BP was not significantly different from baseline at the end of the study; however DBP was significantly lower in the HPD compared to the SPD at the end of the study after adjustment for baseline values. It has been shown that partially exchanging carbohydrate with protein may reduce blood pressure [26]. In a meta-analysis it was shown that SBP decreased by 1.76 mmHg (95% CI: 2.33, 1.20) and DBP decreased by 1.15 mmHg (95% CI: 1.59, 0.71) in the HPD compared to the SPD diets [26]. The median energy intake from protein in these trials was 27% TE which is comparable to the 26.6% of total energy ingested from protein in our trial. In the weight stable state, as well as in weight reduction, protein rich diets have a well described effect on both SBP and DBP [16,27e29]. It is not clear why in this study protein and weight loss had no effect on SBP although the fact that subjects had excellent blood pressure control to begin with led to dose reductions in antihypertensive agents and when analysing the data excluding participants who reduced their antihypertensive medication both SBP and DBP were lower in HPD compared to SPD at 12 months