A 60-year-old man comes to the office for a follow-up of his high blood pressure. His previous blood pressure reading 6 months ago was 136/85 mmHg, and his readings at home since then have been between 130-140 mmHg systolic and 80-90 mmHg diastolic. Past medical history is otherwise unremarkable, and he is not on any medications. He consumes hamburgers and fries with beer at least 4 days per week and does not exercise. He does not use illicit drugs but smokes 5 cigarettes per day for 40 years. His blood pressure at this visit is 140/85 mmHg, and his body mass index (BMI) is 26 kg/m2. His other vital signs are within normal limits, and his physical examination is unremarkable. A complete blood count (CBC), chemistry panel, and lipid panel are normal. An electrocardiogram is within normal limits.
Which of the following would have the greatest impact on decreasing his blood pressure?
A) Dietary Approaches to Stop Hypertension (DASH) diet
In patients with hypertension, lifestyle modifications play a crucial role in managing and reducing blood pressure. Among the interventions listed, the DASH diet has been shown to have the most significant impact on lowering systolic blood pressure.
The DASH diet is a dietary pattern that emphasizes the consumption of fruits, vegetables, legumes, low-fat dairy products, and foods low in saturated and total fats. Clinical studies have demonstrated that adherence to the DASH diet can produce a reduction in systolic blood pressure by approximately 11 mmHg, which is the highest reduction compared to other lifestyle interventions.
Answer choice B: Lose 10 kg of weight, is incorrect. Reducing the BMI to <25 kg/m2 can decrease systolic blood pressure by about 6 mmHg per 10 kg of weight loss. However, the patient's BMI is 26 kg/m2, and losing 10 kg may not be as impactful compared to dietary changes for this patient.
Answer choice C: Smoking cessation, is incorrect. Smoking cessation is crucial for overall cardiovascular health but does not have a significant and consistent effect on lowering blood pressure.
Answer choice D: Stop drinking alcohol, is incorrect. Limiting alcohol intake to ≤2 drinks/day for men and ≤1 drink/day for women can result in a 5 mmHg reduction in systolic blood pressure. However, the impact is generally smaller compared to DASH diet.
Answer choice E: Walking 30 minutes for 5 days per week, is incorrect. Engaging in regular aerobic exercise (30 minutes/day for 5+ days/week) can reduce systolic blood pressure by about 7 mmHg. However, the impact is generally smaller compared to DASH diet.
Key Learning Point
In hypertensive patients, the DASH diet—rich in fruits, vegetables, legumes, and low-fat dairy—can reduce systolic blood pressure by approximately 11 mmHg, making it the most effective lifestyle intervention.
