Introduction
Hypertension is a serious and common condition that is prevalent in both developing and
economically stable countries (Vogt et al., 1999). It increases a patient’s risk for cardiovascular
disease including myocardial infarction, stoke, and end stage renal disease (Vogt et al., 1999).
The use of medical nutrition therapy to treat hypertension focuses on specific life-style changes
that have been proven to reduce blood pressure leading to a decrease in mortality and morbidity.
This paper describes the importance of medical nutrition therapy in the reduction and treatment
of hypertension and demonstrates the nutrition care process for hypertension using a case study
patient.
Hypertension
Hypertension is the chronic elevation of blood pressure. Blood pressure is measured in
terms of systolic pressure and diastolic pressure. According to the American Heart Association
AHA, systolic blood pressure is the pressure the heart exerts against the arterial wall
when the heart beats. Diastolic blood pressure is the pressure the heart exerts against the arterial
wall when the heart is resting (AHA, 2020). When reading a blood pressure measurement,
systolic pressure is the first and often larger number followed by the diastolic pressure (AHA,
2020). For example, a blood pressure reading of 120/80 indicates a systolic pressure of 120 and a
diastolic pressure of 80.
In a clinical setting hypertension is organized into four levels, normal, elevated, stage 1
and stage 2 (American College of Cardiology, 2017). Below, table1 indicates the blood pressure
measurements for each stage.
The Nutrition Care Process Related to Hypertension 3
Table 1
There are two separate types of hypertension, primary, also known as essential, and
secondary. Primary hypertension has no known causes (Nelms & Sucher, 2016). Secondary
hypertension, however, is caused from other disorders such as kidney disease, heart disease, and
disorders of the endocrine system (Mayo Clinic, 2020). Primary hypertension is the most
common type of hypertension and is usually related to lifestyle factors such as high sodium
intake, low potassium intake, obesity, low activity levels, and/or genetics (Nelms & Sucher,
2016). Additionally, there is a possibility for hypertension to respond poorly to medications
which is known as resistant hypertension. Resistant hypertension is defined as stage 2 (>140/90
mmHg) hypertension that is not normalized even after treatment with three to four
antihypertensive medications (Sheppard, et al., 2017). The treatment for resistant hypertension
typically includes the addition of four or more medications to normalize blood pressure
(Sheppard, et al., 2017). The treatment goals for hypertension are to reduce blood pressure and
reduce patient’s risk for the common comorbidities associated with hypertension through
pharmacologic interventions and medical nutrition therapy (Nelms & Sucher, 2016).
Pathophysiology
Introduction
Hypertension Levels Systolic Pressure
(mm of Hg)
Diastolic pressure
(mm of Hg)
Normal <120 And <80 Elevated 120-129 And >80
Stage 1 130-139 Or 80-89
Stage 2 ≥140 And/ Or ≥90
The Nutrition Care Process Related to Hypertension 4
Elevated blood pressure is the result of an increase in cardiac output or an increase in
peripheral vascular resistance or a combination of the two (Mayet & Hughes, 2003). Blood
pressure regulation is controlled by several systems within the body including the autonomic and
sympathetic nervous systems, the renin-angiotensin system, and the endocrine system. Defects
from any one of these systems can lead to an increase in systemic vascular resistance and/or an
increase in cardiac output leading to an increase in blood pressure (Beevers, et al, 2001).
Additionally, research found an increase in blood pressure can be caused by insulin resistance,
obesity, and high salt intake (Beevers, et al, 2001). The pathophysiology of hypertension greatly
differs patient to patient. The following will review basic information regarding the
pathophysiology of hypertension related to the autonomic nervous system, endocrine system, and
the renin-angiotensin system.
Autonomic nervous system
Within the autonomic nervous system, the two branches of the system, parasympathetic
and sympathetic, work together to regulate blood pressure. When stimulated, the sympathetic
nervous system increases blood pressure using the neurotransmitters norepinephrine and
epinephrine (Grassi & Mancia, 2014). The parasympathetic nervous system regulates the
increase of blood pressure through neurotransmitter acetylcholine which slows down the heart
rate. Hypertension has been shown to be related to an impairment of the parasympathetic system
and an overdrive of the sympathetic system, which causes an increase on norepinephrine (Grassi,
2015).
Endocrine system
Although epinephrine and norepinephrine are controlled by the autonomic nervous
system, they are released by the adrenal glands, part of the endocrine system. Endocrine
The Nutrition Care Process Related to Hypertension 5
disorders that result in an excessive release of epinephrine and norepinephrine can result in
hypertension (Nelms & Sucher, 2016). Furthermore, it has been found that patients with
hypertension have an increased sensitivity and release of norepinephrine (Mayet & Hughes,
2003; Foex & Sear 2004).
Renin-angiotensin system
The renin-angiotensin system regulates blood pressure through the release of many
different hormones. Renin is released from the granular cell in the kidney in response to
sympathetic stimulation, reduced sodium-chloride and a decrease in blood flow to the kidney.
Renin is used to convert angiotensin to angiotensin I which is then converted to angiotensinconverting enzyme (ACE) (Nelms & Sucher, 2016). ACE indirectly causes vasoconstriction
through the breakdown of bradykinin, which is a vasodilator and ACE converts angiotensin I
into angiotensin II (Beevers, 2001). Angiotensin II is a vasoconstrictor and will cause a rise in
blood pressure (Beevers, 2001). Angiotensin II triggers aldosterone to be release from the
adrenal cortex (Nelms & Sucher, 2016). The release of aldosterone also causes a rise in blood
pressure by influencing the kidney to retain sodium which will increases blood volume (Nelms &
Sucher, 2016).
The renin-angiotensin system works in a negative feedback loop (Foex & Sear, 2004).
When the renin-angiotensin system is operating correctly, high salt intake will cause a decrease
in angiotensin II, thus decreasing the need for sodium retention (Drenjančević-Perić et al., 2011).
In 40-50% of patients with primary hypertension, the mechanisms in which angiotensin II is
controlled does not react to an increase in sodium intake (Drenjančević-Perić et al., 2011). In
some incidences of hypertension, this phenomenon is caused by a salt sensitivity. In patients with
a salt sensitivity, changes in blood pressure has a positive correlation with salt intake. For
The Nutrition Care Process Related to Hypertension 6
example, an increase in salt intake raises blood pressure and a decrease in salt lowers blood
pressure (Drenjančević-Perić et al., 2011). Salt sensitivities are common in individuals with renal
disease, diabetes, obesity, hypertension, and old age (Drenjančević-Perić et al., 2011).
Symptoms
Hypertension typically does not present with symptoms, however, the symptoms can
occur in some patients, such as shortness of breath, nose bleeds, and headaches (Mayo Clinic,
2020). However, even though high blood pressure does not cause any specific symptoms,
uncontrolled hypertension can lead to many health risks such as heart attacks and strokes (Mayo
Clinic, 2020). Fortunately, because checking a patient’s blood pressure is part of routine
assessments, hypertension can be easily caught by physicians (Mayo Clinic, 2020).
Etiology
Hypertension is associated with many risk factors that are both controllable and fixed. A
few examples of controllable risks factors are smoking, poor diet, inactivity, obesity, diabetes
mellitus and hyperlipidemia, and a few examples of fixed risk factors are chronic kidney disease,
family history, and increased age (Whelton et al., 2018). The prevalence of hypertension
increases from 6.8% to 11% in 20 to 34-year-olds, and to 78% in populations 75 years and older
(Nelms, M., Sucher, K., 2016). Additional fixed risk factors include, gender, low socioeconomic
status, obstructive sleep apnea, and psychosocial stress (Whelton et al., 2018). Diabetes is also a
very common risk factor for hypertension. Seventy-one percent of adults in the Unites States
who have been diagnosed with diabetes also are diagnosed with hypertension (Whelton et al.,
2018). Hypertension is also related to the overactivation of the renin-angiotensin-aldosterone
system (Whelton et al., 2018). Race is also a risk factor for hypertension where black populations
have the highest prevalence at 40.3% for men and 42.9% for females (Nelms, M., Sucher, K.,
The Nutrition Care Process Related to Hypertension 7
2016) The second highest prevalence of hypertension is within the white population at 30.4% for
men and 27.6% for females (Nelms, M., Sucher, K., 2016).
Epidemiology:
Hypertension is also known as the silent killer. This is because it often has no symptoms
and goes is under diagnosed. According to the Center for Disease Control (2020), half of all
adults in the United States have hypertension, however, only 1 in 4 of those adults have their
hypertension under control. In 2018, hypertension was associated with approximately 500,000
deaths. (Center for Disease Control, 2020). Additionally, there is an estimated cost of $46 billion
in health care cost in 2009, both directly and indirectly related to hypertension (Nelms, M.,
Sucher, K., 2016).
Nutrition Care Process
The nutrition care process includes, nutrition assessment, nutrition diagnosis, nutrition
intervention, and nutrition monitoring and evaluation (Nelms & Sucher, 2016). The nutrition
care process related to hypertension includes medical nutrition therapy interventions related to
lifestyle modifications (Nelms & Sucher, 2016). According to the Evidence Analysis Library for
the Academy of Nutrition and Dietetics, the current nutrition practice guidelines for the
management of hypertension focus on medical nutrition therapy (MNT), vitamin D, potassium,
calcium, magnesium, sodium, the Dietary Approaches to Stop Hypertension (DASH) dietary
pattern, alcohol, and physical activity (Lennon, et al., 2017).
The DASH diet is high in fruits, vegetables, and whole grains, while limiting fats intake and
high in potassium, calcium, magnesium, and fiber (AND, 2020). To provide additional benefits it
is recommended to limit sodium levels to between 1,500-2,400 mg per day in patient with
hypertension (AND, 2020). Research has shown that when compared to the typical American
The Nutrition Care Process Related to Hypertension 8
diet, following the DASH diet can decrease systolic blood pressure by 5-6 mmHg and diastolic
blood pressure by 3 mmHg (Lennon et al., 2017). Patients with hypertension are recommended
to meet the dietary reference intake (DRI) for calcium, magnesium, potassium, and vitamin D. In
patients who are not able to meet the DRIs for these nutrients, supplementation has been found to
improve blood pressure (Lennon et al, 2017). Weight loss is usually another important aspect to
the treatment of hypertension. Counseling patients on a calorie-controlled DASH diet has been
shown to reduce systolic blood pressure by 2 to 11 mmHg and diastolic blood pressure by 0 to 9
mmHg. Additionally, engaging in 150-300 minutes of moderate to vigorous physical activity can
lower systolic pressure 4-9 mmHg (Nelms & Sucher, 2016). However, even increasing physical
activity to at least 30 minutes per day is shown to have a positive impact on lowering blood
pressure (Nelms & Sucher, 2016). Smoking cessation is considered the most important lifestyle
change an individual can do to reduce the risk of hypertension (Nelms & Sucher, 2016).
Nutrition Assessment
A nutrition assessment is an important part of the nutrition care process. Information
gathered during a nutrition assessment by a registered dietitian nutritionist (RDN) sets the
foundation for the rest of the nutrition care process (Nelms & Sucher, 2016). A nutrition
assessment aids the RDN in identifying nutrition related problems, creating a nutrition
intervention, and successfully monitoring and evaluating the patient’s progress (Nelms &
Sucher, 2016). During the assessment, the RDN focuses on dietary factors and patterns that are
commonly associated with hypertension (Nelms, M., Sucher, K., 2016). The following nutrition
assessment was conducted on patient X, including patient history, anthropometric data,
biochemical data, nutrition focused physical exam, and food and nutrient related history.
The Nutrition Care Process Related to Hypertension 9
Patient History
Patient history includes both the patient’s medical history and social history. Social
factors such as socioeconomic status, education level, support systems, lifestyle, knowledge, and
beliefs and attitudes are important to gather during a nutrition assessment (Nelms, M., Sucher,
K., 2016). RDNs must consider social factors when planning and implementing a nutrition
intervention. These factors play a large role in nutrition status and can affect the patient’s
compliance with a nutrition intervention (Nelms, M., Sucher, K., 2016). Additionally, when
assessing a patient with hypertension, it is important to identify any comorbidities. Comorbidities
such as obesity, diabetes, dyslipidemia, and renal failure are common in patients with
hypertension and can impact the personalized nutrition intervention (Nelms & Sucher, 2016).
When gathering the patients past medical history, the RDN should also enquire a list of the
patient’s current medications. Medications are often used with lifestyle modifications to control
hypertension and they many antihypertensive medications have possible food drug interactions
(Nelms & Sucher, 2016).
Patient X is a 52-year-old male who was diagnosed with hypertension when he was 13
years old. The patient’s family history includes a mom and sister with hypertension, indicating a
potential genetic factor relating to his hypertension. The patient has a history of obesity, and type
II diabetes. He is married with five children. Currently the patient is getting around six hours of
sleep at night and has no history of sleep apnea. Patient X has worked at a high stress job for 25
years. Recently the patient has gotten a new job which he has described as more stressful than his
previous one, indicating that chronic stress could also contribute to the patient’s hypertension.
His job also includes traveling to various places across the United States, but over the past 25
years has been able to decrease the amount of time he is traveling. Currently, the patient travels
The Nutrition Care Process Related to Hypertension 10
about twice a month for periods ranging from three to five days a week. This lifestyle is
significant when planning and implementing a nutrition intervention. Large amounts of traveling
indicate that the patient must eat out or eat in a hotel room frequently. A nutrition intervention
should be modified to work with the patient’s lifestyle. Patient X does not smoke or use
smokeless tobacco. He currently takes medication to control his hypertension and diabetes. A
current list of the patient’s medications includes, low does Aspirin, Losartan Potassium,
Glipizide, Metformin HCL ER, and Simvastatin. Patient’s taking Losartan Potassium may have
increased serum potassium levels and should avoid salt substitutes (Nelms & Sucher, 2016).
Patient X states that being diagnosed with hypertension has had a limited impact on his life,
besides having to take additional medication. This is very common in patients with hypertension;
therefore, hypertension is often referred to as the silent killer.
Anthropometric data
Anthropometrics data is imperative to any nutrition assessment and includes weight,
height, body mass index, percent usual body weight, and recent weight changes (Nelms &
Sucher, 2016). Anthropometric data helps RDNs identify clients who are nutritionally at risk
(Nelms & Sucher, 2016). It is common for patients diagnosed with hypertension to be
overweight or obese. When hypertension is present in such patients, additional increased weight
will also cause an increase in blood pressure (US Department of Health and Human Services,
2003). Weight loss is advised for patients with hypertension who are obese, meaning a BMI of
30 or greater or patients who are overweight, meaning a BMI of 25-29, if they have two or more
risk factors for heart disease (US Department of Health and Human Services, 2003). Weight loss
can reduce systolic blood pressure by 5 to 20 mmHg per ten kilograms of body weight (Nelms &
Sucher, 2016). Thus, even a small reduction in weight can have a large impact on managing
The Nutrition Care Process Related to Hypertension 11
hypertension. When assessing a patient who has hypertension anthropometric data aids the RDN
in assessing if a patient is overweight or obese.
Patient X is currently 6’1” and weighs 263 pounds. He is obese indicated by a BMI of 35
and a waist circumference of 42 inches. It is important to note that patient X has a large muscle
tone especially in his legs and arms and in the past few years, patient X has had a planned weight
loss of 95 pounds totaling a 26% weight change. The patient reported this weight change did not
impact his blood pressure. The accuracy of this statement is questioned and additional
information such as past blood pressure measurements. Patient X has an ideal body weight of
184 pounds, which means an additional weight loss may aid patient X in getting his blood
pressure under control.
Biochemical data
Biochemical lab results are used by the RDN to determine nutritional markers and organ
function (Nelms & Sucher, 2016). An RDN should carefully evaluate biochemical lab values
because many different factors influence nutritional markers. Nutritional markers and organ
function can be influenced by food and fluid intake, certain medications, diseases, and organ
malfunction (Nelms & Sucher, 2016). It can be determined by many different tests including, but
not limited to, samples of blood, urine, feces, and tissues (Nelms & Sucher, 2016). Biochemical
data is used in assessments for patients with hypertension to indicate causes that are contributing
to the patient’s hypertension and to monitor organ function (AHA, 2017). Additionally, patients
with hypertension have an increased risk to various comorbidities such as cardiovascular disease,
chronic kidney disease, and diabetes (Mayo Clinic, 2020). Due to this increased risk,
biochemical lab values that may indicate additional high-risk comorbidities are standard during
an assessment for hypertension.
The Nutrition Care Process Related to Hypertension 12
For a patient with hypertension, the primary measurement that should be assessed by the
RDN is the patient’s blood pressure. This indicates to the RDN the severity of the patient’s
hypertension. Additional biochemical labs that should be assessed are lab values that indicate
diabetes, such as hemoglobin A1C and blood glucose levels (AHA, 2017). A fasting glucose
greater than 126mg/dL and a hemoglobin A1C greater than 6.5% indicate the presence of
diabetes (Nelms & Sucher, 2016). Abnormalities of lipid serum panel indicate increased risk for
cardiovascular disease (Nelms & Sucher, 2016). Optimal lipid serum levels include total
cholesterol less than 199mg/dL, HDL cholesterol levels between 40mg/dL and 59mg/dL, LDL
cholesterol levels less then 100mg/dL for individuals at high risk for heart disease, and
triglyceride levels less than 150mg/dL (Nelms & Sucher, 2016). Thyroid-stimulating hormone
(TSH) is another basic test for patients with hypertension because hyperthyroidism and
hypothyroidism can cause hypertension (AHA, 2017). Normal lab values for TSH range between
0.5 to 5.0 mlU/L. Biochemical lab values related to liver and kidney function tests are standard
for patients with cardiovascular diseases (Academy of Nutrition and Dietetics [AND], 2020).
These tests include blood urea nitrogen (8-18mg/dL), creatinine (0.6-1.2 mg/dL), and glomerular
filtration rate (135-200L/day) (Nelms & Sucher, 2016). Additionally, serum electrolyte lab
values such as serum sodium (136-145mEq/L) and potassium (3.5-5.5mEq/L) should be included
in a biochemical assessment for patients with hypertension (AND, 2020). Abnormal values for
both serum potassium and serum sodium are not always indicators of inadequate or excessive
intake. These values are also used to assess kidney function, hydration status, electrolyte
imbalances and acid-base imbalances (Nelms & Sucher, 2016).
The last time patient X checked his blood pressure it was measured at 122/86. This is an
indication that even though the patient is on medications to help control his hypertension, he still
The Nutrition Care Process Related to Hypertension 13
is at stage 1 of hypertension. Patient X’s last hemoglobin A1C level was 7.9%. This raises a
concern that the patient is not in control of his diabetes and additional diabetes education should
be considered as part of his treatment plan. Other biochemical data that should be assessed are
the patient’s lipid profile, electrolytes such as sodium and potassium, and labs related to kidney
and liver function.
Nutrition focused physical finding
A nutrition focused physical exam is completed by an RDN to assess the patient for signs
of malnutrition and nutrient deficiencies (Nelms & Sucher, 2016). When a RDN completes a
nutrition focused physical exam, they look for signs of muscle wasting and subcutaneous fat loss
(Nelms & Sucher, 2016). Additionally, during a nutrition focused physical exam, an RDN will
assess a patient’s hair, nails, skin and eyes for signs of nutrient deficiencies and the presence of
any edema (Nelms & Sucher, 2016). The RDN should assess the patient for abdominal obesity as
abdominal obesity increases the risk for diabetes, metabolic syndrome, and other cardiovascular
diseases (Nelms & Sucher, 2016). Abdominal obesity can be assessed by using waist
circumference, which for men is equal to or greater than 40 inches for men, while 35 inches for
women is associated with obesity and chronic disease (Nelms & Sucher, 2016). Another
important finding during a nutrition focused physical exam is any odor related to cigarette smoke
and/or alcohol (AND, 2020). These are indications that the patient has consumed these
substances recently. Regarding patient X, no signs of muscle wasting, or subcutaneous fat loss
were found. Skin, nails, hair, and eyes appeared to be within normal limits and there were no
signs of edema present.
Food and nutrition intake
The Nutrition Care Process Related to Hypertension 14
During an assessment, an RDN, gathers information related to the patient’s food and fluid
intake, as well as physical activity (Nelms & Sucher, 2016). For patients with hypertension, the
RDN should gather a food history (AND, 2020). Food histories can be gathered through a few
different methods including a 24-hr recall, food frequency questionnaire, and/or a food diary
(Nelms & Sucher, 2016). Each method of gathering information has its advantages and
disadvantages and the RDN should choose the method that is the best fit for the patient. When
gathering a food history from a patient with hypertension, the RDN should pay attention to
several factors that could impact the patient’s hypertension or risk for comorbidities. This
includes fat and cholesterol intake, mineral intake such as sodium, potassium, calcium and
magnesium, fiber, sterols and stanols, and omega 3-fatty acids (AND, 2020). The RDN should
also ask the patient specific questions, such as how often they eat fruits and vegetables, whole
grains, and legumes, and if the patient has any food allergies or intolerances (AND, 2020).
Additionally, the RDN should gather information on lifestyle factors that may influence food
intake such as the frequency of meals, snacks, and desserts, any recent changes in meal patterns
or intake, how they are preparing their meals, where they are eating, and if they have ever tried
any diets in the past (AND, 2020). The RDN should also gather information on the patient’s
current physical activity (AND, 2020).
Patient X stated that he tries to eat as healthy as he can. He does not add extra salt into his
meals, however, does have a sweet tooth. For a few months, the patient was trying to follow the
keto diet program by Sanford Profile, however, the last few weeks he has not been following it
as closely. The patient currently eats around three meals per day and has one to three snacks a
day. The patient eats out approximately twice a week and more often when he is traveling. His
typical breakfast is a protein shake, protein bar, and coffee with cream and sugar. His typical
The Nutrition Care Process Related to Hypertension 15
lunch consists of a salad with chicken or a protein shake. For dinner patient X usually eats
whatever his wife makes. These meals are usually spaghetti, tacos, or stir fry. The patient
typically eats something sweet after dinner and an evening snack. The patient usually has one
glass of whiskey a week. He claims to drink around a gallon of water every day and keeps a
water bottle at his desk while he works. When interviewing the patient, he reported that in the
last week he ate at In-N-Out Burger, 5 Guys, and had Chinese food twice. At this time, the
patient was traveling and due to the current COVID-19 pandemic he had to eat at fast food
restaurants as opposed to normally dining in at restaurants while traveling. The patient is
currently exercising twice a week, however, tries to exercise for closer to 3 to 4 times per week,
for approximately 40 minutes to an hour-long increment. He enjoys bike rides but also runs on
occasion.
Comparative standards
Using the Mifflin St. Jeor equations with an activity factor of 1.3 the patient’s current
estimate energy needs are 2700kcal per day (AND, 2020). Using 0.8 grams of protein per kg of
ideal body weight the patient’s protein needs are 70 grams of protein per day and current fluid
needs are 2700 mL per day (AND, 2020). For a patient with hypertension, the comparative
standards for the DASH diet include less than 7% of daily fat intake from saturated fat and less
than 2300 mg of sodium per day (Nelms & Sucher, 2016). Additionally, the daily recommended
intakes (DRIs) for potassium, calcium and magnesium are recommended for patients with
hypertension (Nelms & Sucher, 2016).
Nutrition Diagnosis
Nutrition diagnosis is independent of the medical diagnosis. It identifies the nutrition
related problem that the RDN will treat through nutrition interventions (Nelms & Sucher, 2016).
The Nutrition Care Process Related to Hypertension 16
Specific nutrition diagnosis related to hypertension include excessive oral intake (NI-2.2),
excessive mineral intake (sodium) (NI-5.10.7), overweight/obesity (NC-3.3), physical inactivity
(NB-2.1), food and nutrition related knowledge deficit (NB-1.1) (AND, 2020). Three possible
PES statements include:
- (NI-2.2) Excessive oral intake related to loss of appetite awareness, as evidence by
estimated intake that exceeds estimated energy needs. - (NC-3.3) obesity related to excessive oral intake as evidence by a waist
circumference more than normative for age and sex. - (NI-5.10.7) Excessive sodium intake related to a food and nutrition related knowledge
deficit concerning food sources of sodium as evidence by an estimated intake
containing high amounts of sodium compared to the recommended daily allowance.
Due to the information Patient X provided during the assessment, an appropriate PES
statement for Patient X would be (NI-5.10.7) excessive sodium intake related to a food and
nutrition related knowledge deficit concerning food sources of sodium as evidence by an
estimated intake containing high amounts of sodium compared to the recommended daily
allowance.
Nutrition Intervention
Nutrition intervention is the stage in the nutrition care process where the RDN plans to
treat the patient’s most pressing nutrition related problem (Nelms & Sucher, 2016). The RDN
must work with the patient, as well as other health care professionals, the patient’s family, or
caregiver to create the best realistic treatment plan for the patient and to implement that plan into
action (Nelms & Sucher, 2016). The four domains of the nutrition care process are food and
nutrient delivery, nutrition education, nutrition counseling and coordination of care with other
The Nutrition Care Process Related to Hypertension 17
health care professionals (Nelms & Sucher, 2016). Nutrition interventions for patients with
hypertension typically focus on nutrition education, nutrition counseling and coordination of
care. Nutrition education is used to teach patients about ways they can reduce their hypertension
through diet and exercise (AND, 2020). Nutrition counseling is used to collaborate with the
patient to establish goals, then implement a plan that will help the patient achieve these goals in a
way that works for the patient (AND, 2020). Coordination of care with a mental health
professional for stress maintenance or smoking cession may also be an important part of an
intervention plan. Nutrition interventions for patients with hypertension should be targeted at
initiating a diet, such as the DASH diet that emphasize:
• A high intake of vegetables, fruits, and whole grains.
• Incorporating low fat dairy items, poultry, fish, legumes, vegetable oils and nuts
into meals.
• Limiting intake of red meats, sodium, and sweets.
Additionally, nutrition interventions should include weekly physical activity goals and
maintenance of a healthy weight (AND, 2020).
The current recommendation for patients with hypertension is to follow the DASH diet
while limiting sodium intake to 1,500-2400mg per day (AND, 2020). An intervention plan for
Patient X should include education on the DASH diet with a sodium restriction of less than
2,300mg per day (Lennon, et al, 2017). Additionally, diet education about healthy eating while
traveling should be provided to the patient. Nutrition counseling should be used to collaborate
with Patient X to create individualized goals and a plan on how the patient will meet these goals.
Monitoring and Evaluation
The Nutrition Care Process Related to Hypertension 18
Monitoring and evaluating the patient’s progress is an important part of the nutrition care
process. After the initial assessment, three follow-up appointments should be scheduled with the
patient every other week, and then once a month for the first year (Lennon, et al, 2017). After the
first year, appointments should be made 2-3 times per year (Lennon, et al, 2017). The RDN will
monitor the patients progress and evaluate the success of the nutrition intervention at these
appointments by evaluating the patient’s weight, blood pressure and food intake through a 24-
hour recall. The RDN may provide additional medical nutrition therapy techniques such as
motivational interviewing, additional nutrition education or adjustments to the patient’s nutrition
intervention plan if progress is not being shown.
Conclusion/Prevention
Hypertension is a very prevalent condition around the world. Diet and lifestyle changes
can greatly reduce a patient’s blood pressure, as well as reduce the risk of further health
complications associated with hypertension. Additionally, similar diet and lifestyle modifications
can be used to prevent hypertension. These include eating a diet high in fruit, vegetables and
whole grains and low in sodium and fat; maintaining a healthy weight; getting at least 2 hours
and 30 minutes of physical activity per week; limiting alcohol intake and getting enough sleep
(Center for Disease Control, 2020). The nutrition care process in important for the treatment of
hypertension. A nutrition intervention can reduce the patient’s blood pressure, leading to
decrease in the health risks associated with hypertension. A successful intervention can improve
patient quality of life as well as decrease the risk for mortality and morbidity.
The Nutrition Care Process Related to Hypertension 19
Citations
Academy of Nutrition and Dietetics. (2020). Nutrition Care Manual.
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