Dietary management of blood pressure

Hypertension is a major cause of morbidity and mortality in the United States, particularly in the African-American population. Although there have been indications since the beginning of this century that blood pressure might be influenced by dietary factors, this has been generally ignored, and the mainstay of hypertension treatment has been the use of pharmacologic antihypertensives. Attention is now being focused, however, on dietary management of hypertension because of the high cost of drug therapy, the adverse reactions associated with some antihypertensives, and the fact that hypertensives treated only by pharmacologic means remain at risk for target-organ damage. The literature is replete with evidence that vegetarian and low-sodium dietary patterns are associated with lower blood pressure levels. This implies that if many people could adopt vegetarian and low-salt dietary habits, the prevalence of hypertension would be significantly reduced. However, most people find "unsalted" vegetarian diets tasteless and unacceptable. We therefore need to identify the macro- and micronutrients (other than sodium) that directly influence blood pressure. Several studies indicate that dietary patterns rich in fiber, calcium, potassium, and magnesium are favorable for blood pressure control. This review highlights some of these findings and emphasizes the need for large clinical trials to test blood-pressure-reducing dietary patterns by incorporating the aforementioned macro- and micronutrients into socioculturally acceptable and palatable menus, especially in the African-American population.