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Hypertension

HTN: Executive Summary of Recommendations (2015)

Executive Summary of Recommendations

Below are the major recommendations and ratings for the Academy of Nutrition and Dietetics Diabetes Hypertension (2015) Evidence-Based Nutrition Practice Guideline. View the Guideline Overview from the Introduction section. More detail (including the evidence analysis supporting these recommendations) is available on this website to Academy members and EAL subscribers under the Major Recommendations section. 

To see a description of the Academy Recommendation Rating Scheme (Strong, Fair, Weak, Consensus, Insufficient Evidence), click here.

The Hypertension 2015 Recommendations are listed below. [Note: If you mouse-over underlined acronyms and terms, a definition will pop up.]

 
  • Nutrition Intervention
    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.
    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.  
    Strong
    Imperative
    HTN: Vitamin D
    The registered dietitian nutritionist (RDN) should encourage adults with hypertension (HTN) to consume adequate amounts of vitamin D to meet the dietary reference intakes (DRI). While important for health, vitamin D may or may not aid in blood pressure (BP) control. Data from observational and intervention studies are inconclusive regarding the association between vitamin D status or intake (from supplements or food sources) and BP in individuals with HTN.  
    Weak
    Imperative
    HTN: Dietary Potassium
    The registered dietitian nutritionist (RDN) should encourage adults with hypertension (HTN) to consume adequate amounts of dietary potassium to meet the dietary reference intakes (DRI) to aid in blood pressure (BP) control. Research indicates that potassium excretion as a marker of dietary intake was inversely associated with BP. In a dietary intervention study, increasing potassium intake up to 2,000mg increased the likelihood of DBP control.
    Fair
    Imperative
    HTN: Potassium Supplements
    If an adult with HTN is unable to meet the DRI for potassium with diet and food alone, and if not contraindicated by risks and harms, the RDN may consider recommending potassium supplementation of up to 3,700mg per day to aid in BP control. Research indicates that potassium supplementation up to approximately 3,700mg reduced SBP and DBP by 3mm Hg to 13mm Hg and 0mm Hg to 8mm Hg, respectively, in adults with HTN. 
     
    Fair
    Conditional
    HTN: Dietary Calcium
    The registered dietitian nutritionist (RDN) should encourage adults with hypertension (HTN) to consume adequate amounts of dietary calcium to meet the dietary reference intakes (DRI) to aid in blood pressure (BP) control. Research indicates that dietary calcium intake of 800mg or more per day reduced systolic blood pressure (SBP) up to 4mm Hg and diastolic blood pressure (DBP) up to 2mm Hg in adults with HTN
    Fair
    Imperative
    HTN: Calcium Supplements
    If an adult with HTN is unable to meet the DRI for calcium with diet and food alone, the RDN may consider recommending calcium supplementation of 1,000mg to 1,500mg per day to aid in BP control. A strong body of research indicates that calcium supplementation of 1,000mg to 1,500mg per day reduced SBP up to 3.0mm Hg and DBP up to 2.5mm Hg in adults with HTN. 
    Strong
    Conditional
    HTN: Dietary Magnesium
    The registered dietitian nutritionist (RDN) should encourage adults with hypertension (HTN) to consume adequate amounts of dietary magnesium to meet the dietary reference intakes (DRI). While important for health, adequate dietary magnesium may or may not aid in blood pressure (BP) control. Results from two studies suggest that the relationship between magnesium intake from food sources and BP in adults with HTN is unclear. 
    Weak
    Imperative
    HTN: Magnesium Supplements
    If an adult with HTN is unable to meet the DRI for magnesium through food and diet alone, the RDN may consider recommending magnesium supplementation of up to 350mg per day to aid in BP control. Research indicates that magnesium supplementation of 240mg up to 1,000mg per day reduced systolic blood pressure (SBP) by 1.0mm Hg to 5.6mm Hg and diastolic blood pressure (DBP) by 1.0mm Hg to 2.8mm Hg in adults with HTN. 
    Fair
    Conditional
    HTN: Sodium
    The registered dietitian nutritionist (RDN) should counsel on reducing sodium intake for blood pressure (BP) reduction in adults with hypertension (HTN).  Research indicates that lowering dietary sodium intake to 1,500mg to 2,000mg per day reduced systolic blood pressure (SBP) and diastolic blood pressure (DBP) up to 12mm Hg and 6mm Hg, respectively.  
    Strong
    Imperative
    HTN: DASH Diet
    The registered dietitian nutritionist (RDN) should counsel on a Dietary Approaches to Stop Hypertension (DASH) dietary pattern plus reduced sodium intake for blood pressure (BP) reduction in adults with hypertension (HTN). Research indicates that in adults with pre-hypertension and HTN, the DASH dietary pattern, compared with the typical American diet lowered systolic blood pressure (SBP) by 5mm Hg to 6mm Hg and diastolic blood pressure (DBP) by 3mm Hg. Reducing sodium intake in those consuming the typical American diet or DASH diet also lowered BP. DASH in combination with a reduced sodium diet lowered BP more than reduced sodium intake alone. The effect was greater in those with HTN.
    Strong
    Imperative
    HTN: DASH Diet and Weight Reduction
    For overweight or obese adults with HTN, the RDN should counsel on a calorie-controlled DASH dietary pattern for weight management and BP reduction. Research indicates that the DASH diet with a sodium range of 1,500mg to 2,400mg reduced systolic blood pressure (SBP) by 2mm Hg to 11mm Hg and diastolic blood pressure (DBP) by 0mm Hg to 9mm Hg in overweight or obese hypertensive adults, regardless of anti-hypertensive medications. DASH plus weight reduction resulted in greater reductions in SBP of 11mm Hg to 16mm Hg and DBP of 6mm Hg to 10mm Hg than weight reduction alone.
    Strong
    Imperative
    HTN: Alcohol Intake in Moderate Drinkers
    If an adult with hypertension (HTN) is a moderate drinker, the registered dietitian nutritionist (RDN) should advise that reducing or refraining from alcohol may or may not aid in blood pressure (BP) management. Research indicates that the effect of alcohol on BP is unclear in moderate drinkers with HTN, since studies in this population yielded contradictory results.
     
    Weak
    Conditional
    HTN: Alcohol Intake in Heavy Drinkers
    If an adult with HTN is a heavy drinker, the RDN should recommend abstinence from alcohol to aid in BP management. Research indicates that abstinence from alcohol resulted in a decrease in systolic blood pressure (SBP) of up to 28mm Hg and a decrease in diastolic blood pressure (DBP) of up to 18mm Hg in chronic heavy drinkers with HTN
    Strong
    Conditional
    HTN: Physical Activity
    The registered dietitian nutritionist (RDN) should encourage adults with hypertension (HTN) to engage in regular aerobic activity to lower blood pressure (BP). Physical activity should be of moderate intensity to vigorous intensity three to four times per week for an average of 40 minutes per session. Research indicates that among adult men and women at all BP levels, including individuals with HTN, aerobic physical activity decreases systolic BP and diastolic BP, on average by 2mm Hg to 5mm Hg and 1mm Hg to 4mm Hg, respectively. Typical interventions shown to be effective for lowering BP include aerobic physical activity of, on average, at least 12 weeks of duration, with three to four sessions per week, lasting on average 40 minutes per session and involving moderate-intensity to vigorous-intensity physical activity.  
    Strong
    Imperative