Also, make sure that her doctors review medications for drivers. Some meds lead to weight gain (several psych meds, anti-seizure meds, corticosteroids). They should also consider causes of “secondary hypertension” such as sleep apnea, cushing syndrome, renal artery stenosis.

Essential hypertension is mostly due to insulin resistance. The current medical establishment dietary recommendation focuses on reduction in salt. This is important for a subset of patient. I think reduction in sugar and specifically fructose is more potent for blood pressure reduction. Broadly speaking (long term), lifestyle adjustments that lead to loss of adipose tissue (fat) and/or additional of muscle mass will help. Maintaining high protein intake is probably the most important dietary target for maintaining muscle mass. Beyond that whatever strategy leads to a calorie deficit will help. I don’t like the advice to eat less and move more because I don’t think that we exercise conscious control over these variables, like we think. When one strategy fails, add one or try something different. Whatever dietary adjustments are helpful for achieving calorie reduction is highly individual. A reduction in refined carbohydrate intake works for many (there’s little to no nutritional value in these foods). For individuals who don’t look particularly overweight, but who have increased fat tissue between the organs in the abdomen (visceral fat) increasing muscle mass through resistance training is really helpful (for those that can achieve it). Cate Shannahan makes a compelling case for cutting out seed oils. Her book Dark Calories and Deep nutrition got me to stop eating chips and french fries. These seed oils hidden in all processed foods lead to metabolic changes that shift toward increased adipose tissue. Increase fiber intake (from real foods) and/or protein to fill the gap. She may need to focus on eating high protein, whole vegetables and still need to count calories to achieve a calorie deficit. She may find a ketogenic diet sustainable and still need to count calories to achieve a calorie deficit.