Effects of the DASH Diet and Walking on Blood Pressure in Patients With Type 2 Diabetes and Uncontrolled Hypertension: A Randomized Controlled Trial

Abstract

Data on the potential beneficial effects of combining diet and exercise on blood pressure (BP) are still scarce. A 4‐week randomized controlled clinical trial was undertaken in 40 hypertensive patients with type 2 diabetes with uncontrolled blood pressure (BP) in office and daytime ambulatory BP monitoring (ABPM). Patients were assigned to follow a Dietary Approaches to Stop Hypertension (DASH) diet associated with advice to increase walking using a pedometer (intervention group) or a diet based on the American Diabetes Association recommendations (control group). The lifestyle intervention caused a greater ABPM (mm Hg) reduction in systolic 24‐hour, diastolic 24‐hour, nighttime systolic, daytime systolic, and daytime diastolic measurements than observed in the control group. In the intervention group there was a decrease in urinary sodium and an increase in urinary potassium, plasma aldosterone, and the number of steps per day (P<.05). The DASH diet and increased walking were associated with clinically significant reductions in ABPM values in hypertensive patients with type 2 diabetes.

Comparison of the effect of Dietary Approaches to Stop Hypertension diet and American Diabetes Association nutrition guidelines on lipid profiles in patients with type 2 diabetes: A comparative clinical trial

“…The results of a study by Paula et al . in 2015, which compared the effects of the DASH diet together with walking versus the ADA diet on patients with T2DM, showed that none of the two diets had a significant effect on HDL and TC . However, the DASH diet significantly reduced the TG and LDL levels while the effect of the ADA regimen was insignificant.…”

Effects of individual micronutrients on blood pressure in patients with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials

“…However, dietary advice for hypertension in diabetes4691011 has been mostly based on studies conducted in non-diabetic subjects578. In patients with type 2 diabetes, the beneficial association of the DASH diet with BP was previously demonstrated in both a cross-sectional study12 and clinical trials1314.…”

Novel Approaches to Investigate One-Carbon Metabolism and Related B-Vitamins in Blood Pressure

“…Two additional DASH studies, also reporting ABPM, confirmed these findings and reported a lowering of systolic BP of between 9.5 and 15 mmHg in response to intervention [128,129]. The greatest lowering achieved (a mean reduction in systolic BP of 15 mmHg) reported by Paula et al is likely to be explained by the inclusion of an exercise component within this intervention [129]. …”

“…Other studies have reported that higher concentrations of serum calcium, phosphate and parathyroid hormone are associated with the non-dipping pattern in hypertensive patients without renal disease [126]. The majority of other studies failed to report the dipping pattern, mean arterial pressure, heart rate and/or pulse pressure despite the use of ABPM [127,128,129,130,131,132,133,134,135,136,137,138,139]. …”

“…In an eight-week study investigating the ABPM response to the DASH diet versus a control diet or a diet rich in fruits and vegetables, the DASH diet was shown to result in the greatest BP lowering, achieving a mean systolic BP lowering of 4.5 mmHg [127]. Two additional DASH studies, also reporting ABPM, confirmed these findings and reported a lowering of systolic BP of between 9.5 and 15 mmHg in response to intervention [128,129]. The greatest lowering achieved (a mean reduction in systolic BP of 15 mmHg) reported by Paula et al is likely to be explained by the inclusion of an exercise component within this intervention [129].…”