A 56-year-old man comes to the office for follow-up of high blood pressure. At his 3 previous visits, systolic blood pressure has been 140-145 mm Hg, and diastolic blood pressure has been 90-96 mm Hg. The patient has no other medical problems and takes no medications. He has smoked 2 or 3 cigarettes daily for 30 years and drinks 1 or 2 glasses of wine nightly. The patient's diet mainly consists of fried foods and meat, with limited intake of fruits and vegetables. There is no family history of diabetes mellitus, coronary artery disease, hyperlipidemia, or hypertension. Blood pressure is 146/97 mm Hg and pulse is 80/min. BMI is 27 kg/m². Physical examination is normal. Which of the following nonpharmacologic interventions is likely to have the greatest impact on this patient's blood pressure?

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11ec25c8_d218_f2d6_bc81_bddd7561e725_MD0003_00 Guidelines define hypertension as systolic blood pressure ≥130 mm Hg and/or diastolic blood pressure ≥80 mm Hg, as confirmed by multiple blood pressure readings. Although most patients with hypertension require pharmacologic therapy, all patients with hypertension should also institute lifestyle interventions to reduce blood pressure. Major interventions include dietary modification, weight loss (for overweight and obese patients), regular aerobic exercise, and limitation of alcohol intake. One of the most effective interventions to treat hypertension is the DASH (Dietary Approaches to Stop Hypertension) diet, which is a combination diet rich in fruits, vegetables, legumes, low-fat dairy products, and low in saturated and total fat. In patients with hypertension, the DASH diet can produce a reduction in systolic blood pressure of approximately 11 mm Hg, with a corresponding reduction in diastolic pressure. Overweight and obese patients should also be counseled on additional dietary and exercise interventions for weight loss, which can further reduce blood pressure. (Choice B) Although regular aerobic exercise consistently reduces blood pressure in hypertensive patients, isometric resistance training has not demonstrated this effect. (Choice C) The base DASH diet generally provides less sodium than many patients with hypertension typically consume; a specific low-sodium version of the DASH diet can further reduce blood pressure. However, blood pressure reduction from sodium restriction alone is variable and generally less than either version of the DASH diet. (Choice D) Smoking cessation should be recommended to all patients to reduce the overall risk of cardiovascular complications. However, the effect of smoking on blood pressure is small and generally inconsistent; discontinuation of this patient's light smoking habit is unlikely to have a significant effect in reducing his blood pressure. Educational objective: In patients with hypertension, the DASH (Dietary Approaches to Stop Hypertension) diet, which is a combination diet rich in fruits, vegetables, legumes, low-fat dairy products, and low in saturated and total fat, can produce a reduction in systolic blood pressure of approximately 11 mm Hg, with a corresponding reduction in diastolic pressure. References: Non-pharmacological aspects of blood pressure management: what are the data? (http://www.ncbi.nlm.nih.gov/pubmed/21389976) Nonpharmacologic therapy for hypertension: does it really work? (http://www.ncbi.nlm.nih.gov/pubmed/17059793) A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. (http://www.ncbi.nlm.nih.gov/pubmed/9099655)

A 56-Year-Old Man Comes to the Office for Follow-Up of High