Hypertension Nutrition Management

Publication Date: September 1, 2017
Last Updated: December 16, 2022

Nutrition Intervention

HTN: Effectiveness of Medical Nutrition Therapy (MNT)

MNT provided by a registered dietitian nutritionist (RDN) is recommended to reduce blood pressure (BP) in adults with hypertension (HTN). A strong body of research indicates that MNT provided by an RDN using individual or group sessions reduces BP in persons with HTN or pre-hypertension. (Strong, Imperative)
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HTN: Duration and Frequency of MNT Encounters

To reduce BP in adults with HTN, the RDN should provide MTN encounters at least monthly for the first year. After the first year, the RDN should schedule follow up sessions at least two to three times per year to maintain reductions in BP. A strong body of research indicates that reductions in systolic blood pressure (SBP) up to 10mm Hg and in diastolic blood pressure (DBP) up to 6mm Hg were achieved in the first three months of MNT provided every other week for at least three sessions. Similar significant reductions in BP were reported at six to 12 months when MNT was provided at least monthly, or with follow-up provided after five or more sessions. Sustained reductions in BP for up to four years was reported when MNT was provided at least two to three times per year. (Strong, Imperative)
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HTN: Vitamin D

The RDN should encourage adults with HTN to consume adequate amounts of vitamin D to meet the dietary reference intakes (DRI). While important for health, vitamin D may or may not aid in BP control. Data from observational and intervention studies are inconclusive regarding the association between vitamin D status or intake (from supplements or food sources) and BP in individuals with HTN. (Weak, Imperative)
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HTN: Dietary Potassium

The RDN should encourage adults with HTN to consume adequate amounts of dietary potassium to meet the DRI to aid in BP control. Research indicates that potassium excretion as a marker of dietary intake was inversely associated with BP. In a dietary intervention study, increasing potassium intake up to 2,000mg increased the likelihood of DBP control. (Fair, Imperative)
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HTN: Potassium Supplements

If an adult with HTN is unable to meet the DRI for potassium with diet and food alone, and if not contraindicated by risks and harms, the RDN may consider recommending potassium supplementation of up to 3,700mg per day to aid in BP control. Research indicates that potassium supplementation up to approximately 3,700mg reduced SBP and DBP by 3mm Hg to 13mm Hg and 0mm Hg to 8mm Hg, respectively, in adults with HTN. (Fair, Conditional)
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HTN: Dietary Calcium

The RDN should encourage adults with HTN to consume adequate amounts of dietary calcium to meet the DRI to aid in BP control. Research indicates that dietary calcium intake of 800mg or more per day reduced SBP up to 4mm Hg and DBP up to 2mm Hg in adults with HTN. (Fair, Imperative)
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HTN: Calcium Supplements

If an adult with HTN is unable to meet the DRI for calcium with diet and food alone, the RDN may consider recommending calcium supplementation of 1,000mg to 1,500mg per day to aid in BP control. A strong body of research indicates that calcium supplementation of 1,000mg to 1,500mg per day reduced SBP up to 3.0mm Hg and DBP up to 2.5mm Hg in adults with HTN. (Strong, Conditional)
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HTN: Dietary Magnesium

The RDN should encourage adults with HTN to consume adequate amounts of dietary magnesium to meet the DRI. While important for health, adequate dietary magnesium may or may not aid in BP control. Results from two studies suggest that the relationship between magnesium intake from food sources and BP in adults with HTN is unclear. (Weak, Imperative)
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HTN: Magnesium Supplements

If an adult with HTN is unable to meet the DRI for magnesium through food and diet alone, the RDN may consider recommending magnesium supplementation of up to 350mg per day to aid in BP control. Research indicates that magnesium supplementation of 240mg up to 1,000mg per day reduced SBP by 1.0mm Hg to 5.6mm Hg and DBP by 1.0mm Hg to 2.8mm Hg in adults with HTN. (Fair, Conditional)
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HTN: Sodium

The RDN should counsel on reducing sodium intake for BP reduction in adults with HTN. Research indicates that lowering dietary sodium intake to 1,500mg to 2,000mg per day reduced SBP and DBP up to 12mm Hg and 6mm Hg, respectively. (Strong, Imperative)
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HTN: DASH Diet

The RDN should counsel on a Dietary Approaches to Stop Hypertension (DASH) dietary pattern plus reduced sodium intake for BP reduction in adults with HTN. Research indicates that in adults with pre- hypertension and HTN, the DASH dietary pattern, compared with the typical American diet lowered SBP by 5mm Hg to 6mm Hg and DBP by 3mm Hg. Reducing sodium intake in those consuming the typical American diet or DASH diet also lowered BP. DASH in combination with a reduced sodium diet lowered BP more than reduced sodium intake alone. The effect was greater in those with HTN. (Strong, Imperative)
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HTN: DASH Diet And Weight Reduction

For overweight or obese adults with HTN, the RDN should counsel on a calorie-controlled DASH dietary pattern for weight management and BP reduction. Research indicates that the DASH diet with a sodium range of 1,500mg to 2,400mg reduced SBP by 2mm Hg to 11mm Hg and DBP by 0mm Hg to 9mm Hg in overweight or obese hypertensive adults, regardless of anti-hypertensive medications. DASH plus weight reduction resulted in greater reductions in SBP of 11mm Hg to 16mm Hg and DBP of 6mm Hg to 10mm Hg than weight reduction alone. (Strong, Imperative)
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HTN: Alcohol Intake In Moderate Drinkers

If an adult with HTN is a moderate drinker, the RDN should advise that reducing or refraining from alcohol may or may not aid in BP management. Research indicates that the effect of alcohol on BP is unclear in moderate drinkers with HTN, since studies in this population yielded contradictory results. (Weak, Conditional)
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HTN: Alcohol Intake In Heavy Drinkers

If an adult with HTN is a heavy drinker, the RDN should recommend abstinence from alcohol to aid in BP management. Research indicates that abstinence from alcohol resulted in a decrease in SBP of up to 28mm Hg and a decrease in DBP of up to 18mm Hg in chronic heavy drinkers with HTN. (Strong, Conditional)
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HTN: Physical Activity

The RDN should encourage adults with HTN to engage in regular aerobic activity to lower BP. Physical activity should be of moderate intensity to vigorous intensity three to four times per week for an average of 40 minutes per session. Research indicates that among adult men and women at all BP levels, including individuals with HTN, aerobic physical activity decreases systolic BP and diastolic BP, on average by 2mm Hg to 5mm Hg and 1mm Hg to 4mm Hg, respectively. Typical interventions shown to be effective for lowering BP include aerobic physical activity of, on average, at least 12 weeks of duration, with three to four sessions per week, lasting on average 40 minutes per session and involving moderate-intensity to vigorous-intensity physical activity. (Strong, Imperative)
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Recommendation Grading

Overview

Title

Hypertension Nutrition Management

Authoring Organization

Academy of Nutrition and Dietetics

Publication Month/Year

September 1, 2017

Last Updated Month/Year

March 19, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Provide an evidence-based summary of nutrition therapy for the management of HTN in adults aged 18 years or older.

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Dietician nutritionist, nurse, nurse practitioner, physician, physician assistant

Scope

Treatment, Management

Diseases/Conditions (MeSH)

D006973 - Hypertension, D007676 - Kidney Failure, Chronic

Keywords

chronic kidney disease, hypertension, high blood pressure

Source Citation

Lennon, S. L., DellaValle, D. M., Rodder, S. G., Prest, M., Sinley, R. C., Hoy, M. K., & Papoutsakis, C. (2017). 2015 Evidence Analysis Library Evidence-Based Nutrition Practice Guideline for the Management of Hypertension in Adults. Journal of the Academy of Nutrition and Dietetics, 117(9), 1445–1458.e17. doi:10.1016/j.jand.2017.04.008