COMMENTARY

The Best Antihypertensive Nutritional Advice

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

Disclosures

July 24, 2013

In This Article

The Mediterranean Diet and Hypertension

Dr. Black: What is your feeling about the Mediterranean diet, for example, and about walnuts and other things that seem to be pretty tasty? It's interesting that in the PREDIMED study,[2] diet was added to the drugs instead of what is usually the other way around.

Dr. Appel: I'm very familiar with that study. I wrote an editorial on it.[3] There is actually a large body of evidence that Mediterranean-style diets are beneficial. One thing that's very important is that just like the DASH diet, it's not a single diet. The Mediterranean is a large body of water with lots of countries and lots of cultures that surround it. The diet that is characterized as being healthful is what we call the traditional Mediterranean diet, which has lots of vegetables, fruits, nuts, olive oil, some alcohol, some fish, and not much meat. There is also a lifestyle component. These people are very physically active, which has been shown in numerous observational studies to have benefit. The case was pretty strong even without the trial.

The trial is very interesting, but it was neither a clean test of the Mediterranean diet nor a clean test of the supplemental foods that were provided. There was advice to consume the Mediterranean diet and there were some changes that moved people in that direction. This study was done in Spain, so it's likely that the subjects were already consuming the diet. They moved a little bit, but the most striking differences in that study were related to the supplemental foods that were provided to people. People were given almost a liter of extra-virgin olive oil per week for them and their families to consume. A second group was given nuts, and both of them did much better than the group that got neither. What was very interesting were the clinical events that were prevented. It seemed like there was a general reduction in all cardiovascular disease, but the one that was most striking was stroke. An early paper from this study showed that the groups that got the extra-virgin olive oil and nuts had pretty substantial reductions in blood pressure, at least 5 mm Hg overall -- maybe a bit more in the subgroup that was hypertensive. There's reason to believe that, beyond some of the recommendations we made in the American Heart Association document, there are some other nutrients that could have a benefit in terms of lowering blood pressure.

Dr. Black: Dr. Appel, thank you very much for this very important discussion on what we do with diet in hypertensive patients and the general population. It has been a pleasure talking to you.

Dr. Appel: Thanks for having me on this program.

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