COMMENTARY

The Best Antihypertensive Nutritional Advice

Henry R. Black, MD; Lawrence J. Appel, MD, MPH

Disclosures

July 24, 2013

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In This Article

The DASH Diet and Hypertension

Henry R. Black, MD: Hi. I'm Dr. Henry Black, Clinical Professor of Internal Medicine at the New York University School of Medicine and former President of the American Society of Hypertension.

I'm here today with my friend and colleague, Dr. Larry Appel. Larry, it's nice to have you.

Lawrence J. Appel, MD, MPH: It's a pleasure to be here.

Dr. Black: You're at Johns Hopkins now, right?

Dr. Appel: Yes. I'm a faculty member at both the School of Medicine and the School of Public Health, and I direct a research unit called the Welch Center for Prevention, Epidemiology, and Clinical Research, which does interdisciplinary research.

Dr. Black: What comes to mind when I think of you is advice about dietary recommendations for hypertensive and prehypertensive patients. Would you review those for us?

Dr. Appel: Sure. As part of the American Heart Association and other organizations, we have synthesized evidence for the role of diet in both preventing hypertension and controlling blood pressure in those who are taking medication. We came up with a set of recommendations[1] that I think are very applicable not just for controlling blood pressure but for general cardiovascular health. Up front and center is an overall healthy dietary pattern, one that has been termed the DASH diet. It's actually not a single diet but is a pattern that is characterized by a high intake of fruits and vegetables (roughly 8-10 servings per day) along with reduced-fat dairy products and reduced saturated fat.

Dr. Black: There don't seem to be any fad diets here. These seem to be very reasonable things that people can do. Has the public accepted this diet?

Dr. Appel: It has been very well accepted in terms of what people want to do, but I think it is a challenge to consume a healthy diet given that the current environment is aligned against us. People have to make an active decision that they are going to include at least 2-3 servings of fruits or vegetables at each meal. That can be challenging for people who might not have those foods available or where people are overwhelmed with other types of foods that might not be as healthy.

Dr. Black: Is that food very expensive or difficult to get?

Dr. Appel: Fruits and vegetables can be expensive at times, but what people don't realize is that when we tested the DASH diet, we actually used very few fresh fruits and vegetables. We had to make sure when we did the trial that it could be implemented at all centers, so lots of frozen vegetables and some canned products were used as well. A key thing that is also related to a second recommendation is that the fruits and vegetables tended to be high in potassium, which we think has blood pressure-lowering effects. Not all fruits and vegetables are rich in potassium, but we think that it is an important component of the diet.

Dr. Black: Which ones? I know about raisins, tomatoes, and bananas. What else?

Dr. Appel: You hit the main players. Oranges and orange juice. When we say fruits and vegetables, we are including fruit juices. A pretty easy way to adhere to the diet is to consume fruit juices that are reasonably high in potassium instead of soda. Other products are cantaloupe and raisins, which you mentioned. They are rich in potassium and magnesium. We don't eat a lot of pumpkin, but they are also rich in potassium. Potatoes are okay, but you need to be very careful because they also tend to be very high in calories.

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