Systematic Review| Volume 48, ISSUE 1, P42-53.e1, January 2016

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The Effect of the Mediterranean Diet on Hypertension: A Systematic Review and Meta-Analysis

  • Mariela Nissensohn
    Research Institute of Biomedical and Health Sciences, Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain

    Ciber Obn Physiopathology of Obesity and Nutrition, Institute of Health “Carlos III”, Madrid, Spain
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  • Blanca Román-Viñas
    Ciber Obn Physiopathology of Obesity and Nutrition, Institute of Health “Carlos III”, Madrid, Spain

    Nutrition Research Foundation, Barcelona, Spain

    Sports Sciences Department, Faculty of Psychology, Education Sciences and Sport Blanquerna, Ramon Llull University, Barcelona, Spain
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  • Almudena Sánchez-Villegas
    Research Institute of Biomedical and Health Sciences, Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain

    Ciber Obn Physiopathology of Obesity and Nutrition, Institute of Health “Carlos III”, Madrid, Spain
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  • Suzanne Piscopo
    Nutrition, Family, and Consumer Studies, Department of Mathematics, Science, and Technical Education, Faculty of Education, University of Malta, Msida, Malta
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  • Lluis Serra-Majem
    Address for correspondence: Lluis Serra-Majem, MD, PhD, Research Institute of Biomedical and Health Sciences, Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain; Phone: (+34) 928453477; Fax: (+34) 928451416
    Research Institute of Biomedical and Health Sciences, Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain

    Ciber Obn Physiopathology of Obesity and Nutrition, Institute of Health “Carlos III”, Madrid, Spain
    Search for articles by this author
Published:October 15, 2015DOI:



      The adoption of a Mediterranean diet (MD) pattern of eating is often described as a strategy to help prevent or manage hypertension. However, this dietary regimen has not been reviewed systematically for its efficacy against hypertension. Therefore, the purpose of this study was to analyze the effect of interventions of at least 1 year duration on blood pressure (BP) values through a systematic review and meta-analysis. The focus was on interventions comparing an MD with a low-fat diet.


      The authors accessed and searched PubMed and Scopus databases up to March, 2015. Randomized control trials comparing MD vs low-fat diet were included. The researchers assessed the methodological quality, extracted the valid data, and conducted the meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.


      Six trials (more than 7,000 individuals) were identified. Meta-analysis showed that interventions aiming at adopting an MD pattern for at least 1 year reduced both the systolic BP and diastolic BP levels in individuals with normal BP or mild hypertension. The effect was higher for the systolic BP (–1.44 mm Hg) but also consistent for the diastolic BP (–0.70 mm Hg). However, the results have to be interpreted with caution owing to the reduced number of studies eligible for inclusion in this meta-analysis. This situation limited the statistical power of the analyses. Furthermore, in all analyses, the pooled effect estimation showed a high evidence of heterogeneity, which compromises the validity of the pooled estimates.

      Conclusions and Implications

      A positive and significant association was found between the MD and BP in adults. However, in all cases the magnitude of the effect was small. Based on this limited group of studies and their heterogeneity, the authors found insufficient convincing evidence to suggest that the MD decreased BP. Further standardized research is urgently needed to reach evidence-based conclusions to clarify the role of MD in BP management, particularly in Europe and other societies where prevalence of cardiovascular diseases is increasing.

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      Linked Article

      • National Heart Health Month
        Journal of Nutrition Education and BehaviorVol. 51Issue 2
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          I realize that all of JNEB's readership knows that February is National Heart Healthmonth. Most of us have taught programs on lower saturated fat, lower sodium, or higher fruit and vegetable eating patterns. In 2015, JNEB published a systematic review and meta-analysis on the effects of the Mediterranean Diet on hypertension, reporting that a positive, significant effect was found between the Mediterranean Diet and blood pressure although the effect was small.1 At that time only 6 trials were available.
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