grade: III
    • 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: What is the effect of the Mediterranean diet pattern on blood pressure in adults with hypertension?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Toledo E, Hu FB, Estruch R, Buil-Cosiales P, Corella D, Salas-Salvado J, Covas MI, Aros F, Gomez-Gracia E, Fiol M, Lapetra J, Serra-Majem L, Pinto X, Lamuela-Raventos RM, Saez G, Bullo M, Ruiz-Gutierrez V, Ros E, Sorli JV, Martinez-Gonzalez MA. Effect of the Mediterranean diet on blood pressure in the PREDIMED trial: Results from a randomized controlled trial. BMC Medicine. 2013; 11: 207.
  • Search Plan and Results: HTN: Diet Patterns (Mediterranean Diet) 2014