According to several international, regional, and national guidelines on hypertension, lifestyle interventions are the first-line treatment to lower blood pressure (BP). Although diet is one of the major lifestyle modifications described in hypertension guidelines, dietary fiber is not specified. Suboptimal intake of foods high in fiber, such as in Westernized diets, is a major contributing factor to mortality and morbidity of noncommunicable diseases due to higher BP and cardiovascular disease. In this review, we address this deficiency by examining and advocating for the incorporation of dietary fiber as a key lifestyle modification to manage elevated BP. We explain what dietary fiber is, review the existing literature that supports its use to lower BP and prevent cardiovascular disease, describe the mechanisms involved, propose evidence-based target levels of fiber intake, provide examples of how patients can achieve the recommended targets, and discuss outstanding questions in the field. According to the evidence reviewed here, the minimum daily dietary fiber for adults with hypertension should be >28 g/day for women and >38 g/day for men, with each extra 5 g/day estimated to reduce systolic BP by 2.8 mm Hg and diastolic BP by 2.1 mm Hg. This would support a healthy gut microbiota and the production of gut microbiota-derived metabolites called short-chain fatty acids that lower BP. Awareness about dietary fiber targets and how to achieve them will guide medical teams on better educating patients and empowering them to increase their fiber intake and, as a result, lower their BP and cardiovascular disease risk.

中文翻译：

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使用膳食纤维改善血压控制的建议

根据多项国际、地区和国家高血压指南，生活方式干预是降低血压 (BP) 的一线治疗方法。尽管饮食是高血压指南中描述的主要生活方式改变之一，但膳食纤维并未具体说明。高纤维食物（例如西化饮食）的摄入量不理想，是导致高血压和心血管疾病导致的非传染性疾病死亡率和发病率的一个主要因素。在这篇综述中，我们通过检查和倡导将膳食纤维作为控制血压升高的关键生活方式改变来解决这一缺陷。我们解释什么是膳食纤维，回顾支持其用于降低血压和预防心血管疾病的现有文献，描述所涉及的机制，提出基于证据的纤维摄入目标水平，提供患者如何实现推荐目标的示例，以及讨论该领域的突出问题。根据此处审查的证据，成人高血压患者的每日最低膳食纤维含量应为女性 >28 克/天，男性 >38 克/天，预计每增加 5 克/天，收缩压可降低 2.8 毫米汞柱舒张压降低 2.1 毫米汞柱。这将支持健康的肠道微生物群以及肠道微生物群衍生的代谢物（称为短链脂肪酸）的产生，从而降低血压。对膳食纤维目标以及如何实现这些目标的认识将指导医疗团队更好地教育患者，并帮助他们增加纤维摄入量，从而降低血压和心血管疾病的风险。