Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet

Sacks, Frank M.; Svetkey, Laura P.; Vollmer, William M.; Appel, Lawrence J.; Bray, George A.; Harsha, David W.; Obarzanek, Eva; Conlin, Paul R.; Miller, Edgar R.; Simons‐Morton, Denise G.; Karanja, Njeri; Lin, Pao‐Hwa

doi:10.1056/nejm200101043440101

Cited by 4,749 publications

(3,218 citation statements)

References 33 publications

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“…It is known that the DASH diet effectively lowers blood pressure 43. In line with this, we found significant cross‐sectional inverse associations of DASH score with systolic blood pressure, diastolic blood pressure, and mean arterial pressure.…”

Section: Discussionsupporting

confidence: 88%

Dietary Approach to Stop Hypertension (DASH) diet and risk of renal function decline and all-cause mortality in renal transplant recipients

Osté

Gomes-Neto

Corpeleijn

et al. 2018

American Journal of Transplantation

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Renal transplant recipients (RTR) are at risk of decline of graft function and premature mortality, with high blood pressure as an important risk factor for both. To study the association of the Dietary Approach to Stop Hypertension (DASH) diet with these adverse events, we conducted a prospective cohort study of adult RTR. Dietary data were collected using a validated 177‐item food frequency questionnaire and an overall DASH‐score was obtained. We included 632 stable RTR (mean ± standard deviation age 53.0 ± 12.7 years, 57% men). Mean DASH score was 23.8 ± 4.7. During median follow‐up of 5.3 (interquartile range, 4.1‐6.0) years, 119 (18.8%) RTR had renal function decline, defined as a combined endpoint of doubling of serum creatinine and death‐censored graft failure, and 128 (20.3%) died. In Cox‐regression analyses, RTR in the highest tertile of the DASH score had lower risk of both renal function decline (hazard ratio [HR] = 0.57; 95% confidence interval [CI], 0.33‐0.96, P = .03) and all‐cause mortality (HR = 0.52; 95%CI, 0.32‐0.83, P = .006) compared to the lowest tertile, independent of potential confounders. Adherence to a DASH‐style diet is associated with lower risk of both renal function decline and all‐cause mortality. These results suggest that a healthful diet might benefit long‐term outcome in RTR.

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Section: Discussionsupporting

confidence: 88%

Dietary Approach to Stop Hypertension (DASH) diet and risk of renal function decline and all-cause mortality in renal transplant recipients

Osté

Gomes-Neto

Corpeleijn

et al. 2018

American Journal of Transplantation

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“…Most of these risk factors are more common among blacks compared with whites. Also, higher levels of physical fitness and adherence to DASH diet have been associated with reductions in BP and lower risk for hypertension among blacks and whites 30, 31. In the JHS (Jackson Heart Study), a cohort comprised exclusively of blacks, higher BMI and physical inactivity and a less heart healthy diet were all modifiable health behaviors associated with an increased risk for incident hypertension 32.…”

Section: Discussionmentioning

confidence: 99%

Cumulative Incidence of Hypertension by 55 Years of Age in Blacks and Whites: The CARDIA Study

Thomas

Booth

Dai

et al. 2018

JAHA

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BackgroundBlacks have higher blood pressure levels compared with whites beginning in childhood. Few data are available on racial differences in the incidence of hypertension from young adulthood through middle age.Methods and ResultsWe calculated the cumulative incidence of hypertension from age 18 to 55 years among participants in the CARDIA (Coronary Artery Risk Development in Young Adults) study. Incident hypertension was defined by the first visit with mean systolic blood pressure ≥130 mm Hg, mean diastolic blood pressure ≥80 mm Hg, or self‐reported use of antihypertensive medication. Among 3890 participants without hypertension at baseline (aged 18–30 years), cumulative incidence of hypertension by age 55 years was 75.5%, 75.7%, 54.5%, and 40.0% in black men, black women, white men, and white women, respectively. Among participants with systolic blood pressure/diastolic blood pressure <110 and 70, 110 to 119/70 to 74, and 120 to 129/75 to 79 mm Hg at baseline, blacks were more likely than whites to develop hypertension: multivariable‐adjusted hazard ratios 1.97 (95% confidence interval, 1.65, 2.35), 1.80 (95% confidence interval, 1.52, 2.14), and 1.59 (95% confidence interval, 1.31, 1.93), respectively. Parental history of hypertension and higher body mass index, serum uric acid, and systolic blood pressure/diastolic blood pressure categories were associated with a higher risk for hypertension among blacks and whites. A higher Dietary Approaches to Stop Hypertension diet adherence score was associated with a lower risk for hypertension in blacks and whites.ConclusionsRegardless of blood pressure level in young adulthood, blacks have a substantially higher risk for hypertension compared with whites through 55 years of age.

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“…Most previous studies have targeted individuals at high risk of disease as ‘at risk’ individuals are more motivated than the general population; other studies have had a small sample size or non-representative sample [40–43]. Instead of overall health promotion, most of the studies to date have focused on single outcome such as reducing weight, blood pressure or cancer prevention [40,44,45]. Some trials have provided incentives to the participants in the form of provision of diets free of cost, while others made fruits and vegetables available at low cost in the study area [44,45].…”

Section: Discussionmentioning

confidence: 99%

“…Instead of overall health promotion, most of the studies to date have focused on single outcome such as reducing weight, blood pressure or cancer prevention [40,44,45]. Some trials have provided incentives to the participants in the form of provision of diets free of cost, while others made fruits and vegetables available at low cost in the study area [44,45]. In some trials, the control group did not receive any intervention which raises questions about study validity [41,46,47].…”

Section: Discussionmentioning

confidence: 99%

“…In some trials, the control group did not receive any intervention which raises questions about study validity [41,46,47]. The majority of the identified interventions had no theoretical basis, and most of them used traditional methods of education such as individual/group counseling or printed material, and most did not achieve a significant change in dietary behaviour [40–45,48]. Whilst a few studies have reported change in one or another dietary behaviour using information technology tools most had one of the methodological flaws mentioned above [40,49,50,51].…”

Section: Discussionmentioning

confidence: 99%

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Protocol for a cluster randomised controlled trial on information technology-enabled nutrition intervention among urban adults in Chandigarh (India): SMART eating trial

Kaur

Webster

et al. 2018

Global Health Action

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Nutrition is an important determinant of health. At present, nutrition programs in India mainly emphasize improving maternal and child nutrition. Adult nutrition has not received due attention, though diseases like hypertension and diabetes are largely preventable through changes in dietary and physical activity behaviour. Little is known about the best approaches to improve dietary behaviours, especially the role of modern information technology (IT) in health education. We describe the protocol of the SMART Eating (Small, Measurable and Achievable dietary changes by Reducing fat, sugar and salt consumption and Trying different fruits and vegetables) health promotion intervention. A Cluster Randomised Controlled Trial will evaluate the effect of an IT-enabled intervention on nutrition behaviour among urban adults of Chandigarh, India. Formative research using a qualitative exploratory approach was undertaken to inform the intervention. The IT-enabled intervention programme includes website development, Short Message Service (SMS), e-mail reminders and interactive help by mobile and landline phones. The IT-enabled intervention will be compared to the traditional nutrition education program of distributing pamphlets in the control group. The primary outcome will be the percentage of study participants meeting the dietary intake guidelines of the National Institute of Nutrition, Hyderabad, India and the change in intake of fat, sugar, salt, fruit and vegetables after the intervention. The difference in differences method will be used to determine the net change in dietary intakes resulting from the interventions. Measurements will be made at baseline and at 6 months post-intervention, using a food frequency questionnaire. The formative research led to the development of a comprehensive intervention, focusing on five dietary components and using multi-channel communication approach including the use of IT to target urban North Indians from diverse socio-economic backgrounds. The Cluster Randomised Controlled Trial design is suitable for evaluating the effectiveness of this IT-enabled intervention for dietary behaviour change.

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Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet

Cited by 4,749 publications

References 33 publications

Dietary Approach to Stop Hypertension (DASH) diet and risk of renal function decline and all-cause mortality in renal transplant recipients

Dietary Approach to Stop Hypertension (DASH) diet and risk of renal function decline and all-cause mortality in renal transplant recipients

Cumulative Incidence of Hypertension by 55 Years of Age in Blacks and Whites: The CARDIA Study

Protocol for a cluster randomised controlled trial on information technology-enabled nutrition intervention among urban adults in Chandigarh (India): SMART eating trial

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