Changes in Diet Offer Best Defense in Hypertensive Patients

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For young and middle-aged individuals with high blood pressure, tweaking the diet may be the most effective way to cut the risk of cardiovascular disease, based on recent research presented at the American Heart Association's (AHA) Hypertension Scientific Sessions 2022.

The Dietary Approaches to Stop Hypertension diet, better known as the DASH diet, includes plenty of fruits and vegetables, whole grains, low-fat dairy products, healthy fats, and limited sodium, red meat, and added sugar. The diet may aid in treating stage 1 hypertension, defined as a systolic pressure of 130-139 and a diastolic measure of 80-89. For reference, systolic is the top number and diastolic is the bottom number.

In addition to diet changes, reducing heavy alcohol intake and getting regular physical activity could save over a billion dollars in health care costs and thousands of deaths related to heart disease in the next 10 years. Following a DASH diet may have the best benefit as an estimated 15,000 deaths due to heart disease in men and 11,000 deaths in women could be thwarted. 

The study indicates that nearly 9 million adults aged 35 to 64 have untreated stage 1 hypertension. Lifestyle changes including weight loss, moderate alcohol consumption, regular exercise and the DASH diet would be advised in this population.

If other health conditions including type 2 diabetes or kidney disease and predicted 10-year risk of CVD are not present, individuals with stage 1 hypertension are not considered high risk for heart attack or stroke compared to those with stage 2 or higher hypertension.

Stage 2 hypertension is more serious with systolic numbers of 140 or higher and diastolic numbers of 90 of up. Stage 1 hypertension is typically treated with lifestyle modification versus medicine.

According to Kendra D. Sims, Ph.D., M.P.H., a postdoctoral fellow at the University of California, San Francisco and co-lead researcher of this study, "Nearly nine million young and middle-aged adults with untreated stage 1 hypertension represent a significant, impending burden for health care systems, Our results provide strong evidence that large-scale, healthy behavior modifications may prevent future heart disease, related complications and excess health care costs."

Data from previous meta-analysis and trial data about the impact of dietary changes, weight loss, smoking cessation, regular exercise, and reduction in alcohol on blood pressure reduction were used to mimic heart disease, stroke, mortality and health care costs between 2018 and 2027. Roughly half of the population modeled were women and over 60% of them had access to regular health care.

The study researchers discovered that adopting recommended lifestyle changes to lower blood pressure to under 130 systolic and 90 diastolic could have dramatic health and financial benefits. They believe the changes could:

  • Prevent 26,000 cardiovascular disease events, including stroke, heart failure or heart attack;
  • Avoid 2,900 deaths; and
  • Save $1.6 billion in associated health care costs.

One barrier they noted is that healthy food is not always accessible or affordable to allow individuals to adopt the DASH diet. Clinicians need to be mindful of their patients living in food deserts or locations with limited walkability. Counselors should discuss these barriers to blood pressure management.

The AHA published a policy statement, Strengthening U.S. Food Policies and Programs to Promote Equity in Nutrition Security in May. It recommends expanding and improving U.S. nutrition policies and programs to ensure all Americans have access to nutritious food. The AHA launched the National Hypertensive Control Initiative in 2020, a collaborative initiative with the U.S. Department of Health and Human Services with a goal to improve blood pressure control among racial and ethnic minorities, who are the most vulnerable populations.

Sims commented that "Members of many disadvantaged communities face barriers to healthy food and regular health care access.” They do not always receive counseling from a doctor. “Future research should investigate the big picture: social conditions granting people the time and resources to make healthy lifestyle choices. Only with this information can we develop policies for the prevention of heart disease, especially for vulnerable adults."

By Lisa Andrews, MEd, RD, LD

For real-world strategies to help your audience implement the DASH diet, check out the post Tipsheet: Help Your Clients Change Their Eating Patterns for the Better.


Pengxiao C. Wei, M.P.H.; Brandon K. Bellows, Pharm.D., M.S.; Joanne Penko, M.S., M.P.H.; Susan Hennessy, Ph.D.; Dhruv S. Kazi, M.D., M.S.; Ross Boylan, Ph.D.; Andrew E. Moran, M.D., M.S.; and Kirsten Bibbins-Domingo, Ph.D., M.D. American Heart Association. "Diet change may make biggest impact on reducing heart risk in people with hypertension." ScienceDaily. ScienceDaily, 7 September 2022. <>.

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