FACT SHEET: Hypertension & Diet
How to prevent and treat hypertension with nutrition

Key points
  • International guidelines 1)Cuspidi C, Tadic M, Grassi G, Mancia G. Treatment of hypertension: The ESH/ESC guidelines recommendations. Pharmacol Res. 2018;128:315-321. doi:10.1016/j.phrs.2017.10.003  recommend dietary changes as initial, fundamental and continuous treatment.
  • Dietary changes can significantly reduce blood pressure and can decrease, sometimes even prevent or eliminate, the need for medication.
  • The optimal diet is low in sodium (< 2.3 g/d) and high in whole plant foods such as whole grains, fruit and vegetables.
  • An optimal diet does not only reduce hypertension, it also reduces the risk for complications of hypertension, such as coronary heart disease, stroke, and others.

Hypertension and its complications kill more than nine million people every year 2)WHO, A Global Brief on Hypertension, 2013, https://apps.who.int/iris/bitstream/handle/10665/79059/WHO_DCO_WHD_2013.2_eng.pdf?sequence=1

Pathomechanisms That Are Influenced by Diet:

Cardiac output

  • Bodyweight
    Weight loss is supposed to decrease blood volume and thus blood pressure
  • Sodium
    Sodium intake might have a hypertensive effect due to a potential increase in extracellular fluid
  • Potassium
    Potassium has both diuretic and
    vasodilatory effects
  • Calcium
    Calcium acts as an indirect natriuretic and diuretic peptide
  • Fructose
    Excessive sugar intake, especially
    fructose, leads to an acute and chronic increase of serum uric acid which, in turn, causes activation of the RAAS
    Fructose directly promotes intestinal uptake and renal reabsorption of sodium

Vascular resistance

Autonomous nervous system

  • Caffeine Caffeine increases blood pressure in nonhabituated individuals

Endothelial dysfunction

  • Fatty acids omega-3-fatty acids improve endothelial function and augment endothelial relaxation
    Saturated, trans, monounsaturated (MUFA) and omega-6-polyunsaturated (PUFA) fatty acids impair endothelial function. The effect of MUFA und PUFA can be antagonized by the intake of antioxidants
  • Antioxidants from fruits and vegetables dietary protect LDL molecules against oxidation, preserve endothelial-dependent vasorelaxation and limit atherosclerosis
  • Nitrate from vegetables has a vasodilatory and thus antihypertensive effect 

The Scientific Evidence

Epidemiological evidence

  • 15.0% vs. 5.8% hypertension prevalence in male meat eaters vs. vegans
  • 12.1% vs. 7.7% hypertension prevalence in female meat eaters vs. vegans
  • 4.2 vs. 2.6 mmHg systolic | 2.8 vs. 1.7 mmHg diastolic mean blood pressure differences between meat eaters and vegans 3) Appleby PN, Davey GK, Key TJ. Hypertension and blood pressure among meat eaters, fish eaters, vegetarians and vegans in EPICOxford. Public Health Nutr. 2002;5(5):645-654. doi:10.1079/PHN2002332

Evidence from RCTs and corresponding meta-analyses

  • 11.3 mmHg SBP reduction among hypertensive patients by following the DASH diet compared to a
    control diet 4)Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. 1997;336(16):1117-1124. doi:10.1056/NEJM199704173361601
    The DASH diet is high in whole grains, fruits, vegetables, and low-fat dairy products, and low in red and processed meat as well as in sugar sweetened foods and beverages
  • >20 mmHg SBP reduction in patients with SBP ≥ 150 mm Hg by following the DASH diet including sodium reduction compared to a high-sodium standard diet 5) Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001;344(1):3-10. doi:10.1056/NEJM200101043440101
  • -1.7 mm Hg/-1.5 mm Hg by following a Mediterranean diet compared to a low-fat diet 6)Nordmann AJ, Suter-Zimmermann K, Bucher HC, et al. Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors. Am J Med. 2011;124(9):841-851.e2. doi:10.1016/j.amjmed.2011.04.024
  • -4.8 mm Hg/-2.2 mm Hg by following a vegetarian diet compared to an omnivorous diet 7)Yokoyama Y, Nishimura K, Barnard ND, et al. Vegetarian diets and blood pressure: a meta-analysis. JAMA Intern Med. 2014;174(4):577-587. doi:10.1001/jamainternmed.2013.14547
  • -4.10 mm Hg/-4.01 mm Hg by following a vegan diet compared to a less-restrictive diet in patients with baseline systolic blood pressure ≥130 mmHg 8)Lopez PD, Cativo EH, Atlas SA, Rosendorff C. The Effect of Vegan Diets on Blood Pressure in Adults: A MetaAnalysis of Randomized Controlled Trials. Am J Med. March 2019. doi:10.1016/j.amjmed.2019.01.044

General Recommendations

Eat predominantly or entirely from a wide variety of whole plant foods:

  • Maximize the intake of high-quality plant foods such as vegetables, whole grains, legumes, fruits, nuts, seeds, herbs, and spices; your health will benefit from every step towards more whole plant foods.
  • Eliminate or limit all processed foods, refined carbohydrates, and sugar-sweetened foods and beverages.
  • Eliminate or limit red and processed meat products (such as burgers, sausages, bacon, ham, salami, dried meat, canned meat, and pastrami).
  • Eliminate or limit other animal products such as poultry, fish, eggs, cheese, and dairy.
  • Make sure to cover potentially critical nutrients with a wide variety of plant foods, enriched foods/drinks, or supplements (especially vitamin B12 and vitamin D); find more information in our Nutrition Library.

Disease-Specific Recommendations

  • Fiber is especially important to tackle hypertension – always choose whole grain options (pasta, bread, rice, etc.), include nuts and legumes in your daily diet, and get extra fiber with a daily tablespoon or two of (ground or sprouted) flaxseed or chia (e.g., in your muesli or on your salad).
  • Limit sodium intake – avoid processed foods (which are always high in salt), and experiment with different spices and herbs to give flavor to your food while reducing the amount of salt.
  • Regularly include some of the following foods as they are proven to be especially effective against hypertension: beetroots (beetroot juice), leafy green vegetables (broccoli, kale, brussels sprouts, bok choy, etc.), garlic, oats, green tea, hibiscus tea, and dark chocolate.