Dietitians can help improve outcomes in hypertensive adults

Adults with elevated blood pressure (BP) may benefit from help provided by dietitians, suggests a study.

A team of investigators searched the databases of Medline, Cinahl, and Cochrane Central for randomized controlled trials (RCTs) published in peer-reviewed journals from 1985‒2022. They assessed risk of bias using version 2 of the Cochrane tool for RCTs.

The DerSimonial-Laird random-effects model was used to perform the meta-analyses. Finally, certainty of evidence (COE) was evaluated for each outcome via the Grading of Recommendations, Assessment and Evaluation method.

Forty articles representing 31 RCTs met the eligibility criteria. A dietitian-provided medical nutrition therapy (MNT) was effective in reducing systolic (mean difference [MD], ‒3.63 mm Hg, 95 percent confidence interval [CI], ‒4.35 to ‒2.91) and diastolic BP (MD, ‒202 mm Hg, 95 percent CI, ‒2.56 to ‒1.49; p<0.001), as well as body weight (MD, ‒1.84 kg, 95 percent CI, ‒2.72 to ‒0.96; p<0.001).

MNT also brought improvements in antihypertensive medication usage, relative risk of stroke (MD, 0.34, 95 percent CI, 0.14‒0.81; p=0.02), and CVD risk score (standardized mean difference [SMD], ‒0.20, 95 percent CI, ‒0.30 to ‒0.09; p<0.001) relative to controls. COE was moderate.

In addition, MNT helped reduce arterial stiffness (SMD, ‒0.45, 95 percent CI, ‒0.71 to ‒0.19; p=0.008) and waist circumference (SMD, ‒1.18 cm, 95 percent CI, ‒2.00 to ‒0.36; p=0.04). COE was low.

No between-group difference was noted in the risk of myocardial infarction. Notably, dietitian interventions resulted in a reduction in BP and related cardiovascular outcomes for adults with prehypertension or hypertension.

“Dietitians play a critical role in improving cardiometabolic risk factors for adults with elevated BP,” the investigators said. “[I]mproved payment for and access to MNT services has the potential to significantly impact public health.”