Pre-Hypertension and Hypertension Systematic Review (2022-24)

Pre-Hypertension and Hypertension Systematic Review (2022-24)

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 2021.1 While approximately 50% of adults in the United States (US) are affected by high blood pressure (BP), it is well-controlled in only one of four individuals.2,3 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.3 Estimated annual costs attributed to hypertension have been reported to be almost $56 billion US Dollars.3 

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:

  • Forty articles representing 31 RCTs were included in analyses. 
  • MNT provided by a dietitian may reduce systolic and diastolic BP, arterial stiffness, body weight and waist circumference. Certainty of evidence was low. 
  • MNT improved anti-hypertensive medication usage, risk of stroke and CVD 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 QoL and mortality and therefore, no firm conclusions could be reached. 


  1. 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.
  2. 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 Guidelies.  J Am Coll Cardiol, 2018 71(19): e127-e248.
  3. 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.