Mediterranean diet and blood pressure reduction in adults with and without hypertension: A systematic review and meta-analysis of randomized controlled trials

Filippou, Christina; Thomopoulos, Costas; Kouremeti, M.; Sotiropoulou, Lida; Nihoyannopoulos, Petros; Tousoulis, Dimitrios; Tsioufis, Costas

doi:10.1016/j.clnu.2021.01.030

Cited by 56 publications

(59 citation statements)

References 61 publications

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“…However, sodium restriction as a measure to promote BP reduction has usu-ally been examined in randomized controlled trials (RCTs) separately from other interventions and less likely in combination with other lifestyle changes, such as weight loss, physical exercise, or adoption of a specific dietary pattern [9,10]. Examples of dietary patterns that have been recognized as effective dietary interventions to reduce BP are the Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean diet (MedDiet) [11,12]. However, the contribution of salt restriction under and above these dietary patterns on BP reduction remains by and large unclear.…”

Section: Stating the Problemmentioning

confidence: 99%

Overview of salt restriction in the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet for blood pressure reduction

Filippou¹,

Tatakis²,

Polyzos³

et al. 2022

Rev. Cardiovasc. Med.

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Despite considerable advances in pharmacological treatments, hypertension remains a major cause of premature morbidity and mortality worldwide since elevated blood pressure (BP) adversely influences cardiovascular and renal outcomes. Accordingly, the current hypertension guidelines recommend the adoption of dietary modifications in all subjects with suboptimal BP levels. These modifications include salt intake reduction and a healthy diet, such as the Dietary Approaches to Stop Hypertension (DASH) diet or the Mediterranean diet (MedDiet), independently of the underlying antihypertensive drug treatment. However, dietary modifications for BP reduction in adults with prehypertension or hypertension are usually examined as stand-alone interventions and, to a lesser extent, in combination with other dietary changes. The purpose of the present review was to summarize the evidence regarding the BP effect of salt restriction in the context of the DASH diet and the MedDiet. We also summarize the literature regarding the effects of these dietary modifications when they are applied as the only intervention for BP reduction in adults with and without hypertension and the potent physiological mechanisms underlying their beneficial effects on BP levels. Available data of randomized controlled trials (RCTs) provided evidence about the significant BP-lowering effect of each one of these dietary strategies, especially among subjects with hypertension since they modulate various physiological mechanisms controlling BP. Salt reduction by 2.3 g per day in the DASH diet produces less than half of the effect on systolic blood pressure (SBP)/diastolic blood pressure (DBP) (-3.0/-1.6 mmHg) as it does without the DASH diet (-6.7/-3.5 mmHg). Although their combined effect is not fully additive, low sodium intake and the DASH diet produce higher SBP/DBP reduction (-8.9/-4.5 mmHg) than each of these dietary regimens alone. It is yet unsettled whether this finding is also true for salt reduction in the MedDiet.

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Section: Stating the Problemmentioning

confidence: 99%

Overview of salt restriction in the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet for blood pressure reduction

Filippou¹,

Tatakis²,

Polyzos³

et al. 2022

Rev. Cardiovasc. Med.

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“…The Mediterranean diet has a less significant impact on BP than DASH-diet, probably because it is not strictly a low-salt diet. Another reason is related to the fact that a part of the available trials compared the effect of high adherence to low adherence to Mediterranean diet in Mediterranean countries (in particular Italy and Spain) where the low adherence is represented by a dietary pattern that is always healthier than the one in North-Europe or North-America [ 17 ]. This attenuate the measured effect of Mediterranean diet on BP.…”

Section: Dietary Patterns Improving Blood Pressure Controlmentioning

confidence: 99%

Dietary Intervention to Improve Blood Pressure Control: Beyond Salt Restriction

Cicero

Veronesi

Fogacci

2021

High Blood Press Cardiovasc Prev

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Lifestyle improvement is a cornerstone of cardiovascular disease prevention and has a relevant effect on blood pressure control. During the last decades the attention of the researcher has focused on low-salt diets as the lifestyle modification most effective in blood pressure reduction. Current international guidelines thus suggest to stress the importance of the implementation of the dietary approach to stop hypertension (DASH) diet and of a low-salt Mediterranean diet to achieve the best results in term of blood pressure decrease. However, salt reduction in diet could be not the only nor the main determinant of blood pressure reduction under dietary treatment. DASH and low-salt Mediterranean diet are also characterized by a high intake of vegetables (NO and polyphenol sources), whole grains, some low-fat dairy products, and low intake of red meat, sugar, and trans-hydrogenated fats. Lacto-ovo vegetarian diet are also per se associated to a significant improvement in blood pressure levels. Moreover, these diets are particularly effective when associated with a significant weight loss. Furthermore, blood pressure can also be lowered by some nutraceuticals (beetroot, magnesium, vitamin C, catechin-rich beverages, lycopene, etc). The aim of this narrative review is to critically resume the most recent evidence supporting a complete approach to dietary counseling for hypertension prevention and management.

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“…The null association reported herein was unexpected given that there is strong expert opinion favouring the Mediterranean diet pattern for better cardiovascular health outcomes [32,33] and evidence from systematic reviews of randomized controlled trials showing small but significant reductions in blood pressure [34,35]. Furthermore, the Mediterranean diet pattern has been associated with healthy weight outcomes [14] and cardio-vascular benefit [36] in both the Mediterranean and non-Mediterranean regions.…”

Section: Discussionmentioning

confidence: 71%

Is the Mediterranean Diet Pattern Associated with Weight Related Health Complications in Adults? A Cross-Sectional Study of Australian Health Survey

et al. 2021

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We hypothesized that unhealthy dietary pattern would be associated with weight related complications among overweight. We analysed data from the Australian Health Survey conducted from 2011 to 2013. A total of 5055 adults with at least overweight (body mass index ≥25 kg/m2) were analysed. We used logistic regression to assess the association between unhealthy dietary pattern, defined by low adherence to Mediterranean Diet Score (MDS), and weight related complications, defined by the Edmonton Obesity Staging System (EOSS). We repeated the logistic regression models by age and socio-economic disadvantage strata in sensitivity analyses. We also repeated the main analysis on a propensity score matched dataset (n = 3364). Complications by EOSS ≥2 was present in 3036 (60.1%) participants. There was no statistically significant association between unhealthy dietary pattern and weight related complication (odds ratio 0.98 (95%confidence interval: 0.85, 1.12)). The null association remained the same after repeating the analysis on three age and five socio-economic indexes for areas strata. The finding persisted after the analysis was repeated on a propensity score matched dataset. We found no evidence to support the hypothesis that unhealthy dietary pattern was associated with weight related complications in this cross-sectional study of the Australian population with overweight or obesity.

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Mediterranean diet and blood pressure reduction in adults with and without hypertension: A systematic review and meta-analysis of randomized controlled trials

Cited by 56 publications

References 61 publications

Overview of salt restriction in the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet for blood pressure reduction

Overview of salt restriction in the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet for blood pressure reduction

Dietary Intervention to Improve Blood Pressure Control: Beyond Salt Restriction

Is the Mediterranean Diet Pattern Associated with Weight Related Health Complications in Adults? A Cross-Sectional Study of Australian Health Survey

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