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SPECIALREPORT

Whats the Right Menu to


Control Hypertension?

Dietary interventions like DASH shown to improve high blood pressure.

REVIEWING THE EVIDENCE: The new meta-

analysis, published in the journal Hypertension, looked at data from 24 randomized controlled trials with a total of 23,858
participants conducted over the past 25
years. Such studies are considered the
gold standard of scientific research and
are designed to elicit cause and effect.
Overall, the net effect of dietary
interventions averaged reductions of 3.07
mmHg for systolic pressure (the top number in a blood-pressure reading) and 1.81
mmHg for diastolic pressure (the bottom
number). The DASH diet produced the
largest improvements in blood pressure:
minus 7.62 mmHg for systolic pressure
and minus 4.22 mmHg for diastolic pressure. Low-sodium, low-sodium/high-potassium, low-sodium/low-calorie and lowcalorie diets were all also associated with

reductions in both systolic and diastolic


pressure. Participants on a Mediterranean
diet saw only a small reduction in diastolic
blood pressure (-1.44 mmHg).
Dietary interventions were more effective for people with pre-existing hypertension and those who were not already taking medication for high blood pressure.
As with any treatment, Tufts Lichtenstein adds, some people will reap greater
benefit than others, particularly for blood
pressure where we know responsiveness
to dietary modification is highly variable.
We cant predict who those people will be
ahead of time. Given that the characteristics of a diet good for blood-pressure lowering will have general benefits in other areas,
we should all strive to achieve them.

IMPORTANCE OF CONTROL: The numbers

when you get your blood pressure checked


represent the amount of force pushing
against your artery walls when the heart is
contracting (systolic) and when the heart
is at rest (diastolic). When pressure rises
in the vessels, the heart has to work harder
and the arteries have to stretch more. Over
time, high blood pressure damages the
artery walls, making them more vulnerDASH eating plan goals for a
2,000-calorie-a-day diet
Daily
Food Group
Servings
Grains
6-8
Meats, poultry and fish
6 or fewer
Vegetables
4-5
Fruit
4-5
Low-fat or fat-free dairy products 2-3
Fats and oils
2-3
Sodium
2,300 mg*
Weekly
Servings
Nuts, seeds, dry beans, and peas 4-5
Sweets
5 or less
*1,500 milligrams (mg) sodium may lower blood
pressure even further than 2,300 mg sodium daily.

DASH DETAILS: The DASH eating plan

shown to be effective against hypertension requires no special foods; it shares


common elements with most healthy
diet plans. Built on daily and weekly nutritional goals (see box), the DASH plan
recommends:
Eating vegetables, fruits and whole
grains.
Including fat-free or low-fat dairy
products, fish, poultry, beans, nuts and
vegetable oils.
Limiting foods that are high in
saturated fat, such as fatty meats, full-fat
dairy products, and tropical oils such as
coconut, palm kernel and palm oils.
Limiting sugar-sweetened beverages and sweets.
When following the DASH eating plan,
it is important to choose foods that are:
Low in saturated and trans fats, replacing these fats with those high in mono-

W W W. N U T R I T I O N L E T T E R . T U F T S . E D U

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f youre worried about high blood


pressure, a new systematic review of
scientific evidence has good news:
Changing your diet really can make a
difference. Not surprisingly, the most
effective diet for reducing hypertension
was one designed specifically for that
purposethe Dietary Approaches to
Stop Hypertension (DASH) plan. But
other interventions, including cutting
salt and calories, also were associated
with blood-pressure benefits.
Many healthy diets have common
elements, whether they are a named
diet such as DASH, or not, says Alice
H. Lichtenstein, DSc, director of Tufts
Cardiovascular Nutrition Laboratory and
executive editor of the Health & Nutrition
Letter. Common elements include cutting
calories, decreasing salt and refined carbohydrates, increasing fruits and vegetables,
and focusing on healthy fats. To get the
most benefit from any diet, the critical
element is making small but sustainable
and, if necessary, incremental changesto
ensure long-term benefits.

able to damage and prone to


plaque buildup (atherosclerosis).
Since hypertension
increases the workload
on the heart, it can eventually damage those muscles and valves and
cause heart failure, in which the heart
can no longer keep up with the bodys
demands. High blood pressure puts you at
greater risk of heart attack, heart disease
and aortic dissection (tearing in the heart).
This type of damage to the arteries
can also affect the brain, and high blood
pressure is a leading cause of stroke.
High blood pressure is also associated
with a greater risk of dementia.
Other risks from uncontrolled hypertension include kidney damage, vision loss,
erectile dysfunction, fluid in the lungs,
angina (chest pain) and peripheral artery
disease. But these are effects, not symptomsuncontrolled high blood pressure is
sometimes called the silent killer because
it has no symptoms. Until a doctor diagnoses hypertension, you may not be aware
that its damaging your arteries, heart
and other organs. Its estimated that of all
people with high blood pressure, more
than 20% are unaware of their condition.

SPECIALREPORT
unsaturated and polyunsaturated fats.
Rich in potassium, calcium, magnesium, fiber and protein.
Lower in sodium.
To learn more about the DASH plan,
see <www.nhlbi.nih.gov/health/healthtopics/topics/dash>.

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LIFESTYLE CHANGES: The American

Heart Association <www.heart.org> recommends seven main ways you can help
control your blood pressure through
smart lifestyle choices:
1. Eat a better diet. The
advice includes eating
a diet rich in: fruits;
vegetables; wholegrain, high-fiber foods;
fat-free and low-fat or
1% dairy products; beans;
skinless poultry and lean
meats; fish, especially fatty fish containing omega-3 fatty acids, such as salmon,
trout and herring (at least twice a week).
Your diet should be low in saturated
and trans fats (replacing these fats with
monounsaturated and polyunsaturated
fats) and sodium, and you should limit
added sugars.
2. Enjoy regular physical activity.
3. Achieve and maintain a healthy
weight.
4. Manage stress.
5. Avoid tobacco products.
6. Comply with medication prescriptions.
7. If you drink, limit alcohol.

FRUITS, VEGGIES AND FLAVONOIDS: Its

not surprising that both the DASH


plan and the American Heart Association emphasize fruits and vegetables as
key to controlling hypertension. These
foods are packed with healthy vitamins,
minerals and fiber, and when fruits and
vegetables occupy more of your plate,
youll eat less of foods that add to hypertension risk.
Fruits and vegetables are also rich
sources of lesser-known phytonutrients
called flavonoids. A new French study,
published in the American Journal of
Clinical Nutrition, reported that women

consuming the most flavonoids were less


likely to develop hypertension.
The study looked at data on 40,574
healthy French women. Over a 15year followup period, 9,350 developed
hypertension. Women in the one-fifth of
the study population who consumed the
most of three types of flavonoids were
less likely to develop high blood pressure
than those in the lowest consumption
group: flavonols (10% lower risk), anthocyanins and proanthocyanidin polymers
(both 9% lower risk). A similar association was seen for total
flavonoid intake.
Flavonoids might
help to protect against
high blood pressure, although this study was not
designed to prove cause and
effect. It could be simply that
flavonoid intake is a marker for consumption of fruits and vegetables. Either way,
the findings support recommendations to
put plenty of produce on your plate.

BERRIES VS. BP: Other recent studies

have spotlighted specific plant foods that


seem to reduce your risk of hypertension or to lower high blood pressure. Its
important to remember, however, that
these apparent benefits are likely not
unique to these foods. When blueberries,
for example, are found to have bloodpressure effects, its quite possible that
similar effects might be associated with
other berries.
That research on blueberries, published in the Journal of the Academy of
Nutrition and Dietetics, compared freezedried blueberry powderequivalent
to eating a cup of berries a daywith a
placebo powder. The eight-week clinical
trial involved 48 postmenopausal women
in the early stages of hypertension. Those
randomly assigned to the blueberry powder showed improved blood pressure and
reduced arterial stiffness; average systolic
blood pressure declined 5.1%, while diastolic pressure dropped 6.3%.
These findings suggest that blueberries may prevent the progression to
full-blown hypertension, the research-

JULY 2016

ers commented. The changes in blood


pressure noted in this study are of clinical significance, as they demonstrate that
blood pressure can be favorably altered
by the addition of a single dietary component (e.g., blueberries). (See the April
2015 newsletter for more on blueberries.)

TEA TIME: Although consumed as a

beverage, tea can also be thought of as


a plant food in terms of its phytonutrients, and several studies have linked
drinking tea to blood-pressure improvements. One Australian study, for
example, reported that drinking three
cups daily of regular black tea was associated with a small but significant drop
in blood pressure. At the studys start,
the 95 participants had systolic blood
pressure readings ranging from 115 to
150 (normal to stage-one hypertension).
After six months, those randomly assigned to drink more tea saw an average
drop in systolic pressure of two to three
points and about a two-point drop in
diastolic pressure, compared to the
control group.
Tufts research has also shown that
herbal teas containing hibiscus, rich in
phytonutrients including anthocyanins,
flavones, flavonols and phenolic acids,
can help lower high blood pressure.
In one study, Diane L. McKay, PhD, a
scientist in Tufts HNRCA Antioxidants
Research Laboratory, recruited 65 pre- or
mildly hypertensive volunteers, ages 30
to 70. Those randomly assigned to drink
three cups of hibiscus tea per day for
six weeks saw a 7.2-point drop in their
systolic blood pressure. Those results are
comparable to that delivered by standard
blood-pressure medications.
Participants with the highest blood
pressure at the studys start showed the
most significant reductionsa drop of
13.2 points. That subgroups diastolic
pressure went down by 6.4 points.
Its your overall dietary pattern that
matters most, of course, as the latest
DASH findings demonstrate. But the
good news is that you can make a difference in your blood pressure with smart
lifestyle choices.

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