Dietary aspects of the treatment of hypertension

Based upon currently available evidence, a practical dietary prescription should be: For the overweight, weight reduction should be the primary goal. For all hypertensives, dietary sodium should be restricted to a 2 g (88 mmol/d) level. Potassium intake need not be specifically increased since it will rise with a lowered sodium intake. Those who are hypokalemic may benefit from potassium supplementation. Supplemental magnesium and calcium should only be given to those who are deficient, until additional evidence of their efficacy is available. Caution is advised in not reducing the dietary sources of calcium when dietary sodium is reduced. More fiber and less saturated fat are beneficial for other reasons and may also help to lower the blood pressure. Alcohol should be limited to two ounces per day. The 1984 report of the Joint National Committee (23) recommends that "nonpharmacologic approaches [be] used both as definitive intervention and as an adjunct to drug therapy." In addressing the 40% of all hypertensives who are in the 90 to 94 mmHg range, the report states, "Nonpharmacologic therapy should be pursued aggressively while blood pressures are carefully monitored." Dietary changes are the major components of nondrug therapy. They should be enthusiastically offered to all hypertensives, while providing the various motivational tools and follow-up procedures that are readily available to maximize their acceptance and effectiveness.