Rationale and design of the Dietary Approaches to Stop Hypertension trial (DASH)

Sacks, Frank M.; Obarzanek, Eva; Windhauser, Marlene M.; Svetkey, Laura P.; Vollmer, William M.; McCullough, Marjorie L.; Karanja, Njeri; Lin, Pao‐Hwa; Steele, P.; Proschan, Michael A.; Evans, Marguerite; Appel, Lawrence J.; Bray, George A.; Vogt, Thomas; Moore, Thomas J.; Investigators, Dash

doi:10.1016/1047-2797(94)00055-x

Cited by 390 publications

(106 citation statements)

References 48 publications

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“…14 However, recent controlled clinical studies showed no significant effect of magnesium on BP. 15,16 The Dietary Approaches to Stop Hypertension (DASH) trial 17 showed that in addition to calorie balance and intake of sodium chloride and alcohol, multiple nutrients influence BP. In this 8-week feeding study, a "combination" diet that was high in fruits, vegetables, low-fat dairy products, whole grains, poultry, fish, and nuts and low in fats, red meat, and sweets produced relatively large decreases in BP.…”

Section: Bp Responsiveness To Dietary Sodium and Other Nutrientsmentioning

confidence: 99%

National Heart, Lung, and Blood Institute Workshop on Sodium and Blood Pressure

2000

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T he Workshop on Sodium and Blood Pressure was convened by the National Heart, Lung, and Blood Institute (NHLBI) in Bethesda, Md, on January 28 and 29, 1999, to update earlier reviews of this topic. [1][2][3] Other topics covered were sodium intake in relation to other cardiovascular disease (CVD) and non-CVD conditions, research needs, and public policy considerations. More than 55 invited speakers and other attendees from the United States and abroad reviewed and discussed the scientific information. This review synthesizes the presentations and discussions. Overview of Relation Between Sodium and Blood PressureEpidemiological studies conducted over the past 50 years have shown a clear curvilinear relation of higher adult blood pressure (BP) levels to higher rates of coronary heart disease (CHD), stroke, heart failure, and kidney failure. A continuous relation is apparent from below the 120/80 mm Hg level. Thus, a significant portion of CVD occurs in persons whose BP has not reached the arbitrary 140/90 mm Hg level defining hypertension. Studies show unequivocally that lowering high BP in hypertensive patients can reduce the likelihood of developing or dying from CVD, including CHD and stroke. Dietary factors in individuals and in the population at large have important effects on BP levels, which are generally assumed to translate to CVD risk. For the nonhypertensive subset, a population-wide approach to lowering BP (an approach based on lifestyle modifications that have been shown to prevent or delay increases in BP) could affect the total CVD burden as much as or more than treating only those with established hypertension.There is an abundance of scientific evidence demonstrating a direct relation between salt intake and BP. Studies in laboratory animals show that high BP can be induced by diet. 4 Recent evidence comes from a randomized trial involving 26 chimpanzees that were given a low salt/high potassium diet (preintervention period). Subsequently, one half of these nonhuman primates continued this diet, and the remainder received increasing amounts of additional dietary salt (5 g/d for 19 weeks, 10 g/d for 3 weeks, and 15 g/d for 67 weeks). BP increased progressively to levels averaging 33/10 mm Hg higher in the group consuming additional salt. On cessation of the additional salt, the BPs fell quickly to preintervention levels. 5 A positive relation between dietary sodium and BP has been shown from observational studies in humans. The Yi People Study 6 in China compared Yi farmers in remote areas with a group of Yi farmers who had migrated to an urban area and a group of Han residents of the same urban area. BP rose very little with age in the Yi farmers but increased with age in Yi migrants and Han residents. In a sample of 419 men, there was a positive relation between sodium intake and higher BP. Other factors, such as body mass index (BMI), were also involved. 6 Several large, long-term, randomized clinical trials have shown that a moderate reduction in sodium intake reduces BP levels. The Trials of...

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Section: Bp Responsiveness To Dietary Sodium and Other Nutrientsmentioning

confidence: 99%

National Heart, Lung, and Blood Institute Workshop on Sodium and Blood Pressure

2000

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“…Chemical analysis of duplicate meals confirmed that the nutrient content of the menus approximated the nutrient goals. 3,5 The protocol consisted of screening for eligibility, a 3-week run-in feeding period, randomization to 1 of the 3 dietary patterns, and an 8-week intervention feeding period. The clinical sites provided participants with all of their food during the run-in and intervention feeding periods.…”

Section: Participants and Methodsmentioning

confidence: 99%

Effects of Dietary Patterns on Blood Pressure

et al. 1999

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Objective: To determine the effects of dietary patterns on blood pressure in subgroups.Methods: Dietary Approaches to Stop Hypertension (DASH) was a randomized controlled feeding study conducted at 4 academic medical centers. Participants were 459 adults with untreated systolic blood pressure less than 160 mm Hg and diastolic blood pressure 80 to 95 mm Hg. For 3 weeks, participants were fed a "control" diet. They were then randomized to 8 weeks of (1) control diet; (2) a diet rich in fruits and vegetables; or (3) a combination diet rich in fruits, vegetables, and low-fat dairy foods, and reduced in saturated fat, total fat, and cholesterol (the DASH combination diet). Weight and salt intake were held constant. Change in diastolic blood pressure was the primary outcome variable, and systolic blood pressure a secondary outcome. Subgroups analyzed included race, sex, age, body mass index, years of education, income, physical activity, alcohol intake, and hypertension status.

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“…15 The DASH study was specifically designed to test interventions other than weight loss and reduced sodium intake, which were already known to lower BP (see below). 16 The impact of this dietary pattern on BP was tested in a randomized, controlled feeding study in 459 individuals with DBP 80 to 95 mm Hg and SBP Ͻ160 mm Hg. 16,17 Thus, the trial included individuals with prehypertension (71%) as well as those with stage 1 hypertension (29%).…”

Section: Dietary Approaches To Stop Hypertension Dietary Patternmentioning

confidence: 99%

“…16 The impact of this dietary pattern on BP was tested in a randomized, controlled feeding study in 459 individuals with DBP 80 to 95 mm Hg and SBP Ͻ160 mm Hg. 16,17 Thus, the trial included individuals with prehypertension (71%) as well as those with stage 1 hypertension (29%).…”

Section: Dietary Approaches To Stop Hypertension Dietary Patternmentioning

confidence: 99%

Management of Prehypertension

Svetkey

2005

Hypertension

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A 58-year-old woman is evaluated by her primary care physician, her gynecologist, or at employee health. On 2 separate occasions, duplicate seated blood pressure (BP) measurements average 132/84 mm Hg. She is informed that she has "prehypertension." At her last check-up in 2002, she had a similar reading but was told she had normal BP.The BP category "prehypertension" was first introduced by the Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) in 2003, replacing former categories of "highnormal" and "above-optimal" BP. 1 The rationale for redefining this category was to emphasize the excess risk associated with BP in this range and to focus increased clinical and public health attention on prevention.Management of prehypertension by lowering BP into a more optimal range can be expected to lower risk. The risks associated with prehypertension are in part related to the tendency of BP to increase with age in industrialized societies. Thus, prehypertension is a precursor of clinical hypertension and consequently of the cardiovascular disease (CVD) and renal risks associated with elevated BP (ie, SBP Ն140 or DBP Ն90 mm Hg). In addition, the relationship between BP and CVD risk is continuous over the whole range of BP, and therefore, prehypertension itself is associated with BP-related morbidity and mortality. Thus, the goals of treating prehypertension are to prevent hypertension and to reduce the excess CVD risk associated with BP in this preclinical range.Although treatment of prehypertension is primarily nonpharmacological lifestyle change, redefining this range of BP also serves to emphasize the role of health care providers in its management. The terms "high-normal" or "aboveoptimal" BP in previous JNC reports might have implied in the past that appropriate action should originate in the public health or the lay public sectors, but the label "prehypertension" clearly calls for the attention of the physician. The management of prehypertension is an appropriate goal for clinicians in a wide range of practice settings. This review will discuss the epidemiology and risk of prehypertension, the evidence underlying treatment recommendations, clinical and public health implications of prehypertension and its management, and issues concerning implementation of treatment recommendations. Definitions and Epidemiology"Prehypertension" is defined as systolic BP (SBP) 120 to 139 or diastolic BP (DBP) 80 to 89 mm Hg, based on "2 or more properly measured seated BP readings on each of 2 or more office visits." 1 If SBP and DBP fall into different categories, the category associated with the higher of the 2 pressures is applied. 2 Prehypertension replaces former categories "highnormal" (130 to 139/85 to 89 mm Hg) and "above-optimal" (120 to 129/80 to 84 mm Hg) BP. 1,2 The term "borderline hypertension" was imprecisely and inconsistently defined, and therefore should not be used. "Normal" (formerly "optimal") BP is defined as SBP Ͻ120 and DBP Ͻ80 mm Hg.Based on ...

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Rationale and design of the Dietary Approaches to Stop Hypertension trial (DASH)

Cited by 390 publications

References 48 publications

National Heart, Lung, and Blood Institute Workshop on Sodium and Blood Pressure

National Heart, Lung, and Blood Institute Workshop on Sodium and Blood Pressure

Effects of Dietary Patterns on Blood Pressure

Management of Prehypertension

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