Substituting carbohydrates with protein and monosaturated fats can further lower blood pressure, improve lipid levels and reduce cardiovascular risk.

In the mid-1990s researchers presented what is now considered a "gold standard" of dietary recommendations for reducing high blood pressure and "bad" LDL cholesterol. The Dietary Approaches to Stop Hypertension (DASH) diet found that a carbohydrate-rich diet emphasizing fruits, vegetables and low-fat dairy products were beneficial. Reduced saturated fat, total fat, and cholesterol substantially reduced blood pressure and "bad" LDL cholesterol. However, the diet also lowered "good" HDL cholesterol and had no effect on triglycerides, both of which are associated with an increased cardiovascular disease risk.

Ten years into the program, it has been discovered that heart attack risk was lowest for people following a diet emphasizing protein and unsaturated fat as opposed to the original DASH diet which emphasized carbohydrates.

"Reducing cardiovascular risk is imperative to leading a healthy lifestyle and while the DASH low-sodium diet remains a hallmark to prevent and treat hypertension, there are additional growing cardiovascular health risks that we need to address," said Frank M. Sachs, MD, Professor of Medicine Harvard Medical School. "The new recommendations, which include substituting some carbohydrates with protein and fats, can help dramatically reduce the risk factors associated with cardiovascular disease and heart attack."

It's easy to adopt the DASH eating plan. Here are some ways to get started:

Change gradually.

• If you now eat one or two vegetables a day, add a serving at lunch and another at dinner.
  

• If you don't eat fruit now or have only juice at breakfast, add a serving to your meals or have it as a snack.
  

• Gradually increase your use of fat free and lowfat dairy products to three servings a day. For example, drink milk with lunch or dinner instead of drinking soda, sugar-sweetened tea, or alcohol.
  

• Choose lowfat (1 percent) or fat free (skim) dairy products to reduce your intake of saturated fat, total fat, cholesterol, and calories.
  

• Read food labels on margarines and salad dressings to choose those lowest in saturated fat and transfat. Some margarines are now transfat free.
  
  

Treat meat as one part of the whole meal, instead of the focus.

• Limit meat to 6 ounces a day (2 servings)—all that's needed. Three to four ounces is about the size of a deck of cards.
  

• If you now eat large portions of meat, cut them back gradually—by a half or a third at each meal.
  

• Include two or more vegetarian-style (meatless) meals each week.
  

• Increase servings of vegetables, rice, pasta, and dry beans in meals. Try casseroles, pasta, and stir-fry dishes which have less meat and more vegetables, grains, and dry beans.
  

Use fruits or other foods low in saturated fat, cholesterol and calories as desserts and snacks.

• Fruits and other lowfat foods offer great taste and variety. Use fruits canned in their own juice. Fresh fruits require little or no preparation. Dried fruits are a good choice to carry with you or to have ready in the car.
  

• Try these snack ideas: unsalted pretzels or nuts mixed with raisins; graham crackers; lowfat and fat free yogurt and frozen yogurt; popcorn with no salt or butter added; and raw vegetables.
  

Try these other tips:

• Choose whole grain foods to get added nutrients, such as minerals and fiber. For example, choose whole wheat bread or whole grain cereals.
  

• If you have trouble digesting dairy products, try taking lactase enzyme pills or drops (available at drugstores and groceries) with the dairy foods. Or, buy lactose-free milk or milk with lactase enzyme added to it.
  

• Use fresh, frozen, or no-salt-added canned vegetables.