Focus group participants highlighted that patients and caregivers strongly valued dietary interventions to lower blood pressure. Although not systematically reviewed in this guideline update, it is generally accepted that comprehensive dietitian-led intervention can positively impact other aspects of cardiovascular health, such as blood lipid and glucose levels, weight loss, and alcohol cessation. However, there may be barriers in obtaining healthy food choices for some patients. Service Members frequently do not get a choice regarding where they are going, what they are doing, or where they will eat in a deployed/training environment. Food sources may vary (e.g., Meals Ready to Eat (MREs), items received in care packages, training area or forward operating base (FOB)/central operating base (COB) dining facilities). Depending on what area of responsibility the Service Member is deployed to/training in, these rations may be high in sodium and fat. These nutritional factors may impact HTN management and necessitate counseling related to diet. As this is a Reviewed, New-replaced recommendation, the Work Group systematically reviewed the relevant evidence identified in the evidence review conducted as part of this guideline update.[89] The Work Group s confidence in the quality of the evidence is low. The body of evidence showed overall modest effect size, although statistically significant, and had some limitations including small size, inadequate allocation concealment and blinding, and inclusion of dietary approach as a part of multidisciplinary intervention in some individual studies. Other considerations regarding this recommendation included patients preferences. The potential benefit of nutritional intervention to improve global cardiovascular health outweighs potential adverse events and burden, which were not found. Thus, the Work Group decided upon a Weak for recommendation. 