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Lifestyle modification for hypertension: The benefits of plant-based diets.

Jessica W. Reynolds

School of Nursing, James Madison University

NSG 464: Introduction to Nursing Research

Dr. Nena Powell

April 17th, 2022

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Lifestyle modification for hypertension: The benefits of plant-based diets.

Abstract

Blood pressure readings of 130/80 mmHg or more is considered hypertension, and according to

the CDC (2021), there were approximately 116 million hypertensive adults living in the United

States. This is about one out of every two adults in the country (CDC, 2021). The prevalence of

adults with hypertension burdens the healthcare system of the United States. Lifestyle

modifications and antihypertensive agents remain the cornerstone of treatment. Nurses are the

persuasive force when advocating lifestyle modifications. Dietary suggestions, as a primary

approach for preventing and curing disease, continue to endure as an initial intervention,

especially with hypertension. Research to determine the benefits of a plant-based diet (PBD) on

blood pressure is the subject of inquiry. The proposed intervention is incorporating a diet that is

plant based in structure. For research purposes, PBD included vegan and vegetarian types.

Animal products were used sparingly or not at all within the studied populations unless it was for

comparative purposes. This paper analyzes six research articles that utilize plant-based

modification as an intervention. Conclusions were made based upon data collected throughout

the studies. Blood pressure readings, serum lipid levels, and bacteria populations in stool

samples, were some of the types of evidence measured. The articles under review provide

evidence to support diets that are plant-based will lower blood pressure or have other beneficial

effects on cardiovascular health markers.

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Introduction

Hypertension is prevalent in the United States, affecting approximately 1 out of every 2

citizens (CDC, 2021). Type 2 diabetes mellitus, coronary artery disease, peripheral artery

disease, and myocardial infarctions are more likely to develop in individuals previously

diagnosed with hypertension (McCance & Heuther, 2019). These complications increase the

burden of not just caretakers and families that provide individualized care, but also on national

healthcare systems. The cornerstone of nursing interventions for hypertension is lifestyle

modifications. Hypertensive adults in the United States could benefit from a plant-based diet in

reducing blood pressure. The identified research question asks: what is the effect of a PBD in

hypertensive adults aged 18 years and older, compared to a diet with sodium restrictions?

Analysis and Synthesis

Six research articles were reviewed to determine the effectiveness of a PBD as a lifestyle

modification on blood pressure in adults. Each article reported noteworthy evidence that

contributes to cardiovascular health. Four articles reported significant reductions in blood

pressure. Three articles highlighted cholesterol, and one article provided extensive evidence that

correlates gut health to cardiovascular health with PBDs. The following review will be organized

by weight of significant findings, addressing articles that offer the most evidence first, followed

by considerations of diet quality, and ending with nursing practice implications. Trends of blood

pressure, cholesterol, and microbiome populations will be noted in the following literature

review.

Comparative conclusions could not be estimated within this research review. The

following studies aimed to establish grounds of PBD legitimacy as an intervention, rather than

comparing it to sodium restrictions. PBD as an intervention has not become a standard in care
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but it can be considered a healthy alterative to western diets in promoting cardiovascular health.

More research needs to be conducted to suggest how a PBD should be balanced to properly

promote optimal health conditions for individuals and populations. Furthering research in this

area would allow a comparative analysis to be possible in the future.

Findings

A pilot study conducted by Ahrens et al. (2021) showed PBDs reduced blood pressure in

the participants. Both diastolic and systolic pressures were reduced from baseline data collected

at the start of their research. This study also showed decreased cholesterol levels and BMI

because of the interventions. Impressively, the findings regarding gut microbiome populations

and the connections to cardiovascular health trends, were most remarkable of all data that was

obtained. When subjects were placed on a PBD, population trends of bacteria colonies were

directly correlated with the trends of triglyceride and blood pressure. Stool samples were

collected at the beginning, and throughout the six days of the study, to measure the composition

of bacteria in the fecal matter of each participant. This study identified specific microbe species

and what that bacterium seems to impact in reference to measurable cardiovascular data. An

increase in Akkermansiaceae and Phascolarctobacterium populations were observed in

individuals that had healthy levels of low-density lipoprotein and a low level of high sensitivity

C-reactive protein. These bacteria populations were increased when participants consumed a diet

composed of plants. PBDs cultivate healthy bacteria in gastrointestinal tracts and have multi-

system benefits for the body, especially the cardiovascular system (Ahrens, et al., 2021).

Diet modifications can also be beneficial for health-conscious individuals. A decrease in

blood pressure and cholesterol levels were observed when researching participants who

identified as vegan or vegetarian in a study conducted by Campbell et al. (2019). A PBD

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constructed of whole foods was incorporated with exercise among these participants as the

intervention and the researchers proved that even PBDs have room for improvement. The whole

food plant-based diet, combined with exercise, significantly decreased blood pressure, BMI, and

serum lipid levels among the participants (Campbell et al., 2019).

A comparative study conducted by Mayra & Johnston (2022), did not show significant

changes in blood pressure or cholesterol levels. It did, however, show an improvement in the

condition of arterial walls, especially for the male subjects. Rigidity and stiffness of vessel

structure is a complication of vascular integrity, a known contributor to hypertension. The

sample of 55 individuals, who were mostly women and younger aged, was not representative of

the population. The evidence can be useful in building knowledge for future trials because men,

older age, and postmenopausal women are more at risk of developing atherosclerosis. Further

investigations could shed light on the cardiovascular trends of both men and postmenopausal

women eating a PBD (Mayra & Johnston, 2022).

The quality of food that is consumed is paramount, even for PBDs. Baden et al. (2019)

made this known in their study. Results collected over 12 years showed that a high quality PBD

will lower the chance of developing cardiovascular disease. Just the opposite was observed with

low quality PBDs which showed increased risks of disease (Baden et al., 2019). This concern for

quality of diet was echoed in a study by Anand et al. (2020), which focused on potassium intake

in Indian populations. This study was significant because diets in India are largely based on plant

consumption, but the study revealed that the higher the potassium levels were in urine, the lower

the blood pressure was in the participant. Researchers concluded that more focus should be

placed on potassium levels rather than solely concentrating on sodium levels in diets (Anand et

al., 2020).
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Nursing Practice Implications

In healthcare, prevention of disease is greater than treatment of disease. Nurses play a

critical role in health promotion by understanding associated risks and complications of diseases.

Nurses must understand which interventions are the most applicable and appropriate for clients.

Hypertension will be a frequent condition throughout healthcare systems and implementing the

best strategies are imperative. Continuing to advocate for lifestyle modifications will influence

an individual’s response to disease, therefore, the capability of a nurse to impact individual

health is promising. Some patients will not consider eating only plants in their diet but stressing

patients to consume more fruit and vegetables will promote health. This advice should be given

as if it was a reflex, instead of the usually rehearsed low sodium diet suggestion. If the patient is

fed with a low calorie, nutrient-dense, quality diet, cardiovascular benefits will be observed.

Nurses will continue to advocate for lifestyle modifications to prevent and manage

hypertension and patient teaching will be imperative for instituting necessary changes in dietary

consumption. Some strategies that can be used may include support groups, cooking classes,

videos to reinforce important concepts, or pamphlets to list available resources. In a study

conducted by Barnard et al. (2018), institution of a class to teach patients about proper dietary

consumption has proven to be a successful strategy employed. This success was documented by

a reduction of HbA1c and cholesterol levels in participants suffering from type 2 diabetes

mellitus (Barnard et al., 2018).

Conclusion

The prevalence of hypertension in adults within the United States is alarming. Lifestyle

modification remain as the first line of treatment in promoting the health of hypertensive adults.
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Suggesting that a PBD be established in modifying a lifestyle can be beneficial and studies show

promising results when diets are focused on the consumption of plants. The articles reviewed

present findings that are potentially promising in addressing hypertension. A reduction of blood

pressure, cholesterol, and promotion of healthy gut bacteria by eating a PBD is evidenced

throughout this literature review.

More research is required about PBDs for this suggested intervention to become a staple

in the standard of care. Nevertheless, the information within this review will suggest the

importance of plants in the diets of patients. By utilizing the information supplied in this review,

nurses can stress the importance of plant-derived food sources in their endeavors of promoting

health and preventing comorbidities in their clients. Increasing the nutrient density of food while

using animal products sparingly will promote cardiovascular health, and subsequently, decrease

blood pressure while improving other cardiovascular health markers.

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References

Ahrens, A.P., Culpepper, T., Saldivar, B., Anton, S., Stoll, S.; Handberg, E.M.; Xu, K., Pepine,

C., Triplett, E.W., & Aggarwal, M. (2021). A six-day, lifestyle-based immersion

program

mitigates cardiovascular risk factors and induces shifts in gut microbiota, specifically

lachnospiraceae, ruminococcaceae, faecalibacterium prausnitzii: A pilot study. Nutrients.

13, 3459. https://doi.org/10.3390/nu13103459

Anand, S., Shivashankar, R., Kondal, D., Garg, V., Khandelwal, S., Gupta, R., Krishnan, A.,

Amarchand, R., Poulter, N., Reddy, K. S., Prabhakaran, D., & Mohan, S. (2020).

Potassium intake in India: Opportunity for mitigating risks of high sodium

diets. American Journal of Preventive Medicine, 58(2), 302–

312. https://doi.org/10.1016/j.amepre.2019.09.017

Baden, M. Y., Liu, G., Satija, A., Li, Y., Sun, Q., Fung, T. T., Rimm, E. B., Willett, W. C., Hu,

F. B., & Bhupathiraju, S. N. (2019). Changes in plant-based diet quality and total and

cause-specific mortality. Circulation, 140(12), 979–991.

https://doi.org/10.1161/CIRCULATIONAHA.119.041014

Barnard, N. D., Levin, S. M., Gloede, L., & Flores, R. (2018). Turning the waiting room into a

classroom: Weekly classes using a vegan or a portion-controlled eating plan improve

diabetes control in a randomized translational study. Journal of the Academy of

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Nutrition and Dietetics, 118(6), 1072–1079. https://doi.org/10.1016/j.jand.2017.11.017

Campbell, E. K., Fidahusain, M., & Campbell Ii, T. M. (2019). Evaluation of an eight-week

whole-food plant-based lifestyle modification program. Nutrients, 11(9), 2068.

https://doi.org/10.3390/nu11092068

Centers for Disease Control and Prevention (CDC). Hypertension cascade: Hypertension

prevalence, treatment, and control estimates among US adults aged 18 years and older

applying the criteria from the American College of Cardiology and American Heart

Association’s 2017 hypertension guideline—NHANES 2015–2018. Atlanta, GA: US

Department of Health and Human Services; 2021. CDC Hypertension Prevalence in the

U.S. Million Hearts® Accessed 03.06.2022 via https://millionhearts.hhs.gov

Mayra, S. T., & Johnston, C. S. (2022). Arterial stiffness and cardiometabolic health in

omnivores and vegetarians: a cross-sectional pilot study. BMC research

notes, 15(1), 69. https://doi.org/10.1186/s13104-022-05957-w

McCance, K. L. & Huether, S. E. (2019). Pathophysiology The Biologic Basis for Disease in

Adults and Children, 8th ed. Elsevier.