Influence of dietary modifications on the blood pressure response to antihypertensive medication.

Identifying dietary modifications that potentiate the blood pressure (BP)-lowering effects of antihypertensive medications and that are practical for free-living people may assist in achieving BP reduction goals. We assessed whether two dietary patterns were effective in lowering BP in persons on antihypertensive therapy and in those not on therapy. Ninety-four participants (38/56 females/males), aged 55·6 (SD 9·9) years, consumed two 4-week dietary regimens in random order (Dietary Approaches to Stop Hypertension (DASH)-type diet and low- Na high-K (LNAHK) diet) with a control diet before each phase. Seated home BP was measured daily for the last 2 weeks in each phase. Participants were grouped based on antihypertensive drug therapy. The LNAHK diet produced a greater fall in systolic BP (SBP) in those on antihypertensive therapy (-6·2 (SD 6·0) mmHg) than in those not on antihypertensive therapy (-2·8 (SD 4·0) mmHg) (P = 0·036), and this was greatest for those on renin-angiotensin system (RAS) blocker therapy (-9·5 (SD 6·4) mmHg) (interaction P = 0·007). The fall in SBP on the DASH-type diet, in those on therapy (overall -1·1 (SD 6·2) mmHg; renin-angiotensin blocker therapy -4·2 (SD 4·7) mmHg), was not as marked as that observed on the LNAHK diet. Dietary modifications are an important part of all hypertension management regimens, and a low-Na and high-K diet enhances the BP-lowering effect of antihypertensive medications, particularly those targeting the RAS.