THE IMPACT OF THE DASH AND MEDITERRANEAN DIETS ON BLOOD PRESSURE AND CARDIOVASCULAR RISK FACTORS: A REVIEW OF SCIENTIFIC EVIDENCE AND PRACTICAL IMPLICATIONS
Abstract
Introduction: Hypertension is one of the major risk factors for premature mortality and cardiovascular diseases. Lifestyle modifications, including diet, play a crucial role in its prevention and treatment. The aim of this review was to assess the impact of the DASH diet and the Mediterranean diet (MedDiet) on blood pressure values.
Materials and methods: Data from randomized controlled trials (RCTs) and meta-analyses examining the effects of the DASH and MedDiet on systolic (SBP) and diastolic blood pressure (DBP) were analyzed. The review included key studies such as PREMIER, DASH-Sodium, ENCORE, PREDIMED, as well as meta-analyses published up to 2021.
Results: The DASH diet was associated with significant reductions in SBP and DBP, particularly when combined with sodium reduction, weight loss, and increased physical activity. The MedDiet also contributed to blood pressure lowering, although the effect was smaller (average reduction in SBP by 1.5 mmHg and in DBP by 0.9 mmHg compared to other diets) and depended on the study population and control group.
Conclusions: Both the DASH and Mediterranean diets are effective non-pharmacological strategies for managing hypertension. Their implementation should be supported through counseling, mobile technology, and systemic actions. Further RCTs with sodium intake monitoring are needed to more fully assess the impact of the MedDiet on blood pressure.
References
WHO. Global Health Observatory (GHO) data: raised blood pressure: situation and trends. [Internet] Geneva: WHO; [cited February, 2016]. Available from: http://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/
Mule G, Castiglia A, Cusumano C, Scaduto E, Geraci G, Altieri D, Di Natale E, Cacciatore O, Cerasola G, Cottone S. Subclinical kidney damage in hypertensive patients: a renal window opened on the cardiovascular system. Focus on microalbuminuria. Adv Exp Med Biol. 2017;956:279–306.
Kjeldsen SE. Hypertension and cardiovascular risk: general aspects. Pharmacol Res. 2018;129:95–9.
Bazzano LA, Green T, Harrison TN, Reynolds K. Dietary approaches to prevent hypertension. Curr Hypertens Rep. 2013;15:694–702.
Savica V, Bellinghieri G, Kopple JD. The effect of nutrition on blood pressure. Annu Rev Nutr. 2010;30:365–401.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A et al.. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW et al.. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:2199–269.
Appel LJ. The effects of dietary factors on blood pressure. Cardiol Clin. 2017;35:197–212.
Chiavaroli L, Viguiliouk E, Nishi SK, Blanco Mejia S, Rahelić D, Kahleová H, Salas-Salvadó J, Kendall CW, Sievenpiper JL. DASH dietary pattern and cardiometabolic outcomes: an umbrella review of systematic reviews and meta-analyses. Nutrients. 2019;11:338.
Your Guide to Lowering Blood Pressure With DASH. National Heart, Lung Lung, and Blood Institute. https://scholar.google.com/scholar?q=intitle:National%20Heart%2C%20Lung%2C%20and%20Blood%20Institute.%20Your%20guide%20to%20lowering%20blood%20pressure%20with%20DASH NIH Publication. 2006
Filippou CD, Tsioufis CP, Thomopoulos CG, Mihas CC, Dimitriadis KS, Sotiropoulou LI, et al. Dietary Approaches to Stop Hypertension (DASH) Diet and Blood Pressure Reduction in Adults with and without Hypertension: a Systematic Review and Meta-Analysis of Randomized Controlled Trials. Advances in Nutrition. 2020; 11: 1150–1160.
Filippou CD, Thomopoulos CG, Kouremeti MM, Sotiropoulou LI, Nihoyannopoulos PI, Tousoulis DM, et al. Mediterranean diet and blood pressure reduction in adults with and without hypertension: a systematic review and meta-analysis of randomized controlled trials. Clinical Nutrition. 2021; 40: 3191–3200.
Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. Appel LJ, Champagne CM, Harsha DW, et al. https://scholar.google.com/scholar?q=intitle:Effects%20of%20comprehensive%20lifestyle%20modification%20on%20blood%20pressure%20control%3A%20main%20results%20of%20the%20PREMIER%20clinical%20trial. JAMA. 2003;23:2083–2093. doi: 10.1001/jama.289.16.2083.
Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. Sacks FM, Svetkey LP, Vollmer WM, et al. https://scholar.google.com/scholar?q=intitle:Effects%20on%20blood%20pressure%20of%20reduced%20dietary%20sodium%20and%20the%20Dietary%20Approaches%20to%20Stop%20Hypertension%20%28DASH%29%20diet. N Engl J Med. 2001;4:3–10. doi: 10.1056/NEJM200101043440101.
Hypertension and lifestyle modification: how useful are the guidelines? Nicoll R, Henein MY. https://scholar.google.com/scholar?q=intitle:Hypertension%20and%20lifestyle%20modification%3A%20how%20useful%20are%20the%20guidelines%3F. Br J Gen Pract J R Coll Gen Pract. 2010;60:879–880. doi: 10.3399/bjgp10X544014.
Influence of Dietary Approaches to Stop Hypertension (DASH) diet on blood pressure: a systematic review and meta-analysis on randomized controlled trials. Saneei P, Salehi-Abargouei A, Esmaillzadeh A, Azadbakht L. https://scholar.google.com/scholar?q=intitle:Influence%20of%20Dietary%20Approaches%20to%20Stop%20Hypertension%20%28DASH%29%20diet%20on%20blood%20pressure%3A%20a%20systematic%20review%20and%20meta-analysis%20on%20randomized%20controlled%20trials. Nutr Metab Cardiovasc Dis NMCD. 2014;24:1253–1261. doi: 10.1016/j.numecd.2014.06.008.
.Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Blumenthal JA, Babyak MA, Hinderliter A, et al. https://scholar.google.com/scholar?q=intitle:Effects%20of%20the%20DASH%20diet%20alone%20and%20in%20combination%20with%20exercise%20and%20weight%20loss%20on%20blood%20pressure%20and%20cardiovascular%20biomarkers%20in%20men%20and%20women%20with%20high%20blood%20pressure%3A%20the%20ENCORE%20study. Arch Intern Med. 2010;25:126–135. doi: 10.1001/archinternmed.2009.470.
Variation in the estimated costs of pivotal clinical benefit trials supporting the US approval of new therapeutic agents, 2015-2017: a cross-sectional study. Moore TJ, Heyward J, Anderson G, Alexander GC. https://scholar.google.com/scholar?q=intitle:Variation%20in%20the%20estimated%20costs%20of%20pivotal%20clinical%20benefit%20trials%20supporting%20the%20US%20approval%20of%20new%20therapeutic%20agents%2C%202015-2017%3A%20a%20cross-sectional%20study. BMJ Open. 2020;1:10. doi: 10.1136/bmjopen-2020-038863.
Effects of the Dietary Approach to Stop Hypertension (DASH) diet on cardiovascular risk factors: a systematic review and meta-analysis. Siervo M, Lara J, Chowdhury S, Ashor A, Oggioni C, Mathers JC. https://dx.doi.org/10.1017/S0007114514003341.%20Epub%202014%20Nov%2028.%20PMID:%2025430608. Br J Nutr. 201514;113:1–15. doi: 10.1017/S0007114514003341.
The Dietary Approaches to Stop Hypertension (DASH) diet pattern and incident heart failure. Goyal P, Balkan L, Ringel JB, et al. https://dx.doi.org/10.1016/j.cardfail.2021.01.011.%20PMID:%2033962741%20PMCID:%20PMC8396128. J Card Fail. 2021;27:512–521. doi: 10.1016/j.cardfail.2021.01.011.
Relation of consistency with the dietary approaches to stop hypertension diet and incidence of heart failure in men aged 45 to 79 years. Levitan EB, Wolk A, Mittleman MA. https://dx.doi.org/10.1016/j.amjcard.2009.06.061.%20Epub%202009%20Sep%2025.%20PMID:%2019892061%20PMCID:%20PMC2774905. Am J Cardiol. 200915;104:1416–1420. doi: 10.1016/j.amjcard.2009.06.061.
The DASH diet and sodium reduction improve markers of bone turnover and calcium metabolism in adults. Lin PH, Ginty F, Appel LJ, et al. https://dx.doi.org/10.1093/jn/133.10.3130.%20PMID:%2014519796. J Nutr. 2003;133:3130–3136. doi: 10.1093/jn/133.10.3130.
DASH diet and change in serum uric acid over time. Tang O, Miller ER 3rd, Gelber AC, Choi HK, Appel LJ, Juraschek SP. https://dx.doi.org/10.1007/s10067-017-3613-x.%20Epub%202017%20Mar%2031.%20PMID:%2028361235%20PMCID:%20PMC5821061. Clin Rheumatol. 2017;36:1413–1417. doi: 10.1007/s10067-017-3613-x. [DOI] [PMC free article]
Adherence to the dietary approaches to stop hypertension (DASH) diet in relation to all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective cohort studies. Soltani S, Arablou T, Jayedi A, Salehi-Abargouei A. https://dx.doi.org/10.1186/s12937-020-00554-8.%20PMID:%2032321528%20PMCID:%20PMC7178992. Nutr J. 2020;22:37. doi: 10.1186/s12937-020-00554-8.
DASH eating plan: an eating pattern for diabetes management. Amy P. Campbell. https://scholar.google.com/scholar?q=intitle:DASH%20Eating%20Plan%3A%20An%20Eating%20Pattern%20for%20Diabetes%20Management.%20Spectrum%20Diabetes%20Journal. Spectrum Diabetes J. 2017;30:76–81. doi: 10.2337/ds16-0084.
Your Guide to Lowering Blood Pressure With DASH. National Heart, Lung Lung, and Blood Institute. https://scholar.google.com/scholar?q=intitle:National%20Heart%2C%20Lung%2C%20and%20Blood%20Institute.%20Your%20guide%20to%20lowering%20blood%20pressure%20with%20DASH NIH Publication. 2006
Clifford J, Maloney K, Anderson J, Prior S, Braithwaite D, Sherman B. 2017. Understanding the DASH Diet. Food and Nutrition Series. Health. Fact Sheet No. 9.374.
The DASH diet for high blood pressure: from clinical trial to dinner table. Karanja N, Erlinger TP, Pao-Hwa L, Miller ER 3rd, Bray GA. https://scholar.google.com/scholar?q=intitle:The%20DASH%20Diet%20for%20High%20Blood%20Pressure%3A%20From%20Clinical%20Trial%20to%20Dinner%20Table. Cleve Clin J Med. 2004;71:745–753. doi: 10.3949/ccjm.71.9.745.
Sookrah R, Dhowtal JD, Nagowah SD. 7th International Conference on Information and Communication Technology (IColCT) IEEE; 2019. A DASH Diet Recommendation System for Hypertensive Patients Using Machine Learning; pp. 1–6.
Dietary interventions on blood pressure: the Dietary Approach to Stopping Hypertension (DASH) trials. Champagne CM. https://scholar.google.com/scholar?q=intitle:Dietary%20Interventions%20on%20Blood%20Pressure%3A%20the%20Dietary%20Approach%20to%20Stopping%20Hypertension%20%28DASH%29%20Trials. Nutr Rev. 2006;64:553–556. doi: 10.1111/j.1753-4887.2006.tb00234.x.
Bach-Faig A, Berry EM, Lairon D, Reguant J, Trichopoulou A, Dernini S, et al. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutrition. 2011; 14: 2274–2284.
Willett WC, Sacks F, Trichopoulou A, Drescher G, Ferro-Luzzi A, Helsing E, et al. Mediterranean diet pyramid: a cultural model for healthy eating. The American Journal of Clinical Nutrition. 1995; 61: 1402S–1406S.
Schwingshackl L, Hoffmann G. Mediterranean dietary pattern, inflammation and endothelial function: a systematic review and meta-analysis of intervention trials. Nutrition, Metabolism, and Cardiovascular Diseases. 2014; 24: 929–939.
De Pergola G, D’Alessandro A. Influence of Mediterranean Diet on Blood Pressure. Nutrients. 2018; 10: 1700.
Medina-Remón A, Estruch R, Tresserra-Rimbau A, Vallverdú-Queralt A, Lamuela-Raventos RM. The effect of polyphenol consumption on blood pressure. Mini Reviews in Medicinal Chemistry. 2013; 13: 1137–1149.
Zheng J, Zhou Y, Li S, Zhang P, Zhou T, Xu D, et al. Effects and Mechanisms of Fruit and Vegetable Juices on Cardiovascular Diseases. International Journal of Molecular Sciences. 2017; 18: 555.
Zheng J, Zhou Y, Li S, Zhang P, Zhou T, Xu D, et al. Effects and Mechanisms of Fruit and Vegetable Juices on Cardiovascular Diseases. International Journal of Molecular Sciences. 2017; 18: 555.
Chiva-Blanch G, Arranz S, Lamuela-Raventos RM, Estruch R. Effects of wine, alcohol and polyphenols on cardiovascular disease risk factors: evidences from human studies. Alcohol and Alcoholism. 2013; 48: 270–277.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal. 2018; 39: 3021–3104.
Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal. 2021; 42: 3227–3337.
Keys A. Coronary heart disease in seven countries. Summary. Circulation. 1970; 41: I186–I195.
Davis C, Bryan J, Hodgson J, Murphy K. Definition of the Mediterranean Diet; a Literature Review. Nutrients. 2015; 7: 9139–9153.
Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: meta-analysis. British Medical Journal. 2008; 337: a1344.
Dinu M, Pagliai G, Casini A, Sofi F. Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials. European Journal of Clinical Nutrition. 2018; 72: 30–43.
Ozemek C, Laddu DR, Arena R, Lavie CJ. The role of diet for prevention and management of hypertension. Current Opinion in Cardiology. 2018; 33: 388–393.
Toledo E, Hu FB, Estruch R, Buil-Cosiales P, Corella D, Salas-Salvadó J, et al. Effect of the Mediterranean diet on blood pressure in the PREDIMED trial: results from a randomized controlled trial. BMC Medicine. 2013; 11: 207.
Filippou CD, Thomopoulos CG, Kouremeti MM, Sotiropoulou LI, Nihoyannopoulos PI, Tousoulis DM, et al. Mediterranean diet and blood pressure reduction in adults with and without hypertension: a systematic review and meta-analysis of randomized controlled trials. Clinical Nutrition. 2021; 40: 3191–3200.
Ndanuko RN, Tapsell LC, Charlton KE, Neale EP, Batterham MJ. Dietary Patterns and Blood Pressure in Adults: a Systematic Review and Meta-Analysis of Randomized Controlled Trials. Advances in Nutrition. 2016; 7: 76–89.
Gay HC, Rao SG, Vaccarino V, Ali MK. Effects of Different Dietary Interventions on Blood Pressure: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Hypertension. 2016; 67: 733–739.
Nordmann AJ, Suter-Zimmermann K, Bucher HC, Shai I, Tuttle KR, Estruch R, et al. Meta-Analysis Comparing Mediterranean to Low-Fat Diets for Modification of Cardiovascular Risk Factors. The American Journal of Medicine. 2011; 124: 841–851.e2.
Nissensohn M, Román-Viñas B, Sánchez-Villegas A, Piscopo S, Serra-Majem L. The Effect of the Mediterranean Diet on Hypertension: a Systematic Review and Meta-Analysis. Journal of Nutrition Education and Behavior. 2016; 48: 42–53.e1.
Rees K, Takeda A, Martin N, Ellis L, Wijesekara D, Vepa A, et al. Mediterranean-style diet for the primary and secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews. 2019; 3: CD009825.
Cowell OR, Mistry N, Deighton K, Matu J, Griffiths A, Minihane AM, et al. Effects of a Mediterranean diet on blood pressure: a systematic review and meta-analysis of randomized controlled trials and observational studies. Journal of Hypertension. 2021; 39: 729–739.
Merino J, Guasch-Ferré M, Martínez-González MA, Corella D, Estruch R, Fitó M, et al. Is complying with the recommendations of sodium intake beneficial for health in individuals at high cardiovascular risk? Findings from the PREDIMED study. The American Journal of Clinical Nutrition. 2015; 101: 440–448.
La Verde M, Mulè S, Zappalà G, Privitera G, Maugeri G, Pecora F, et al. Higher adherence to the Mediterranean diet is inversely associated with having hypertension: is low salt intake a mediating factor? International Journal of Food Sciences and Nutrition. 2018; 69: 235–244.
Views:
50
Downloads:
21
Copyright (c) 2025 Konrad Strużek, Agnieszka Kwiatkowska, Ewelina Mączka, Wiktor Tracz, Patrycja Świercz, Kinga Teper, Sandra Khiralla-Gawlik, Aleksandra Anna Strzelecka, Aleksandra Ewa Basak

This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.