HTN: Executive Summary of Recommendations (2008)
Hypertension (2008) Evidence-Based Nutrition Practice Guideline
Executive Summary of Recommendations
Below are the major recommendations and ratings for the Hypertension (2008) Evidence-Based Nutrition Practice Guideline. More detail (including the evidence analysis supporting these recommendations) is available on this website to Academy members and subscribers under Major Recommendations.
To see a description of the Academy Recommendation Rating Scheme (Strong, Fair, Weak, Consensus, Insufficient Evidence), click here.
HTN: Classification of Blood Pressure 2008
HTN: Blood Pressure Measurement in Assessment
Blood pressure measurement should be used to classify blood pressure as Normal, Prehypertension, or Hypertension (Stage 1 or Stage 2), to estimate risk for disease, and to identify treatment options. Elevated blood pressure is associated with risk of damage to the heart (LVH, angina, MI, coronary artery disease, heart failure), brain (TIA, stroke, dementia), kidney (CKD), peripheral arteries, and eyes (retinopathy).
Consensus, ImperativeHTN: Blood Pressure Measurement in Monitoring and Evaluation
Blood pressure measurement should be used to monitor and evaluate the effectiveness of therapy. Elevated blood pressure is associated with risk of damage to the heart (LVH, angina, MI, coronary artery disease, heart failure), brain (TIA, stroke, dementia), kidney (CKD), peripheral arteries, and eyes (retinopathy).
Consensus, Imperative
Assessment
HTN: Food/Nutrient-Medication Interactions 2008
HTN: Food/Nutrient and Medication Interaction Assessment
Dietitians should assess food/nutrient-medication interactions in patients that are on pharmacologic therapy for hypertension, as many antihypertensive medications interact with food and nutrients.
Consensus, Imperative
Intervention
HTN: Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern 2008
HTN: DASH Diet
Individuals should adopt the Dietary Approaches to Stop Hypertension (DASH) dietary pattern which is rich in fruits, vegetables, low-fat dairy, and nuts; low in sodium, total fat, and saturated fat; and adequate in calories for weight management. The DASH dietary pattern reduces systolic blood pressure by 8-14 mmHg.
Consensus, Imperative
HTN: Physical Activity 2008
Physical Activity
Dietitians should encourage individuals to engage in aerobic physical activity for at least 30 minutes per day on most days of the week, as it reduces systolic blood pressure by approximately 4 - 9 mmHg.
Consensus, Imperative
HTN: Dietary Sodium 2008
HTN: Sodium Intake
Dietary sodium intake should be limited to no more than 2300 mg sodium (100 mmol) per day. Reduction of dietary sodium to recommended levels lowers systolic blood pressure by approximately 2 - 8 mmHg.
Strong, ImperativeHTN: Sodium Intake Monitoring and Evaluation
If the patient demonstrates adherence to a 2300 mg sodium diet but has not achieved the treatment goal, then the dietitian should recommend the DASH dietary pattern and/or reduction in sodium to 1600 mg to further reduce blood pressure.
Strong, Conditional
HTN: Weight Management 2008
Weight Management
Optimal body weight should be achieved and maintained (BMI 18.5 - 24.9) to reduce blood pressure. Weight reduction lowers systolic blood pressure by 5 - 20 mmHg per 22 lbs (10 kg) body weight loss.
Consensus, Imperative
HTN: Omega-3 Fatty Acids 2008
Omega-3 Fatty Acids
Advise that the consumption of omega-3 fatty acids may not be beneficial for the management of hypertension, since their consumption does not appear to lower blood pressure.
Fair, Imperative
HTN: Dietary Protein 2008
Dietary Protein
Advise that the consumption of protein may or may not be beneficial for the reduction of blood pressure, since the effect of increased protein intake on blood pressure is unclear.
Weak, Imperative
HTN: Soluble Fiber 2008
Soluble Fiber
Advise that the consumption of soluble fiber may or may not be beneficial for the reduction of blood pressure, since the effect of increased soluble fiber intake on blood pressure is unclear.
Weak, Imperative
HTN: Potassium 2008
Potassium
Dietitians should advise individuals to consume adequate food sources of potassium as part of Medical Nutrition Therapy to reduce blood pressure. Research suggests that potassium intake lower than recommended levels (DRI) is associated with increased blood pressure.
Fair, Imperative
HTN: Vitamins 2008
Vitamin C
Advise that the consumption of vitamin C may or may not be beneficial for the reduction of blood pressure, since the effect of increased vitamin C intake on blood pressure is unclear.
Weak, Imperative
Vitamin E
Advise that the consumption of vitamin E may or may not be beneficial for the reduction of blood pressure, since the effect of increased vitamin E intake on blood pressure is unclear.
Weak, Imperative
HTN: Dietary Magnesium 2008
Dietary Magnesium
If magnesium is proposed as a therapy to reduce blood pressure, advise that the effect of magnesium as a single nutrient on blood pressure in healthy or hypertensive adults is unknown. The effect of dietary patterns with magnesium intake above the DRI on blood pressure in healthy or hypertensive adults is minimal. However, some dietary patterns that contain magnesium lower than recommended levels (DRI) may be associated with elevated blood pressure.
Fair, Conditional
HTN: Calcium 2008
Calcium
If calcium is proposed as a therapy to reduce blood pressure, advise that the effect of calcium as a single nutrient on blood pressure in healthy or hypertensive adults is unclear. Epidemiological studies report that dietary patterns containing calcium lower than recommended levels (DRI) may be associated with elevated blood pressure. The effect of dietary patterns with calcium intake above the DRI on blood pressure in healthy or hypertensive adults is minimal.
Fair, Conditional
HTN: Fruits and Vegetables 2008
Fruits and Vegetables
Strong, Imperative
Advise the consumption of at least five to ten servings of fruits and vegetables per day, based on research reporting significant reductions in blood pressure after consumption of either the DASH dietary pattern or a diet rich in fruits and vegetables.
HTN: Soy Foods 2008
Soy Foods
Advise that the consumption of soy foods may or may not be beneficial for the reduction of blood pressure, since the effect of increased soy food intake on blood pressure is unclear.
Weak, Imperative
HTN: Garlic 2008
Garlic
Consumption of garlic may or may not be beneficial for the reduction of blood pressure, since the current evidence is inconclusive regarding its effect on blood pressure.
Weak, Imperative
HTN: Cocoa and Chocolate 2008
Cocoa and Chocolate
Consumption of cocoa or chocolate may or may not be beneficial for the reduction of blood pressure, since the current evidence is inconclusive regarding its effect on blood pressure.
Weak, Imperative
HTN: Caffeine 2008
HTN: Caffeine Intake
For those who consume caffeine, advise blood pressure monitoring; while acute intake of caffeine increases blood pressure, the effect of chronic caffeine intake is unclear.
Weak, Conditional
HTN: Alcohol Consumption 2008
Alcohol Consumption
For individuals who can safely consume alcohol, consumption should be limited to no more than 2 drinks (24 oz beer, 10 oz wine, or 3 oz of 80-proof liquor) per day in most men and to no more than 1 drink per day in women. A reduction in alcohol consumption may reduce systolic blood pressure by approximately 2 - 4 mmHg.
Consensus, Conditional
HTN: Management of Blood Pressure 2008
HTN: Comprehensive Program for Blood Pressure Management
Management of elevated blood pressure should be based on a comprehensive program including lifestyle modification (weight reduction, medical nutrition therapy and physical activity) and pharmacologic therapy. Research indicates that a comprehensive program can prevent target organ damage and improve cardiovascular outcomes.
Consensus, Imperative
Monitoring & Evaluation
HTN: Goals of Therapy 2008
HTN: Blood Pressure Treatment Goal
A treatment goal of <140/90 mmHg is recommended for individuals without comorbidities. This level is associated with preventing target organ damage and decreasing cardiovascular risk factors and complications.
Consensus, Imperative
HTN: Goals of Therapy 2008
HTN: Blood Pressure Treatment Goal for Individuals with Diabetes or Renal Disease
For individuals with hypertension and diabetes or renal disease, a treatment goal of <130/80 mmHg is recommended. These individuals are at an increased risk for cardiovascular and renal morbidity and mortality.
Consensus, Conditional