Hypertension
Manual of Clinical Nutrition Management III- 64 Copyright © 2013 Compass Group, Inc.
as an adjunct to treatment. These parameters should be assessed to estimate risk for disease and to identify
treatment options (Grade IV) (12). The food and nutrition history should assess the patient’s intake of sodium,
potassium, and calcium and the frequency at which the patient consumes fruits, vegetables, low-fat dairy
products, and processed food items. The patient should be advised not to use herbal supplements, such as
ephedra (ma huang) and bitter orange,that increase blood pressure (2). Interactions between
antihypertensive medications and nutrients or foods should be examined (Grade IV) (12). Patients who take
monoamine oxidase inhibitors should be advised that consumption of licorice and tyramine-containing foods
will increase their blood pressure (2). Based on the nutritional assessment and the patient’s concomitant
conditions, refer to the following sections for nutritional management:
Section C: “Medical Nutrition Therapy for Diabetes Mellitus”
Section C: “Calorie-Controlled Diet for Weight Management”
Section C: “Medical Nutrition Therapy for Disorders of Lipid Metabolism”
Section G: “Medical Nutrition Therapy for Chronic Kidney Disease”A treatment goal of less than 140/90 mm Hg is recommended for individuals who do not have
comorbidities (Grade IV) (12). This blood pressure level is associated with preventing target organ damage and
decreasing cardiovascular risk factors and complications (Grade IV) (12). For individuals who have hypertension
and diabetes or renal disease, a treatment goal of less than 130/90 mm Hg is recommended (Grade IV) (12). These
individuals are at an increased risk for cardiovascular and renal morbidity and mortality (Grade IV) (12).
Accurate Blood Pressure Measurement
The ausculatory method of blood pressure measurement with a properly calibrated and validated instrument
is recommended (6,7). The patient should be seated quietly for at least 5 minutes in a chair (rather than on an
exam table), with feet on the floor and an arm supported at heart level. Caffeine, exercise, and smoking
should be avoided for at least 30 minutes prior to blood pressure measurement (2). An appropriate-sized cuff
(cuff bladder encircling at least 80% of the arm) should be used to ensure accuracy. At least two
measurements should be made. The systolic blood pressure is the point at which the first two or more
sounds are heard (phase 1), and the diastolic blood pressure is the point before the disappearance of sounds
(phase 5) (6).
Hypertension in Children and Adolescents
In children and adolescents, hypertension is defined as elevated blood pressure that persists on repeated
measurement at the 95th percentile or greater for age, height, and sex (2). Chronic hypertension is becoming
increasingly common in adolescence and is associated with obesity, a sedentary lifestyle, and a family history
of hypertension or other cardiovascular diseases (2). Lifestyle interventions should be recommended for all
children and adolescents with hypertension (2). Pharmacological therapy is recommended for children and
adolescents who have higher levels of blood pressure or who do not sufficiently respond to lifestyle
modifications (2).
Benefits of Lowering Blood Pressure and Lifestyle Modification Intervention
Major lifestyle modifications that lower blood pressure include limiting sodium intake to no more than 2,300
mg/day (Grade I) (12); weight reduction for individuals who are overweight or obese (Grade IV) (12); adoption of the
Dietary Approaches to Stop Hypertension (DASH) eating plan, which is a diet rich in potassium and calcium
and lower in sodium, dietary cholesterol, saturated fat, and total fat (<27% of total energy) (Grade IV) (12,13);
physical activity (Grade IV) (12); and moderation of alcohol consumption (Grade IV) (2,12). (See Table III- 16 ) Lifestyle
modifications reduce blood pressure, prevent or delay the incidence of hypertension, enhance
antihypertensive drug efficacy, and decrease cardiovascular risk (Grade IV) (2,6,12). The effects of a DASH eating
plan that limits daily sodium intake to 1,500 mg are similar to the effects of single-drug therapy (13).
Combinations of two or more lifestyle modifications can achieve even better results (2). Modifiable lifestyle
factors have significant blood pressure–lowering effects, and the adoption of a healthy lifestyle is an
indispensable part of the management of hypertension (2,8).