2015 EAL evidence-based nutrition practice guildeline for the management of hypertension in adults

Authors: LENNON, SHANNON - University Of Delaware; DELLAVALLE, DIANE - Marywood University; RODDER, SUSAN - University Of Texas Southwestern Medical Center; PREST, MELISSA - Academy Of Nutrition And Dietetics; SINLEY, RACHEL - Academy Of Nutrition And Dietetics; Hoy, M Katherine; PAPOUTSAKIS, CONSTANTIA - Academy Of Nutrition And Dietetics

Submitted to: Journal of the Academy of Nutrition and Dietetics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/9/2017
Publication Date: 8/4/2017
Citation: Lennon, S.L., DellaValle, D.M., Rodder, S.G., Prest, M., Sinley, R.L., Hoy, M.K., Papoutsakis, C. 2017. 2015 evidence analysis library evidence-based nutrition practice guildeline for the management of hypertension in adults. Journal of the Academy of Nutrition and Dietetics. 117(9):1445-1458.e17. https://doi.org/10.1016/j.jand.2017.04.008.
DOI: https://doi.org/10.1016/j.jand.2017.04.008

Interpretive Summary: Hypertension (HTN) or high blood pressure (BP) is one of the most prevalent forms of cardiovascular disease and occurs in approximately one of every three adults in the United States. Nutrition therapy is an important component of treatment for hypertension. A review of the peer-reviewed literature published between July 2004 and March 2015 was conducted using methodology of the Academy of Nutrition and Dietetics Evidence Analysis Library to provide an evidence-based summary of nutrition therapy for the management of HTN in adults, aged 18 years or older. Populations included in this guideline consist of individuals with unhealthy lifestyles, obesity, cardiovascular disease, type 2 diabetes, older adults, and African Americans as these populations have a high prevalence of HTN. Studies utilizing multiple study designs were considered, including randomized controlled trials (RCT), cross-sectional studies, cohort studies, and time control studies although greater weight was placed upon studies utilizing a RCT design. While meta-analyses were included, primary studies reported in those meta-analyses were included only once as part of those meta-analyses. Case study reports were excluded. Searches were conducted using PubMed. A total of 70 research studies were included, analyzed, and rated for quality by trained evidence analysts. Nine major recommendations were developed related to hypertension and included medical nutrition therapy, sodium, potassium, magnesium, calcium, vitamin D, DASH diet, Mediterranean diet, and alcohol. To reduce BP in adults with HTN, there is strong evidence to recommend provision of Medical Nutrition Therapy (MNT) by a registered dietitian-nutritionist, adoption of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern, calcium supplementation, physical activity as a component of a healthy lifestyle, reduction in dietary sodium intake, and reduction of alcohol consumption in heavy drinkers. The intake of dietary potassium and calcium as well as supplementation with potassium and magnesium on lowering BP are also recommended (fair evidence). Finally, recommendations were formulated on vitamin D, magnesium, and the putative role of alcohol consumption in moderate drinkers on lowering BP (weak evidence). In conclusion, this guideline describes the most current recommendations on the dietary management of HTN in adults intended to support evidence-based practice by RDNs and other health-professionals.

Technical Abstract: Hypertension (HTN) or high blood pressure (BP) is one of the most prevalent forms of cardiovascular disease and occurs in approximately one of every three adults in the United States. Nutrition therapy is an important component of treatment. The purpose of this Evidence Analysis Library (EAL) guideline is to provide an evidence-based summary of nutrition therapy for the management of HTN in adults, aged 18 years or older. Implementation of this guideline aims to promote evidence-based practice decisions by registered dietitian/nutritionists (RDNs), and other collaborating health professionals in order to decrease/manage HTN in adults, while enhancing patient quality of life and taking into account individual preferences. The systematic review and guideline development methodology of the Academy of Nutrition and Dietetics (AND) were applied. Research questions were developed in the following topic areas as related to hypertension: medical nutrition therapy, sodium, potassium, magnesium, calcium, vitamin D, DASH diet, Mediterranean diet, and alcohol. Inclusion criteria were adults aged 18 years or older with HTN, 10 or more subjects per study group, dropout rate of 20% or greater, and studies published in peer-reviewed journals in the English language. Studies utilizing multiple study designs were considered, including randomized controlled trials (RCT), cross-sectional studies, cohort studies, and time control studies although greater weight was placed upon studies utilizing a RCT design. While meta-analyses were included, primary studies reported in those meta-analyses were included only once as part of those meta-analyses. Case study reports were excluded. Searches were conducted using PubMed, and search dates for the literature review ranged between July 2004 and March 2015. Additional studies were identified by manually searching reference lists of review articles, the American College of Cardiology/American Heart Association (ACC/AHA) Task Force Report, as well as studies in previous related guideline projects of AND and the USDA Nutrition Evidence Library. A total of 70 research studies were included, analyzed, and rated for quality by trained evidence analysts. Evaluation and synthesis of related evidence resulted in the development of nine major recommendations. To reduce BP in adults with HTN, there is strong evidence to recommend provision of Medical Nutrition Therapy (MNT) by a RDN, adoption of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern, calcium supplementation, physical activity as a component of a healthy lifestyle, reduction in dietary sodium intake, and reduction of alcohol consumption in heavy drinkers. The intake of dietary potassium and calcium as well as supplementation with potassium and magnesium on lowering BP are also recommended (fair evidence). Finally, recommendations were formulated on vitamin D, magnesium, and the putative role of alcohol consumption in moderate drinkers on lowering BP (weak evidence). In conclusion, the present Evidence-Based Nutrition Practice Guideline describes the most current recommendations on the dietary management of HTN in adults intended to support the practice of RDNs and other health-professionals.