Hypertension

HTN: Scope of Guideline (2015)

Guideline Scope Characteristics

Below you will find a list of characteristics that describe the Scope of this Guideline.

Disease/Condition(s)

Guideline Scope Characteristics

Below, you will find a list of characteristics that describe the scope of this guideline.

The purpose of this guideline is to provide an evidence-based summary of effective practice in the nutrition management of HTN in adults. Recommendations have been formulated for HTN within the context of the nutrition care process. The focus of this guideline is on dietary and physical activity interventions for HTN. Other lifestyle modifications or adjunct therapies such as stress management, tobacco cessation and antihypertensive medication, while important in the management and treatement of HTN, were outside the scope of this project. In addition, no evidence summary to counsel on the Mediterranean Diet has been included in these guidelines due to the limited number of studies and the strength of evidence evaluating its effect on blood pressure (BP) in hypertensive patients. 

This guideline is primarily intended for use by registered dietitian nutritionists (RDNs) involved in the management and treatment of adults with HTN with or without concomitant chronic conditions or disease states, such as cardiovascular disease and type 2 diabetes. Clinical judgment should be used when evaluating patients with co-morbid conditions. It may also be a valuable resource for other health care professionals involved in the care and treatment of HTN. In addition, other stakeholders (e.g., public health and nutrition program and policy planners, and hospital and community outreach workers) may find the information in this guideline helpful to assess effective practice in the nutrition management of HTN in adults or for consumer education purposes.

The scope of this guideline is not intended for the following:

  • Interventions typically within the scope of practice of a certified exercise physiologist or other professional, for which, adequate training in physical activity interventions and other therapies is necessary. 
  • Hypertension related to chronic kidney disease
  • Prevention of HTN in normotensive adults
  • Children and teens.
The information in this guideline should be used to provide individualized nutrition care with practical nutrition recommendations that are based on the most current evidence to treat HTN. 

Practitioners interested in more specific information on blood pressure goals, special populations and anithypertensive medications are encouraged to review the JNC8 Report: James PA, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311(5): 507-520. doi:10.1001/jama.2013.284427.

Guideline Category

Management, Prevention, Treatment

Clinical Specialty

Cardiology, Chiropractic, Dentistry, Endocrinology, Family Practice, Geriatrics, Internal Medicine, Nursing, Nutrition, Obstetrics and Gynecology, Ophthalmology, Optometry, Pharmacology, Physical Medicine and Rehabilitation, Pulmonary Medicine, Rheumatology

Intended Users

Registered Dietitians, Advanced Practice Nurses, Allied Health Personnel, Chiropractors, Dentists, Health Care Providers, Nurses, Optometrists, Pharmacists, Physical Therapists, Physician Assistants, Physicians, Public Health Departments, Students

Guideline Objective(s)

Overall Objective

To provide Medical Nutrition Therapy (MNT) guidelines for HTN.

Specific Objectives

  • To define evidence-based recommendations for RDNs that are carried out in collaboration with other healthcare providers
  • To guide practice decisions that integrate medical and lifestyle interventions (nutrition, physical activity and behavioral elements)
  • To reduce variations in practice among RDNs
  • To promote self-management strategies that empower the patient to take responsibility for day-to-day management and to provide the RDN with data to make recommendations to adjust MNT or recommend other therapies to achieve clinical outcomes
  • To enhance the quality of life for the patient, utilizing customized strategies based on the individual’s preferences, lifestyle and goals
  • To develop content for intervention that can be tested for impact on clinical outcomes
  • To define the highest quality of care within cost constraints of the current healthcare environment.

Target Population

Adult (19 to 44 years), Middle Age (45 to 64 years), Aged (65 to 79 years), Male, Female

Target Population Description

Adults with pre-hypertension or HTN.

 

Interventions and Practices Considered

The Hypertension Evidence-Based Guideline is based on the Academy of Nutrition and Dietetics' Nutrition Care Process and Model, which involves the following steps. Terms relevant to the treatment of adults with HTN come from the International Dietetics & Nutrition Terminology (IDNT) Reference Manual: Standardized Language for the Nutrition Care Process. Fourth Edition.

  • Nutrition Assessment
  • Nutrition Diagnosis
  • Nutrition Intervention
  • Nutrition Monitoring and Evaluation.

This guideline addresses topics that correspond to the following areas of the Nutrition Care Process.
 
I. Referral to a Registered Dietitian Nutritionist
II. Medical Nutrition Therapy.

Future Research Needs

Based on the review of topics within the scope of this project, additional research is needed in pre-hypertensive and hypertensive populations to:
  • Determine the short and long-term effect of alcohol intake alone on BP in moderate drinkers with HTN. 
  • Determine if there is a relationship between vitamin D status or intake (from supplements or food sources) and HTN in adults with HTN. 
  • Determine the effect of dietary magnesium intake from food and effect on BP in adults with HTN.
  • Determine the optimal range of dietary and supplemental potassium and calcium intake to achieve BP control. 
  • Determine the effect of the DASH diet on BP in normal weight adults with HTN.
  • Confirm the effect of dietary calcium intake from food sources other than dairy products on BP in adults with HTN.
  • Confirm the effect of magnesium supplementation on BP using magnesium levels within the DRI. 
  • Confirm the effect of the Mediterranean diet on BP in adults with HTN. A standard description for the Mediterranean diet should be defined by consensus for comparison between studies.