Treating malignant hypertension with a low-sodium, low-protein, low-fat diet

BackgroundThe Rice Diet (RD), a low-sodium (<150mg/day), low-protein (20g/day), low-fat (<5g/day), diet was used to treat patients with malignant hypertension (MH) beginning in the 1940s, before any effective anti-hypertensive drugs were available. We retrospectively analyzed a curated cohort of RD patients with MH to assess factors, including dietary adherence, associated with blood pressure (BP) reduction. MethodsFrom 17,487 RD charts, we identified 544 MH patients (baseline systolic BP (SBP) [&ge;]170 mmHg and with concurrent retinal hemorrhage and/or papilledema), excluding those with diabetes, brain tumor, or prior sympathectomy. Outcome data were censored after any 30-day break in consecutive data. Baseline features, BP changes from baseline to Week 4, and adherence (assessed by urinary chloride, UCl) were evaluated using summary statistics, univariate and multivariable analyses. ResultsMost patients participated in the RD program before antihypertensive drugs were available; only 48 (4.2%) received any anti-hypertensive medications in the first month. The cohort (68.9% male) had a median baseline BP of 213/128 mmHg and BMI of 23.6 kg/m2. Median time in the program before censoring was 109 days; median total amount of time in the RD program was 333 days. BP declined significantly within the first week, reaching 179/108 mmHg at Week 4. UCl dropped from 217 to 21 mg/dL by Week 4. Lower UCl, higher baseline BP and female gender, but not retinal hemorrhage and/or papilledema, were associated with greater SBP reduction. ConclusionThe low-sodium, low-fat, low-protein RD effectively lowered BP in patients with MH in four weeks, independent of antihypertensive medications.