To a lesser extent, the Mediterranean (which incorporates the basics of healthy eat- ing but emphasizes consumption of legumes and monoun- saturated fat, avoidance of red meats, and moderate intake of wine) has been effective in reducing BP, as well as improving lipid profile. Recommendation-Specific Supportive Text 1. Weight loss is a core recommendation and should be achieved through a combination of reduced calorie intake and increased physical activity.S6.2-1 The BP-lowering effect of weight loss in patients with elevated BP is con- sistent with the corresponding effect in patients with established hypertension, with an apparent dose re- sponse relationship of about 1 mm Hg per kilogram of weight loss. Achievement and maintenance of weight loss through behavior change are challengingS6.2-64 S6.2-66 but feasible over prolonged periods of follow-up.S6.2-64 For those who do not meet their weight loss goals with nonpharmacological interventions, pharmacotherapy or minimally invasive and bariatric surgical procedures can Surgical procedures tend to be more effective but are usually reserved for those with more severe and intractable obesity because of the fre- quency of complications.S6.2-69 2. The DASH eating plan is the diet best demonstrated to be effective for lowering BP. Because the DASH diet is high in fruits, vegetables, and low-fat dairy products, it pro- vides a means to enhance intake of potassium, calcium, magnesium, and fiber. In hypertensive and nonhyperten- sive adults, the DASH diet has produced overall reduc- tions in SBP of approximately 11 mm Hg and 3 mm Hg, and the diet was especially effective When combined with weight lossS6.2-6 or a reduction in sodium intake,S6.2-5,S6.2-30 the effect size was substantially increased. Most of the clinical trial Table 15. 