Effect of Dietary Interventions on Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Público

Abstract

Importance: Previous studies have shown a beneficial effect of dietary strategies for blood pressure control, but their relative effectiveness is not well established.

Objective: To conduct a systematic review and meta-analysis of different dietary interventions on blood pressure control and assess their comparative effectiveness.

Data Sources: PubMed, EMBASE and Web of Science databases were searched to identify studies published between January 1, 1990 and February 28, 2015.

Study Selection: All studies met the following inclusion criteria: (i) randomized, controlled trial design; (ii) adult participants (≥ 19 years); (iii) dietary intervention aimed at improving health; (iv) control group receiving standard follow-up or advice only; (v) ability to collect or calculate mean difference in systolic or diastolic BP; and (vi) duration of at least six months. Exclusion criteria included the following: (i) secondary causes of hypertension; (ii) congestive heart failure; (iii) overlapping participants; (iv) intervention consisting of nutritional supplements only.

Data Extraction and Synthesis: Data was collected regarding study design, participant demographics and baseline characteristics, dietary details, and outcomes. The data were pooled using a random effects model.

Main Outcomes and Measures: Net differences in systolic and diastolic BP associated with various dietary interventions.

Results: 24 trials with 23,858 total participants were included. The overall pooled net effect of dietary intervention on systolic BP and diastolic BP was -3.07 mmHg (95% CI, -3.85 to -2.30; P < 0.001) and -1.81 mmHg (95% CI, -2.24 to -1.38; P <0.001), respectively. The Dietary Approaches to Stop Hypertension diet had the largest effect and was associated with a net change in systolic BP of -7.62 mmHg (95% CI, -9.95 to -5.28; P < 0.001) and diastolic BP of -4.22 mmHg (95% CI, -5.88 to -2.57; P < 0.001). Low sodium; low sodium, high potassium; low sodium, low calorie; and low calorie diets also led to significantly lower systolic and diastolic BP, while the Mediterranean diet was associated with a significant reduction in diastolic BP but not systolic BP.

Conclusions and Relevance: Dietary modifications are associated with lower BP and could be useful as an alternative to pharmacologic therapy in some situations.

Table of Contents

BACKGROUND. 1

METHODS. 3

Study Selection. 3

Data Extraction. 4

Statistical Analysis. 5

Bias Assessment. 7

RESULTS. 8

Selection Process and Study Characteristics. 8

Change in Blood Pressure. 9

Subgroup Analysis and Meta-Regression. 10

Bias Assessment. 11

DISCUSSION. 12

CONCLUSION. 16

REFERENCES. 17

TABLES AND FIGURES. 23

Table 1. 23

Table 2. 24

Figure 1. 25

Figure 2. 26

Figure 3. 28

Figure 4. 29

Figure 5. 30

Figure 6. 31

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palabra Clave	Blood Pressure Diet Lifestyle Hypertension
Committee Chair / Thesis Advisor	Ali, Mohammed K, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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