Effect of dietary patterns on hypertension/blood pressure

ESC/ESH 2018

• 'adopting a healthy and balanced diet may assist in BP reduction'

• Recommendation on 'Eating a diet that is rich in whole grains, fruits, vegetables, polyunsaturated fats and dairy products and reducing food high in sugar, saturated fat and trans fats, such as the DASH diet. Increase intake of vegetables high in nitrates known to reduce BP, such as leafy vegetables and beetroot. Other beneficial foods and nutrients include those high in magnesium, calcium and potassium such as avocados, nuts, seeds, legumes and tofu.'

• 'Reduced-salt DASH diet has a reduction in systolic blood pressure both in normotensives and hypertensives.'

Effect of salt intake on hypertension/blood pressure

• 'Reducing sodium intake significantly reduced systolic and diastolic blood pressure in adults and children.'
• 'Reducing sodium intake to <2 g/day was more beneficial for blood pressure than reducing sodium intake but still consuming >2 g/day.'

• 'There is evidence of a causal relationship between sodium intake and BP, and excessive sodium consumption (>5 g sodium per day, e.g. one small teaspoon of salt per day) has been shown to have a pressor effect and be associated with an increased prevalence of hypertension and the rise in SBP with age.'

• 'Higher salt intake is causally related to higher blood pressure, and a small and sustained reduction in salt intake causes a fall in blood pressure in almost everyone across the whole range of blood pressure.'

• 'There is a progressive dose-response relationship between sodium intake and blood pressure.'
• 'lower sodium intake will attenuate the usual age-related increase in blood pressure.'
• 'reduction of sodium decreases blood pressure and […] the effect is greater among hypertensive subjects.'

Effect of potassium intake on hypertension/blood pressure

• 'Increased potassium intake is associated with BP reduction and may have a protective effect against hypertension.'

• 'a diet rich in potassium alone, or in combination with calcium and magnesium, might have a favourable effect on blood pressure'

Effect of dietary fibre intake on hypertension/blood pressure

• 'small, but rather consistent, effects on blood pressure have been observed for diets rich in fibre from e.g. cereals, fruit and vegetables, although the contribution of dietary fibre per se to this effect remains to be established'

• 'Dietary fibre, mainly in the form of viscous fibre, can modulate blood pressure.'

• 'probable evidence that increased dietary fibre consumption in a population with different blood pressure levels lowers the risk of hypertension. This also applies to the food group of whole-grain products.'

Effect of dietary fats intake on hypertension/blood pressure

• 'n-3 LCPUFA from fish oil and other sources may have a slight beneficial effect on blood pressure, especially at higher intakes (>0.5 g per day). For other fatty acids, there is no convincing evidence that they affect blood pressure.'

• 'probable evidence that long-chain n-3 fatty acids have a blood pressure-reducing effect'

Effect of sugar-sweetened beverages on hypertension/blood pressure

• 'the risk of hypertension may increase with increased long term consumption of SSBs’'

• 'there is suggestive evidence that frequent consumption of sugar-sweetened beverages has an unfavourable effect on blood pressure.'

• 'Physical inactivity is recognized as a major independent risk factor for high blood pressure'
• Regular and adequate levels of physical activity help to reduce the risk of hypertension, heart attack, stroke.

• 'regular aerobic physical activity may be beneficial for both the prevention and treatment of hypertension'
• 'Physical activity induces an acute rise in BP, especially SBP, followed by a short-lived decline in BP below baseline'

• 'regular aerobic and resistance exercise may be beneficial for both the prevention and treatment of hypertension'

• 'Regular physical activity and high levels of physical fitness are favourably associated with […] [decreased] blood pressure'

• 'an inverse relationship between physical activity and physical fitness and level of BP and hypertension’ has been demonstrated'

• 'Excessive weight gain is associated with hypertension, and reducing weight towards an ideal body weight decreases BP'

• 'A healthy weight is recommended in order to improve the cardiovascular risk profile by preventing raised blood pressure'

• 'a direct relationship between body mass index and BP that is continuous and almost linear, with no evidence of a threshold'

• 'Alcohol consumption is directly related to high blood pressure. As consumption increases, so does blood pressure.'
• 'significant reductions in alcohol consumption are directly related to mean blood pressure reduction – via a dose-response relationship'

• 'There is a long-established positive linear association between alcohol consumption, BP [and] the prevalence of hypertension'
• 'Binge drinking can have a strong pressor effect'

• 'Positive linear association exists between alcohol consumption, blood pressure, [and] the prevalence of hypertension'

• 'There is convincing evidence that high alcohol intake is associated with increased blood pressure and risk of hypertension.'

• 'Acute tobacco consumption is only associated with a temporary rise in blood pressure per cigarette consumed'
• 'chronic tobacco consumption causes arterial stiffness (that contributes to the rise in systolic blood pressure) that can persist for years after smoking cessation.'

• 'tobacco smoking has an acute prolonged pressor effect that may raise daytime ambulatory BP'

• 'Smoking is an independent risk factor for cardiovascular disease and has a multiplicative effect with other major risk factors such as untreated hypertension.'
• 'Short-term exposure to water pipe smoking is associated with a significant increase in SBP'

• 'Epidemiological studies suggest a higher risk of […] high blood pressure […], in people chronically exposed to high levels of road or air traffic noise.'

• 'In adults, relatively low levels of lead exposure (5 µg/dl) may increase blood pressure'

• 'Increased [systolic] blood pressure is observed with chronic exposure to lead'

• 'strong evidence suggesting that chronic and persistent exposure to air pollution […] has adverse effects on BP regulation'

• 'Chronic stress has been associated to high blood pressure later in life'
• 'Evidence from studies support a negative effect of air pollution on blood pressure in the long-term'