Posted on 05/12/2026 4:54:14 PM PDT by ProtectOurFreedom
Abstract
Dietary interventions are the first-line treatment for overweight individuals (OW) and individuals with obesity (OB) who have high-normal blood pressure (BP) or grade I hypertension, particularly when they are at low-to-moderate cardiovascular risk (CVR). However, current guidelines do not specify the most effective dietary approach for optimising cardiovascular and metabolic outcomes in this population.
This study aimed to compare the effects of a low-calorie, high-protein ketogenic diet (KD) versus a low-calorie, low-sodium, and high-potassium Mediterranean diet (MD) on BP profiles assessed via ambulatory BP monitoring (ABPM). It also evaluated changes in anthropometric measures, metabolic biomarkers, and body composition measured by bioelectrical impedance analysis (BIA).
Methods: This prospective observational bicentric pilot study included 26 non-diabetic adult outpatients with central OW or OB (body mass index, BMI > 27 kg/m²) and high-normal BP (≥130/85 mmHg) or grade I hypertension (140–160/90–100 mmHg), based on office BP measurements. All participants had low-to-moderate CVR according to the SCORE2 risk estimation tool. They were assigned to either the KD group (n = 15) or the MD group (n = 11). Comprehensive blood analysis, BIA, and ABPM were performed at baseline and after three months of intervention.
Results: At baseline, no significant differences were observed between the two groups. After three months, both diets led to substantial reductions in body weight (KD: 98.6 ± 13.0 to 87.3 ± 13.4 kg; MD: 93.8 ± 17.7 to 86.1 ± 19.3 kg, p < 0.001) and waist circumference. Mean 24-hour systolic BP (SBP) and diastolic BP (DBP) declined significantly in both groups (24 h SBP: 125.0 ± 11.3 to 116.1 ± 8.5 mmHg, p = 0.003; 24 h DBP: 79.0 ± 8.4 to 73.7 ± 6.4 mmHg, p < 0.001). Fat-free mass (FFM) increased, while fat mass (FM), blood lipid levels, and insulin concentrations decreased significantly. Improvements in ambulatory BP were correlated with the change in FM relative to FFM (ΔFM/ΔFFM). No significant between-group differences were detected at follow-up.
Conclusions: Both the KD and the MD effectively promoted weight loss, improved body composition, and enhanced bio-anthropometric and cardiovascular parameters in individuals with overweight or obesity and elevated BP. Although larger studies are needed to explore potential long-term differences, these findings indicate that the two popular dietary approaches confer comparable metabolic and cardiovascular benefits. The results highlight the central importance of weight loss and fat mass reduction, regardless of the specific dietary pattern chosen.
NOTE: A "bicentric pilot study" is a small, early-stage research project testing an idea at two different centers to see if it’s promising and practical enough to justify a bigger study later.
You can access the SCORE2 risk estimation tool here:
1. HeartScore by the European Society of Cardiology (ESC)
This is the official interactive tool using the latest SCORE2 algorithm. It calculates the 10-year risk of fatal and non-fatal cardiovascular events. Best option.
2. MDCalc. (very easy to use)
3. U-Prevent
Additional Notes:
• SCORE2 is designed for Europe and requires selecting the correct risk region (low, moderate, high, or very high).
• It is intended for people aged 40–69 years without previous cardiovascular disease or diabetes.
• There are also versions for older adults (SCORE2-OP) and people with diabetes (SCORE2-Diabetes).
Recommendation: Start with the official HeartScore tool or use MDCalc for a quick calculation. Both are free to use.
"Designed for Europe" means the SCORE2 risk estimation tool was statistically developed and calibrated using large European population datasets. This makes its predictions more accurate for European countries by reflecting the actual cardiovascular disease rates observed there.
Why does that matter? Cardiovascular disease rates differ between regions because of:
• Genetics
• Diet and lifestyle patterns (e.g., Mediterranean diet in Southern Europe)
• Smoking rates and physical activity levels
• Healthcare systems and treatment of risk factors
• Socioeconomic and environmental factors
Because of these differences, the same set of risk factors (age, sex, blood pressure, cholesterol, smoking) can translate into different actual risks depending on where you live.
How SCORE2 handles regional differences
The tool divides Europe into four risk regions (low, moderate, high, and very high). For identical risk factors, a person in a high-risk region (e.g., Eastern Europe) will receive a higher predicted risk than someone in a low-risk region (e.g., Spain or Italy).
The United States uses its own calibrated tools (such as the ASCVD Pooled Cohort Equations or the PREVENT calculator), which are based on American data. Using a European tool on an American (or vice versa) can lead to over- or under-estimation of true risk.
Bottom line: “Designed for Europe” simply means the calculator is fine-tuned to European population data for better accuracy in that context. It is not because people are fundamentally different, but because populations have different average disease patterns and lifestyles.
U.S. and European cardiovascular risk tools often deliver noticeably different results for the same person. Real-world evidence shows clear differences:
• In multiple studies, SCORE2 (European) frequently classifies more people into higher risk categories compared to US tools.
• The older US Pooled Cohort Equations (PCE / ASCVD calculator) often estimates higher risk than newer tools.
• The newer US PREVENT calculator usually gives the lowest risk estimates among the three.
Examples from studies:
• SCORE2 often puts more patients into “high/very high risk” than ASCVD/PCE, sometimes doubling the proportion classified as high risk.
• PREVENT reclassifies many people downward compared to the older PCE — sometimes moving 38% of people from above 5% risk to below 5%.
Why the differences occur:
• Different source populations (European vs. American cohorts)
• Different endpoints (SCORE2 focuses on fatal + non-fatal heart attack/stroke; PREVENT includes heart failure too)
• Different risk factor weighting and regional calibration
• Updates over time (newer tools like PREVENT tend to predict lower risks than older ones because actual heart disease rates have declined)
Bottom line: The same individual can easily get a 10-year risk of 3% on one calculator and 7% on another. This is why doctors are advised to use the tool calibrated for their region (SCORE2 in Europe, PREVENT or PCE in the US) and not mix them freely. Clinical judgment, additional tests (like coronary calcium scoring), and shared decision-making remain important when results are borderline.
The results of this Keto vs Mediterranean diet study are largely applicable to the USA.
• The core findings are physiological: both diets produced similar weight loss, fat mass reduction, blood pressure improvement, and metabolic benefits over 3 months. These biological responses (calorie deficit → weight/fat loss → lower BP and better metabolism) occur in humans regardless of continent.
• The participants had typical Western profiles: overweight/obese adults with high-normal or Grade 1 hypertension and low-to-moderate cardiovascular risk — a very common group in the United States.
• Both ketogenic and Mediterranean-style diets are widely studied and used in the US. Many American trials show similar short-term benefits for both approaches.
Important limitations / caveats for US readers:
• The study used SCORE2 (European risk calculator). A US patient with identical risk factors might get a different risk percentage on the American PREVENT or ASCVD calculator.
• The Mediterranean diet in the study was specifically low-sodium, high-potassium — which aligns well with US DASH-style recommendations.
• The ketogenic diet was low-calorie and high-protein (not the classic very-high-fat version), making it more comparable to US versions.
• It was a small Italian pilot study (n=26, only 3 months). Results may vary with larger, longer US-based trials that include more diverse ethnic backgrounds (African American, Hispanic, Asian populations), where average responses can differ slightly.
Bottom line:
You can reasonably apply the main message to the USA. Both a well-formulated low-calorie Keto diet and a low-calorie Mediterranean diet can be effective for weight loss and blood pressure reduction in overweight/obese people with mildly elevated BP. The key driver appears to be weight and fat loss, not the specific diet type.
Seems to me the common factor here is “low-calorie.”
Stop putting too much stuff in your mouth and good things will happen.
a ‘larger’ study is required
No,no,no. Not another diet. I wanna pill so I can still eat Little Debbie’s, and Twinkies.
I lost 40lbs and keep it off with the “paleo” diet. Lots of fish and veggies and eggs. I can’t digest mammalian meat so it is a challenge but not too bad. If I had to pick a “diet” I’m going with the Mediterranean diet. I love that food.
I’m starting to wonder why they just don’t pay big pharma to put the Ozempic stuff directly into the lunchables type crappola the kids eat nowadays.
FReegards
Retatrutide will be the Fountain Of Youth!
Which one is better for hypertension ?
What a name! “retatrutide”
Makes me think of “attitude” and “react” and “Tetris” an “beatitude” all rolled into one.
Good to know.
I’ve tried both and keto is just easier.
For me, the Med Diet is just a pain, too much prep.
Too many ingredients.
But whatever works well is the best plan for you.
Hand to mouth disease.
intermittent fasting doesn't work, unless it also incorporates, "low calorie".
Bookmark
You’re a genius!! Thank of it, Ozempic infused Twinkies. You’re advertising management material.
Drop as much sugar as you can, substitute good for bad carbs and get moving.
Drunk Bama fan saying ROLL TIDE
Bump for later
Cooking is my time to unwind so I don’t mind the prep work for Med food. After a long day at the shop I put in a long evening of cooking. Very fun for me. And Med food doesn’t have to be too complicated. Some orzo, basil, garlic, an onion, and a can of tomatoes works wonders. I gotta figure out saganaki though. When I was vacationing on Crete this restaurant made me the most amazing octopus cheese saganaki stew similar to ciopino. I probably put on 15 lbs on that trip.
I weigh 112 and don;t have a plan. Too much prep would make me seriously crazy. I’ve always hated to cook. Never hungry, only need a late breakfast and . even later dinner. 7:45 here just thinking about dinner. Alaskan Salmon, organic veggies, organic potatoes steamed. Yogurt for dessert, several flavors in the fridge.
Easy and I like all that stuff.
I’ve greatly simplified my diet the past 6 months. Basic whole foods. No fast food. Cut up a lot of veggies to make salads. Simple BBQ’d beef; baked keto chicken casseroles; McCann’s Irish oats prepared overnight; lots of berries on the oatmeal; lots of fresh fruit apples, pears, plums and bananas; protein powder/ Eggs. Some keto non-grain granolas.
I found the simplicity and repeatability really help.
I found a woman on YouTube a couple days ago goes by “Love Sweat Fitness” and she made a video “The ONLY 10 groceries you need to lose weight (this is all I buy)” a couple months ago. It’s very similar to what I’ve been buying and she stresses simplicity and repeatability, too.
https://www.youtube.com/watch?v=UrCmsQawxUE
Dr. Johnny Hadac on YouTube has lots of great recipes, too.
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