The U.S. Food and Drug Administration (FDA) has solicited comments on, but has not yet released, voluntary sodium reduction targets for food manufacturers and restaurants. Patients desire and ability to reduce sodium intake may vary; some may find low sodium diets unpalatable, and others, such as deployed military, may have limited access to fresh/unprocessed foods. Referral to a dietitian can help interested patients incorporate this recommendation into the broader context of a healthful diet. Per the patient focus group, inclusion of spouses/caregivers in nutrition interventions may provide additional benefit, as they may be responsible for household food shopping and/or preparation. Recommendation 22. In patients with additional cardiovascular risk factors, such as dyslipidemia, we suggest considering a dietitian-led Mediterranean Diet as an alternative to the Dietary Approaches to Stop Hypertension Diet. (Weak for | Not Reviewed, Not Changed) Discussion Epidemiologic data has long suggested a cardio-protective effect of a Mediterranean-style diet. Despite known variation in the cuisine of Mediterranean countries, certain characteristic features are commonly used to describe a traditional Mediterranean diet: high intake of vegetables, fruits, nuts, unrefined grains, and olive oil; moderate intake of fish and poultry; low or moderate intake of wine; and low intake of red meat, processed meat, dairy, and sweets. New evidence was not reviewed as part of the current CPG update. Evidence reviewed during the 2014 VA/DoD HTN CPG update is summarized below. Toledo et al. evaluated the effects of a Mediterranean diet on blood pressure in the PREDIMED (PREvenci n con DIeta MEDiterr nea) trial in Spain, which included a large cohort of men and women at high cardiovascular risk.[132] The two intervention groups received individual and group education on an energy-unrestricted Mediterranean diet from registered dietitians, as well as regular supplies of either extra-virgin olive oil or mixed nuts. 