[82-88] Other considerations regarding this recommendation included the benefits of improved blood pressure and medication adherence outweighing the potential harms (none identified). Patient values and preferences were somewhat varied. Thus, the Work Group decided upon a Weak for recommendation. More research is needed to evaluate the effectiveness of nurse-led intervention to manage HTN in specific subgroups (e.g., age, ethnicity, comorbidities). Additionally, more research is needed to evaluate the effectiveness of nurse-led intervention, such as evaluating initiation and titration of antihypertensive medications using established protocols. Recommendation 12. We suggest offering registered dietitian-led nutrition interventions as an option for patients with hypertension who are or are not on medication. (Weak for | Reviewed, New-replaced) Discussion Registered dietitian-led nutrition interventions, such as education about low sodium diets, weight loss, and increasing consumption of fresh fruits and vegetables, have been found to result in modest but statistically significant lowering of SBP and DBP in treated and untreated hypertensive individuals.[89] The current recommendation is based on low quality evidence from an SR by Reigel et al. (2018), which included 4,491 patients across 13 studies, in which nutrition-based interventions resulted in lower SBP (MD -2.82 mm Hg) and lower DBP (MD -1.37 mm Hg), as compared with the usual care.[89] However, when studies were grouped based on whether the nutrition intervention was delivered by a registered dietitian versus other practitioners, significant reductions in SBP (MD -3.5 mm Hg) and DBP (MD -1.37 mm Hg) were only seen in the registered dietitian-led nutrition intervention group. In addition, blood pressure reductions were more pronounced with interventions longer than six months. No significant harms were found with nutrition interventions. Focus group participants highlighted that patients and caregivers strongly valued dietary interventions to lower blood pressure. 