Hypertension

HTN: Introduction (2008)

Guideline Overview

Guideline Title

Hypertension (2008) Evidence-Based Nutrition Practice Guideline

Guideline Narrative Overview

The focus of this guideline is on the treatment of hypertension in adults.  Adults are classified as having prehypertension (120 - 139/80 - 89 mmHg), stage 1 hypertension (140 - 159/90 - 99 mmHg), or stage 2 hypertension (>160/>100 mmHg).

Guideline Development

This guideline is intended to provide the most current information on hypertension based on the systematic review of the literature. The recommendations developed in this guideline involved the review of multiple articles to determine the most appropriate course of action for the practitioner. A summary of the evidence analysis is below:

Topics include:

• Dietary Sodium
• Dietary Magnesium
• Dietary Potassium
• Dietary Calcium
• Caffeine
• Dietary Protein
• Soy Foods
• Fruits and Vegetables
• Soluble Fiber
• Vitamins
• Omega-3 Fatty Acids
• Garlic
• Cocoa and Chocolate

In addition, several recommendations were based on the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7).The purpose JNC 7 is to provide an approach to the prevention and management of hypertension. Given this landmark document, the hypertension working group did not review topics that were already addressed in the review conducted by the JNC 7 group.

The topics presented in this guideline are the first step towards a comprehensive list of recommendations to address hypertension. As an ongoing project, the expert workgroup has identified several other topic areas to address in this guideline, which may include very recent and emerging publications that would present additional or more insightful recommendations. Future revisions of these recommendations will include the clinical impact of Medical Nutrition Therapy on hypertension.

The number of supporting documents for these topics is below:

• Recommendations:  21 
• Conclusion Statements:  14 
• Evidence Summaries:  14
• Article worksheets:  99     

Revision

If a revision is unwarranted, then the search is recorded, dated and saved until the next review and no further action is taken. If the determination is that there could be a change in the recommendation or rating, then the supporting evidence analysis question(s) will be re-analyzed following the standard ADA Evidence Analysis Process (see Methodology tab).

Application of the Guideline

This guideline will be accompanied by a set of companion documents (i.e., a toolkit) to assist the practitioner in applying the guideline. The toolkit will contain materials such as the Medical Nutrition Therapy protocol, documentation forms, outcomes management tools, client education resources and case studies. The toolkit is currently under development and will undergo pilot-testing through the ADA's Dietetic Practice-Based Research Network prior to publication.

The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure

These recommendations for hypertension are based on a combination of recent ADA evidence analysis and recommendations from the guidelines developed by the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure.  Since the publication of the Sixth Report, the NHBPEP Coordinating Committee, chaired by the Director of NHLBI, has regularly reviewed and discussed studies on hypertension.  The Seventh Report of the Joint National Committee was based on the scientific literature from January 1997 through April 2003.  Various systems of grading the evidence were considered, and the classification scheme used in the Sixth Report and other NHBPEP clinical guidelines was selected.

Medical Nutrition Therapy and Hypertension 

National evidence-based guidelines recommend diet therapy as an integral component of a comprehensive treatment program. The registered dietitian plays an integral role in the interdisciplinary healthcare team by designing the optimal nutrition prescription that coincides with physical activity, behavior therapy and drug therapy, when necessary. Based on the client’s treatment plan and comorbid conditions, other nutrition practice guidelines, such as disorders in lipid metabolism and type 2 diabetes mellitus, may be needed in order to provide optimal treatment.

Populations to Whom This Guideline May Apply 

Population groups, medical conditions or coexisting diagnoses, where the hypertension recommendations may be indicated, include:

• Cardiovascular disease (CVD) 
• Diabetes mellitus (type 2)
• Obesity

Other Guideline Overview Material

For more details on the guideline components, click on the Introduction tab to access:

• Scope of Guideline
• Statement of Intent and Patient Preference
• Guideline Methods
• Implementation of the Guideline
• Benefits and Harms of Implementing the Recommendations.

Contraindications

Clinical judgment is crucial in the application of these guidelines.