ASH position paper: Dietary approaches to lower blood pressure

A substantial body of evidence has implicated several aspects of diet in the pathogenesis of elevated blood pressure (BP). Well-established risk factors for elevated BP include excess salt intake, low potassium intake, excess weight, high alcohol consumption, and suboptimal dietary pattern. African Americans are especially sensitive to the BP-raising effects of excess salt intake, insufficient potassium intake, and suboptimal diet. In this setting, dietary changes have the potential to substantially reduce racial disparities in BP and its consequences. In view of the age-related rise in BP in both children and adults, the direct, progressive relationship of BP with cardiovascular-renal diseases throughout the usual range of BP, and the worldwide epidemic of BP-related disease, efforts to reduce BP in nonhypertensive as well as hypertensive individuals are warranted. In nonhypertensives, dietary changes can lower BP and delay, if not prevent, hypertension. In uncomplicated stage I hypertension, dietary changes serve as initial treatment before drug therapy. In hypertensive individuals already on drug therapy, lifestyle modifications can further lower BP. The current challenge is designing and implementing effective clinical and public health interventions that lead to sustained dietary changes among individuals and more broadly in the general population.