Addressing Hypertension via Nutrition (Stalking a Silent Killer)

Because of the uncertain etiology, diet is considered a front-line approach to avoiding high blood pressure and helping to manage it if and when it is diagnosed. In fact, AHA released a statement in 2006¹ that noted, in part: “A substantial body of evidence strongly supports the concept that multiple dietary factors affect blood pressure (BP). Well-established dietary modifications that lower BP are reduced salt intake, weight loss, and moderation of alcohol consumption (among those who drink). Over the past decade, increased potassium intake and consumption of dietary patterns based on the ‘DASH diet’ have emerged as effective strategies that also lower BP.”

The original Dietary Approaches to Stop Hypertension (DASH) clinical study, funded by the National Institutes of Health (NIH), was conducted at Johns Hopkins University, Baltimore, with results published in 1997 in the New England Journal of Medicine.² That study showed the DASH combination diet could help lower BP and control hypertension. The DASH diet emphasizes consuming fruits, vegetables and low-fat dairy products; is low in saturated fat, total fat and cholesterol; and has high levels of dietary fiber, potassium, calcium and magnesium.

While initial interest in and adherence to the DASH diet was positive, the message has lost some of its initial impact. Researchers from the Hypertension Center of the Hattiesburg Clinic, Hattiesburg, Miss., analyzed data from the National Health and Nutrition Examination Survey (NHANES) from the 1988 to 1994 and 1999 to 2004 periods to determine DASH accordance among adults with hypertension.³ They found accordance with the DASH diet was 7.3-percent lower in the more recent NHANES survey than the previous one, suggesting the impact of the initial message is being lost. However, researchers from Duke University, Durham, N.C., conducted an intervention using the DASH diet plus behavioral counseling, and found adding enhancements could increase adherence and inclusion of nutrient-dense foods.⁴ Another possibility was tested in the OmniHeart trial at Brigham and Women’s Hospital, Boston, which found using the DASH diet as a starting point and offering some level of flexibility in macronutrient intake, such as increasing protein levels slightly or raising the level of healthy unsaturated fats, could achieve similar results in relation to high blood pressure while making it easier to follow the diet in the long-term.⁵