Treating Malignant Hypertension With the Low-Sodium, Low-Protein, and Low-Fat Rice Diet.

BACKGROUND: The rice diet (RD), a low-sodium (<200 mg/d), low-protein (≈20 g/d), and low-fat (<5 g/d) diet was used to treat patients with malignant hypertension beginning in the 1940s, before any effective antihypertensive drugs were available. We retrospectively analyzed a curated cohort of RD patients with malignant hypertension to assess factors, including dietary adherence, associated with blood pressure (BP) reduction. METHODS: From 17 487 RD charts, we identified 544 malignant hypertension patients (baseline systolic BP ≥170 mm Hg and with concurrent retinal hemorrhage or papilledema), excluding those with diabetes, brain tumor, or prior sympathectomy. Outcome data were censored after any 30-day break in consecutive data. Baseline features, BP changes from baseline to week 4, and diet adherence (assessed by urinary chloride, UCl) were evaluated using summary statistics, univariate, and multivariable analyses. RESULTS: Most patients participated in the RD program before antihypertensive drugs were available; only 48 (8.8%) received any antihypertensive medications in the first month. The cohort (68.9% male) had a median baseline BP of 213/128 mm Hg and body mass index of 23.6 kg/m2. Median time in the program before censoring was 109 days; median total time in the RD program was 333 days. BP declined significantly within the first week, reaching 179/108 mm Hg at week 4. UCl dropped from 217 to 21 mg/dL by week 4. Lower UCl, higher baseline BP, and female sex, but not retinal hemorrhage or papilledema, were associated with greater systolic BP reduction. CONCLUSIONS: The low-sodium, low-fat, low-protein RD effectively lowered BP in malignant hypertension patients in 4 weeks, independent of antihypertensive medications.