Exploring Non-pharmacological Hypertension Management: DASH, Paleolithic, and Ketogenic Diet Comparisons: A...

Hypertension impacts over one-third of the global population of adults and is a significant contributor to premature mortality, despite substantial progress in pharmaceutical interventions. Increasing evidence supports dietary strategies for the prevention and supplementary management of hypertension.

This systematic review was conducted in accordance with PRISMA 2020 guidelines. Literature was retrieved from PubMed, MEDLINE, and Cochrane databases for studies published between 1995 and 2025, using the keywords: "Hypertension," "DASH Diet," "Paleolithic Diet," "Ketogenic Diet," "Low-Carbohydrate Diet," "Blood Pressure," and "Cardiovascular Risk." Two investigators independently screened all titles and abstracts to determine eligibility for inclusion in the systematic analysis.

This review examined 13 studies involving approximately 87,597 individuals to evaluate the effects of four dietary strategies, DASH, Paleolithic, low-carbohydrate, and ketogenic diets, on hypertension. The DASH diet demonstrated persistent decreases in systolic blood pressure, particularly among adults. Low-carbohydrate and ketogenic diets enhanced both blood pressure and weight in overweight persons. The Paleolithic diet, supported by the most extensive sample, demonstrated significant advantages for blood pressure and metabolic health. All diets showed potential, with the Palaeolithic and DASH diets emerging as the most effective approaches for hypertension management.

Non-pharmacological dietary interventions are increasingly recognized as high-impact and sustainable strategies for the management of hypertension. This review emphasizes that dietrelated strategies, most importantly the DASH and Paleolithic diets, are providing clinically significant reductions in blood pressure and cardiometabolic risk. Short-term outcomes are encouraging, but long-term safety and compliance are important concerns, especially for the ketogenic and lowcarb diets. Variation in study quality, sample size, and measures of adherence complicates direct comparisons. Personalization and integration with lifestyle are central to outcomes.

Dietary interventions showed the highest potential for blood pressure prevention and control. The DASH and Paleolithic diets offer the strongest evidence to support their usage among all the therapies studied. However, further high-quality, long-term clinical studies would be needed to support these results and give evidence-based diet recommendations. Future efforts should focus on nutritional adequacy and sustained adherence to optimize outcomes in the hypertensive population.