Harvard Health Letters

Harvard Health Letters

Fiddling with diet to control cholesterol makes perfect sense. After all, some of the cholesterol that ends up in out arteries starts out in food. Changing your diet to control blood pressure doesn't seem quite so straightforward. Yet food can have a direct and sometimes dramatic effect on blood pressure.

Salt certainly plays a role. But there's far more to a blood pressure-friendly diet than minimizing salt intake. Fruits, vegetables, low-fat dairy foods, beans, nuts, whole-grain carbohydrates and unsaturated fats also have healthful effects on blood pressure.

There isn't a single "magic" food in this list. Instead, it's the foundation for an all-around healthful eating strategy that's good for blood pressure and so much more. Rigorous trials show that eating strategies such as the Dietary Approaches to Stop Hypertension (DASH) diet, DASH variants like the OmniHeart diet, and Mediterranean-type diets lower blood pressure in people with hypertension (high blood pressure) and those headed in that direction. They also help prevent some of the feared consequences of high blood pressure.

Why bother? Hypertension is the ultimate stealth condition. You'd never know you have it without having your blood pressure measured -- or until high blood pressure begins to damage vital organs.

Half of the 65 million American adults with high blood pressure don't have it under control. That's worrisome given the insidious consequences of high blood pressure. It is the leading cause of stroke in the United States. It contributes to thousands of heart attacks. It overworks heart muscle, leading to heart failure. It damages the kidneys, erodes sight, interferes with memory, puts a damper on sexual activity, and steals years of life.


Drugs that lower blood pressure tend to work well. But they don't necessarily attack the cause of the problem. And no matter how safe they are, all drugs have some unwanted or unintended side effects.

A healthful diet is an effective first-line defense for preventing high blood pressure. It is an excellent initial treatment when blood pressure creeps into the unhealthy zone, and a perfect partner for medications. Unfortunately, translating the dietary strategies tested in clinical trials into diets for daily life hasn't been easy.

Drs. Frank M. Sacks and Hanna Campos, of the Department of Nutrition at Harvard School of Public Health, have done just that. In the June 3, 2010, New England Journal of Medicine, they offer evidence-based advice about diet and blood pressure:

1. Eat more poultry, fish, nuts, and legumes (beans) and less red meat.

2. Choose low-fat or nonfat milk and other dairy products instead of full-fat versions.

3. Turn to vegetables and fruits instead of sugary or salty snacks and desserts.

4. Select breads, pasta, and other carbohydrate-rich foods that are made from whole grains instead of highly refined white flour.

5. Eat fruit instead of drinking fruit juice.

6. Use unsaturated fats like olive, canola, soybean, peanut, corn, or safflower oils instead of butter, coconut oil, or palm-kernel oil.

7. Rely on fresh or frozen foods instead of canned and processed foods.

8. Choose low-sodium foods whenever possible; use herbs, spices, vinegar, and other low-sodium flavorings instead of salt.

9. Don't skip meals; try to eat one-third of your calories at breakfast.

10. If you need help, record everything that you eat day by day for a week. Have this information reviewed by a dietitian.


If you are a do-it-yourselfer and enjoy puttering around the kitchen, you can build a blood pressure-friendly diet from these tips. If you like more direction, plus menus and recipes, a cornucopia of help is available. Drs. Sacks and Campos extracted their advice from the DASH, OmniHeart, and Mediterranean-type diets. Much has been published about two of the three.

A 64-page guide to the DASH diet is available at health.harvard.edu/148 for free, or can be mailed to you for a small fee by calling the NHLBI Health Information Center at 301-592-8573.

"The DASH Diet Action Plan," by Marla Heller and "The DASH Diet for Hypertension," by Thomas Moore and Mark Jenkins are available in bookstores. A number of books have been written about the Mediterranean diet, from "How to eat well and stay well the Mediterranean way," written in 1959 by pioneering nutrition researcher Ancel Keys and his wife, Margaret, to "Your Heart Needs the Mediterranean Diet," published in 2007 by Emilia Klapp, a registered dietitian.

Information about the OmniHeart diet is harder to come by. We have posted a summary of it at health.harvard.edu/BPdiet.


Available at Amazon.com:

No More Digestive Problems

Your Heart Needs the Mediterranean Diet

How to eat well and stay well the Mediterranean way

The DASH Diet for Hypertension

The DASH Diet Action Plan








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