Culinary Medicine as a Key Lever in Hypertension Management

Introduction

Hypertension is the most prevalent and modifiable cardiovascular risk factor, linked to coronary artery disease, heart failure, atrial fibrillation, stroke, dementia, chronic kidney disease, and all-cause mortality. The 2025 American College of Cardiology/American Heart Association guideline update on high blood pressure emphasizes lifestyle strategies to reduce sodium and increase dietary potassium. It reaffirms the DASH (Dietary Approaches to Stop Hypertension) pattern, recommending sodium ≤2300 mg/day and potassium 3500–5000 mg/day, and adds a new recommendation for using potassium-containing salt substitutes in cooking, food preparation, and at the table, supported by moderate-strength evidence.¹ Although randomized trials show these substitutes lower blood pressure, their real-world use among U.S. adults with hypertension is minimal. A recent longitudinal analysis reported that fewer than 6% of adults with hypertension use potassium-based salt substitutes, and use has declined over time.² Likely contributors include limited clinician and patient education and the fact that most U.S. sodium comes from processed and restaurant foods, where substitutes are rarely used due to flavor concerns.² In real-world practice, clinicians managing hypertension must decide how to counsel patients on preparing foods that lower sodium while maintaining adequate potassium. This underscores the need to include education on practical, food-based strategies that help patients adopt and sustain the updated guideline recommendations.

Culinary Medicine: A Behavioral, Culinary, and Education Based FIM Program

Given the strong links between dietary patterns and cardiovascular disease, food-based approaches to management of risk factors, such as hypertension, have quickly expanded in the literature and in healthcare settings³. The incorporation of food-based approaches to disease management is paramount to Food is Medicine (FIM) programs, ‘programs that incorporate the provision of healthy food as a complement or component of clinical care’.³ Culinary medicine (CM), a paradigm within FIM, is an interdisciplinary, multi-faceted field that utilizes an evidence-based approach to combine nutrition science, behavior change strategies, and hands-on cooking skills to help patients translate dietary guidance into everyday eating.^3-5 CM can serve as a stand-alone FIM program or be integrated as adjunctive sessions with FIM programs (i.e. medically tailored meals and groceries). Like other FIM programs, CM has demonstrated improvements in dietary quality across diverse populations^4,5.

CM uniquely uses hands-on instruction to facilitate knowledge transfer, offering a unique opportunity for patients with HTN and CV risk factors to learn in a supportive environment and practice behavior change by emphasizing flavorful, lower-sodium cooking strategies, adaptable approaches like ‘half-scratch’ cooking, and techniques that preserve nutrient value in potassium-rich foods. By integrating education, practical skills, and behavior change principles, CM offers pragmatic implementation. Based on our collective experiences with FIM and CM programs, we offer considerations for future guidelines to include food-based strategies incorporating principles of FIM and CM.

Food-Based Strategies for Hypertension and the Challenges of Potassium Salt Substitutes

The DASH trial demonstrates that optimal dietary management of hypertension requires both increased intake of potassium-rich foods and reduced sodium consumption.¹ However, even in households that cook and follow high-quality diets, lowering sodium remains difficult. Potassium-enriched salt substitutes, which partially replace sodium chloride with potassium salts, can reduce blood pressure, stroke, and cardiovascular events but have important limitations.² Many products vary in concentration of potassium. In the U.S. products are often 50 percent or more potassium which can leave a bitter or metallic aftertaste. Adoption is further constrained by food preferences, cultural patterns, and the fact that most U.S. sodium comes from commercially prepared foods, while trials to date have largely targeted discretionary salt use in non-U.S. settings. Limited clinician and consumer awareness and risk of hyperkalemia in people with impaired kidney function or on potassium-sparing medications further restrict use.²

These challenges underscore the need for pragmatic, behaviorally informed strategies, where CM can play a key role. By integrating nutrition science, medical management, and hands-on cooking, CM helps patients prepare culturally tailored meals aligned with DASH, Mediterranean, and other evidence-based patterns.^4,5 It emphasizes potassium-rich whole foods, such as leafy greens, legumes, squash, root vegetables, and avocados, while reducing sodium through simple, recipe-based strategies (Figure 1). Central is flavor-building: using herbs, spices, citrus, vinegars, and umami-rich ingredients (tomatoes, mushrooms, fermented foods) to create satisfying meals with less salt. Teaching these skills can recalibrate taste preferences, reframe understanding of sodium’s health impacts, and build confidence to modify foods in real time. The same techniques can also improve acceptance of potassium-based salt substitutes by mitigating bitterness (e.g., adding acid or umami), positioning CM as a promising adjunct in salt-substitute interventions.

Figure 1.

Schematic of integration of culinary medicine approaches to Lifestyle Management strategies recommended in the current Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Created in BioRender. Farmer, N. (2026) https://BioRender.com/7ya03kl

Implementation of Culinary Medicine

Reducing sodium intake and increasing potassium-rich foods require population-level strategies.¹ CM can serve as a pathway for implementation within healthcare and communities. For example, CM utilizes flexible instructor–learner models where healthcare and culinary professionals jointly train clinicians, trainees, patients, chefs, and community members, thereby supporting risk-factor reduction and expanding nutrition education across clinical and community settings to advance population health. Interprofessional CM integrated into clinical care supports sustainable billing and patient engagement, delivered via adaptable hands-on and virtual sessions, including reimbursable teaching-kitchen shared medical appointments, eConsults, and physician–dietitian coaching.⁴ Broader impact emerges from embedding CM principles in culinary training and disseminating them widely through culinary professional training and cooking media platforms (Figure 1).

Creative culinary strategies reframe sodium reduction as enjoyable and flavorful, while food-centered social connections can reduce loneliness, mitigate psychosocial stressors, and support better cardiovascular health. CM centrally addresses the social role of food, recognizing that cooking is rooted in culture, community, and human connection. Teaching kitchens, the physical and virtual settings where CM instruction occurs, can build confidence and self-efficacy, helping individuals sustain new habits grounded in group-based classes and shared food preparation that foster peer support, motivation, and long-term adherence, ultimately providing social and behavioral pathways for implementation of food-based strategies.

Conclusion

By prioritizing deliciousness, practical skills, education, and social connection, culinary medicine makes FIM a sustainable, clinically billable, empowering way to implement guideline-based nutrition for hypertension, while its integration into medical education and community programs builds the interprofessional workforce needed to scale food-based strategies for hypertension.