Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Comprehensive Approach to Lower Blood Pressure (CALM-BP): a randomized controlled trial of a multifactorial lifestyle intervention Effects of the Dietary Approaches to Stop Hypertension (DASH) Eating Plan on Cardiovascular Risks Among Type 2 Diabetic Patients DASH Diet Lowers Blood Pressure and Lipid-Induced Oxidative Stress in Obesity Determinants and consequences of adherence to the dietary approaches to stop hypertension diet in African-American and white adults with high blood pressure: results from the ENCORE trial. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. The effects of dietary patterns on plasma renin activity: results from the Dietary Approaches to Stop Hypertension trial DASH Lowers Blood Pressure in Obese Hypertensives Beyond Potassium, Magnesium and Fiber Comprehensive lifestyle modification and blood pressure control: a review of the PREMIER trial. Effects of dietary patterns on blood pressure: subgroup analysis of the Dietary Approaches to Stop Hypertension (DASH) randomized clinical trial. A further subgroup analysis of the effects of the DASH diet and three dietary sodium levels on blood pressure: results of the DASH-Sodium Trial. Dietary Patterns and Cognitive Health in Older Adults: A Systematic Review. Effect of lifestyle modifications on blood pressure by race, sex, hypertension status, and age Dietary counselling has no effect on cardiovascular risk factors among Chinese Grade 1 hypertensive patients: a randomized controlled trial. The DASH diet and diet costs among ethnic and racial groups in the United States. Dietary Approaches to Prevent Hypertension Effect of dietary patterns on ambulatory blood pressure : results from the Dietary Approaches to Stop Hypertension (DASH) Trial. DASH Collaborative Research Group. The effect of dietary patterns on blood pressure control in hypertensive patients: results from the Dietary Approaches to Stop Hypertension (DASH) trial. Comparison of associations of adherence to a Dietary Approaches to Stop Hypertension (DASH)-style diet with risks of cardiovascular disease and venous thromboembolism. The DASH diet enhances the blood pressure response to losartan in hypertensive patients. Dietary approach to hypertension based on low glycaemic index and principles of DASH (Dietary Approaches to Stop Hypertension): a randomised trial in a primary care service. Does the DASH diet lower blood pressure by altering peripheral vascular function? Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group.
BACKGROUND Although the DASH ( Dietary Approaches to Stop Hypertension ) diet has been shown to lower blood pressure ( BP ) in short-term feeding studies , it has not been shown to lower BP among free-living individuals , nor has it been shown to alter cardiovascular biomarkers of risk . OBJECTIVE To compare the DASH diet alone or combined with a weight management program with usual diet controls among participants with prehypertension or stage 1 hypertension ( systolic BP , 130 - 159 mm Hg ; or diastolic BP , 85 - 99 mm Hg ) . DESIGN AND SETTING R and omized , controlled trial in a tertiary care medical center with assessment s at baseline and 4 months . Enrollment began October 29 , 2003 , and ended July 28 , 2008 . PARTICIPANTS Overweight or obese , unmedicated out patients with high BP ( N = 144 ) . INTERVENTIONS Usual diet controls , DASH diet alone , and DASH diet plus weight management . OUTCOME MEASURES The main outcome measure is BP measured in the clinic and by ambulatory BP monitoring . Secondary outcomes included pulse wave velocity , flow-mediated dilation of the brachial artery , baroreflex sensitivity , and left ventricular mass . RESULTS Clinic-measured BP was reduced by 16.1/9.9 mm Hg ( DASH plus weight management ) ; 11.2/7.5 mm ( DASH alone ) ; and 3.4/3.8 mm ( usual diet controls ) ( P < .001 ) . A similar pattern was observed for ambulatory BP ( P < .05 ) . Greater improvement was noted for DASH plus weight management compared with DASH alone for pulse wave velocity , baroreflex sensitivity , and left ventricular mass ( all P < .05 ) . CONCLUSION For overweight or obese persons with above-normal BP , the addition of exercise and weight loss to the DASH diet result ed in even larger BP reductions , greater improvements in vascular and autonomic function , and reduced left ventricular mass . CLINICAL TRIAL REGISTRATION clinical trials.gov Identifier : NCT00571844 Complementary medicine advocates the use of a multifactorial approach to address the varied aspects of hypertension . The aim of this study was to compare the blood pressure ( BP ) effect and medication use of a novel Comprehensive Approach to Lowering Measured Blood Pressure ( CALM-BP ) , based on complementary medicine principles , with the st and ard recommended Dietary Approach to Stop Hypertension ( DASH ) . A total of 113 patients treated with antihypertensive drugs were r and omly assigned to either CALM-BP treatment ( consisting of rice diet , walks , yoga , relaxation and stress management ) or to a DASH+exercise control group ( consisting of DASH and walks ) . Ambulatory 24-h and home BP were monitored over a 16-week programme , followed by 6 months of maintenance period . Medications were reduced if systolic BP dropped below 110 mm Hg accompanied by symptoms . In addition to BP reduction , medications were reduced because of symptomatic hypotension in 70.7 % of the CALM-BP group compared with 32.7 % in the DASH group , P<0.0001 . After 6 months , medication status was not altered in the majority of individuals . Significant reductions in body mass index , cholesterol and improved quality -of-life scores were observed only in the CALM-BP group . Lifestyle and diet modifications based on complementary medicine principles are highly effective with respect to BP control , medication use and cardiovascular risk factors OBJECTIVE To determine the effects of the Dietary Approaches to Stop Hypertension ( DASH ) eating pattern on cardiometabolic risks in type 2 diabetic patients . RESEARCH DESIGN AND METHODS A r and omized crossover clinical trial was undertaken in 31 type 2 diabetic patients . For 8 weeks , participants were r and omly assigned to a control diet or the DASH eating pattern . RESULTS After following the DASH eating pattern , body weight ( P = 0.007 ) and waist circumference ( P = 0.002 ) reduced significantly . Fasting blood glucose levels and A1C decreased after adoption of the DASH diet ( −29.4 ± 6.3 mg/dl ; P = 0.04 and −1.7 ± 0.1 % ; P = 0.04 , respectively ) . After the DASH diet , the mean change for HDL cholesterol levels was higher ( 4.3 ± 0.9 mg/dl ; P = 0.001 ) and LDL cholesterol was reduced ( −17.2 ± 3.5 mg/dl ; P = 0.02 ) . Additionally , DASH had beneficial effects on systolic ( −13.6 ± 3.5 vs. −3.1 ± 2.7 mmHg ; P = 0.02 ) and diastolic blood pressure ( −9.5 ± 2.6 vs. −0.7 ± 3.3 mmHg ; P = 0.04 ) . CONCLUSIONS Among diabetic patients , the DASH diet had beneficial effects on cardiometabolic risks Abstract — Evidence suggests that obesity may raise blood pressure ( BP ) through oxidative stress – sensitive mechanisms and that the Dietary Approaches to Stop Hypertension combination diet ( DASH-CD ) may decrease BP by enhancing antioxidant capacity . To address this question , 12 obese patients with high-normal – to – stage 1 hypertension ( hypertensives ) and 12 lean normotensives were studied on their usual diets and after following the DASH-CD and a low-antioxidant diet in r and om sequence for 4 weeks each . Acute oxidative stress was induced by a 4-hour infusion of intralipid and heparin  . Ferric-reducing activity of plasma ( FRAP ) and plasma F2-isoprostanes were measured as biomarkers of antioxidant capacity and oxidative stress , respectively . BP was lower in obese hypertensives on the DASH-CD than on the usual and low-antioxidant diets ( −8.1±1.5/−7.4±1.6 mm Hg , P < 0.05 ) . BP did not change significantly in lean normotensives after 4 weeks on the DASH-CD but tended to rise on the low-antioxidant diet  . FRAP on usual diets was higher in lean subjects than in obese subjects . FRAP increased in obese but not lean volunteers on the DASH-CD compared with usual diet , and the group difference disappeared . F2-isoprostanes increased from baseline during intralipid and heparin in both groups on the low-antioxidant diet but not in obese hypertensives on the DASH-CD . Among free-living obese hypertensives , the DASH-CD  raises antioxidant capacity , lowers BP , and reduces oxidative stress induced by acute hyperlipidemia . The findings are consistent with evidence that elevated BP in obese subjects may reflect an imbalance between antioxidant capacity and oxidative stress that is improved by the DASH-CD BACKGROUND Although the Dietary Approaches to Stop Hypertension ( DASH ) diet is an accepted nonpharmacologic treatment for hypertension , little is known about what patient characteristics affect dietary adherence and what level of adherence is needed to reduce blood pressure ( BP ) . OBJECTIVE Our aim was to determine what factors predict dietary adherence and the extent to which dietary adherence is necessary to produce clinical ly meaningful BP reductions . DESIGN Ancillary study of the ENCORE ( Exercise and Nutrition Interventions for Cardiovascular Health ) trial -- a 16-week r and omized clinical trial of diet and exercise . PARTICIPANTS / SETTING Participants included 144 sedentary , overweight , or obese adults ( body mass index 25 to 39.9 ) with high BP ( systolic 130 to 159 mm Hg and /or diastolic 85 to 99 mm Hg ) . INTERVENTION Patients were r and omized to one of three groups : DASH diet alone , DASH diet plus weight management , and Usual Diet Controls . MAIN OUTCOMES MEASURES Our primary outcomes were a composite index of adherence to the DASH diet and clinic BP . STATISTICAL ANALYSES PERFORMED General linear models were used to compare treatment groups on post-treatment adherence to the DASH diet . Linear regression was used to examine potential predictors of post-treatment DASH adherence . Analysis of covariance was used to examine the relation of adherence to the DASH diet and BP . RESULTS Participants in the DASH diet plus weight management ( 16.1 systolic BP [ SBP ] ; 95 % CI 13.0 to 19.2 mm Hg and 9.9 diastolic BP [ DBP ] ; 95 % CI 8.1 to 11.6 mm Hg ) and DASH diet alone ( 11.2 SBP ; 95 % CI 8.1 to 14.3 mm Hg and 7.5 DBP ; 95 % CI 5.8 to 9.3 mm Hg ) groups showed significant reductions in BP in comparison with Usual Diet Controls participants ( 3.4 SBP ; 95 % CI 0.4 to 6.4 mm Hg and DBP 3.8 ; 95 % CI 2.2 to 5.5 mm Hg ) . Greater post-treatment consumption of DASH foods was noted in both the DASH diet alone ( mean = 6.20 ; 95 % CI 5.83 to 6.57 ) and DASH diet plus weight management groups ( mean = 6.23 ; 95 % CI 5.88 to 6.59 ) compared with Usual Diet Controls ( mean = 3.66 ; 95 % CI 3.30 to 4.01 ; P<0.0001 ) , and greater adherence to the DASH diet was associated with larger reductions in clinic SBP and DBP ( P ≤ 0.01 ) . Only ethnicity predicted dietary adherence , with African Americans less adherent to the DASH diet compared with whites ( 4.68 ; 95 % CI 4.34 to 5.03 vs 5.83 ; 95 % CI 5.50 to 6.11 ; P<0.001 ) . CONCLUSIONS Greater adherence to the DASH diet was associated with larger BP reductions independent of weight loss . African Americans were less likely to be adherent to the DASH dietary eating plan compared with whites , suggesting that culturally sensitive dietary strategies might be needed to improve adherence to the DASH diet CONTEXT Weight loss , sodium reduction , increased physical activity , and limited alcohol intake are established recommendations that reduce blood pressure ( BP ) . The Dietary Approaches to Stop Hypertension ( DASH ) diet also lowers BP . To date , no trial has evaluated the effects of simultaneously implementing these lifestyle recommendations . OBJECTIVE To determine the effect on BP of 2 multicomponent , behavioral interventions . DESIGN , SETTING , AND PARTICIPANTS R and omized trial with enrollment at 4 clinical centers ( January 2000-June 2001 ) among 810 adults ( mean [ SD ] age , 50 [ 8.9 ] years ; 62 % women ; 34 % African American ) with above-optimal BP , including stage 1 hypertension ( 120 - 159 mm Hg systolic and 80 - 95 mm Hg diastolic ) , and who were not taking antihypertensive medications . INTERVENTION Participants were r and omized to one of 3 intervention groups : ( 1 ) " established , " a behavioral intervention that implemented established recommendations ( n = 268 ) ; ( 2 ) " established plus DASH,"which also implemented the DASH diet ( n = 269 ) ; and ( 3 ) an " advice only " comparison group ( n = 273 ) . MAIN OUTCOME MEASURES Blood pressure measurement and hypertension status at 6 months . RESULTS Both behavioral interventions significantly reduced weight , improved fitness , and lowered sodium intake . The established plus DASH intervention also increased fruit , vegetable , and dairy intake . Across the groups , gradients in BP and hypertensive status were evident . After subtracting change in advice only , the mean net reduction in systolic BP was 3.7 mm Hg ( P<.001 ) in the established group and 4.3 mm Hg ( P<.001 ) in the established plus DASH group ; the systolic BP difference between the established and established plus DASH groups was 0.6 mm Hg ( P = .43 ) . Compared with the baseline hypertension prevalence of 38 % , the prevalence at 6 months was 26 % in the advice only group , 17 % in the established group ( P = .01 compared with the advice only group ) , and 12 % in the established plus DASH group ( P<.001 compared with the advice only group ; P = .12 compared with the established group ) . The prevalence of optimal BP ( < 120 mm Hg systolic and < 80 mm Hg diastolic ) was 19 % in the advice only group , 30 % in the established group ( P = .005 compared with the advice only group ) , and 35 % in the established plus DASH group ( P<.001 compared with the advice only group ; P = .24 compared with the established group ) . CONCLUSION Individuals with above-optimal BP , including stage 1 hypertension , can make multiple lifestyle changes that lower BP and reduce their cardiovascular disease risk A diet rich in fruits , vegetables and low-fat dairy products , and reduced in saturated fat , total fat and cholesterol ( the ‘ DASH ’ diet ) significantly lowers blood pressure ( BP ) . Previous studies have documented that certain therapies that lower BP increase plasma renin activity ( PRA ) . Using data from the Dietary Approaches to Stop Hypertension ( DASH ) trial , we assessed the effects of dietary patterns on PRA and determined the relationship of change in PRA with change in BP on each diet . After eating a control diet for 3 weeks , participants were then r and omized to receive for 8 weeks : the control diet , a diet rich in fruits and vegetables ( F/V ) , or the DASH diet . Baseline and follow-up levels of PRA were available in 381 participants . Compared with the control diet , the DASH diet increased PRA by 0.37 ng ml−1 h−1 ( P=0.01 ) . In multivariable linear regression analyses , there was an inverse association of PRA change with systolic BP change on the control diet ( slope=−0.35 , P=0.001 ) , but PRA did not differ by BP change on the F/V diet ( slope=−0.002 , P=0.98 ) or DASH diet ( slope=−0.08 , P=0.32 ) . These data suggest that a blunted counter-regulatory response of the renin – angiotensin system is associated with the BP-lowering effect of the F/V and DASH diets The mechanism underlying blood pressure ( BP ) reduction in the high fruits and vegetables arm of the Dietary Approaches to Stop Hypertension ( DASH ) study is unknown but may include potassium , magnesium and fibre . This study was design ed to separate minerals and fibre from other components of DASH on BP in abdominally obese individuals with metabolic syndrome with pre-hypertension to stage 1 hypertension ( obese hypertensives ) . A total of 15 obese hypertensives and 15 lean normotensives were studied on a st and ardized usual diet , r and omized to DASH or usual diet supplemented with potassium , magnesium and fibre to match DASH , then crossed over to the complementary diet . All diets were 3 weeks long , isocaloric and matched for sodium and calcium . In obese hypertensives , BP was lower after 3 weeks on DASH than usual diet ( −7.6±1.4/−5.3±1.4 mm Hg , P<0.001/0.02 ) and usual diet supplemented ( −6.2±1.4/−3.7±1.4 P<0.005/0.06 ) , whereas BP was not significantly different on usual and supplemented diets . BP values were not different among the three diets in lean normotensives . Small artery elasticity was lower in obese hypertensives than in lean normotensives on the usual and supplemented diets ( P<0.02 ) . This index of endothelial function improved in obese hypertensives ( P<0.02 ) but not lean normotensives on DASH , and was no longer different from values in lean normotensives ( P>0.50 ) . DASH is more effective than potassium , magnesium and fibre supplements for lowering BP in obese hypertensives , which suggest that high fruits and vegetables DASH  lowers BP and improves endothelial function in this group by nutritional factors in addition to potassium , magnesium and fibre The PREMIER trial assessed the aggregate effect on blood pressure ( BP ) of nationally recommended lifestyle modifications in free-living adults with high-normal ( stage 1 ) hypertension . Participants ( N=810 ) were r and omized to the advice-only group ; the established group ( consisting of weight loss , increased physical activity , and reduced sodium and alcohol intake ) ; or the established plus Dietary Approaches to Stop Hypertension ( DASH ) diet group ( consisting of the established interventions in addition to the DASH dietary pattern ) . The primary outcome was change in systolic BP at 6 months . Net of advice only , mean systolic BP declined by 3.7 mm Hg for members of the established group ( p<0.001 ) and 4.3 mm Hg for the established plus DASH group ( p<0.001 ) . The prevalence of hypertension decreased from a baseline of 38 % to 17 % in the established group ( p=0.01 ) and to 12 % in the established plus DASH group ( p<0.001 ) compared with a decrease to 26 % in the advice-only group . The PREMIER trial demonstrated that persons with above-optimal BP and stage 1 hypertension can make multiple lifestyle changes leading to better control of BP OBJECTIVE To determine the effects of dietary patterns on blood pressure in subgroups . METHODS Dietary Approaches to Stop Hypertension ( DASH ) was a r and omized 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 r and omized 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 . RESULTS The combination diet significantly lowered systolic blood pressure in all subgroups ( P<.008 ) , and significantly lowered diastolic blood pressure ( P<.01 ) in all but 2 subgroups . The fruits- and -vegetables diet also reduced blood pressure in the same subgroups , but to a lesser extent . The combination diet lowered systolic blood pressure significantly more in African Americans ( 6.8 mm Hg ) than in whites ( 3.0 mm Hg ) , and in hypertensive subjects ( 11.4 mm Hg ) than in nonhypertensive subjects ( 3.4 mm Hg ) ( P<.05 for both interactions ) . CONCLUSIONS The DASH combination diet , without sodium reduction or weight loss , significantly lowered blood pressure in virtually all subgroups examined , and was particularly effective in African Americans and those with hypertension . The DASH combination diet may be an effective strategy for preventing and treating hypertension in a broad cross section of the population , including segments of the population at highest risk for blood pressure-related cardiovascular disease This study presents an extensive analysis of the effects on blood pressure ( BP ) of changes in sodium intake over a wide array of subgroups , including joint subgroups defined by age and hypertension status , race or ethnicity and hypertension status , and gender and race or ethnicity . Participants were given 3 levels of sodium ( 50 , 100 , and 150 mmol/2,100 kcal ) for 30 days while consuming the Dietary Approaches to Stop Hypertension ( DASH ) diet ( rich in fruits , vegetables , and low-fat dairy ) or a more typical American diet . Within each diet and subgroup , there was a general pattern such that the lower the sodium level , the greater the mean reduction in BP . Sodium reduction from 100 to 50 mmol/2,100 kcal generally had twice the effect on BP as reduction from 150 to 100 mmol/2,100 kcal . Age had a strong and grade d influence on the effect of sodium within the typical and DASH diets , respectively : -4.8 and -1.0 mm Hg systolic for 23 to 41 years , -5.9 and -1.8 mm Hg for 42 to 47 years , -7.5 and -4.3 mm Hg for 48 to 54 years , and -8.1 and -6.0 mm Hg for 55 to 76 years . The influence of age on the effect of sodium reduction was particularly strong in nonhypertensive patients : -3.7 mm Hg systolic for < 45 years and -7.0 mm Hg for > 45 years with the typical diet and -0.7 and -2.8 mm Hg with the DASH diet . Reduced sodium  intake and the DASH diet should be advocated for the prevention and treatment of high BP , particularly because the benefits to BP strengthen as subjects enter middle age , when the rate of cardiovascular disease increases sharply While the role of diet and nutrition in cognitive health and prevention of dementia  in older adults has attracted much attention , the efficacy of different dietary patterns remains uncertain . Previous review s have mainly focused on the Mediterranean diet , but either omitted other dietary patterns , lacked more recent studies , were based on cross-sectional studies , or combined older and younger population s. We followed PRISMA guidelines , and examined the efficacy of current research from r and omized controlled trials and cohort studies on the effects of different dietary patterns . We review ed the Mediterranean diet , Dietary Approach to Stop Hypertension ( DASH ) diet , the Mediterranean-DASH diet Intervention for Neurodegenerative Delay ( MIND ) diet , Anti-inflammatory diet , Healthy diet recommended by guidelines via dietary index , or Prudent healthy diets generated via statistical approaches , and their impact on cognitive health among older adults . Of 38 studies , the Mediterranean diet was the most investigated with evidence supporting protection against cognitive decline among older adults . Evidence from other dietary patterns such as the MIND , DASH , Anti-inflammatory , and Prudent healthy diets was more limited but showed promising results , especially for those at risk of cardiovascular disease . Overall , this review found positive effects of dietary patterns including the Mediterranean , DASH , MIND , and Anti-inflammatory diets on cognitive health outcomes in older adults . These dietary patterns are plant-based , rich in poly- and mono-unsaturated fatty acids with lower consumption of processed foods . Better underst and ing of the underlying mechanisms and effectiveness is needed to develop comprehensive and practical dietary recommendations against age-related cognitive decline among older adult Recommendations for control of high blood pressure ( BP ) emphasize lifestyle modification , including weight loss , reduced sodium intake , increased physical activity , and limited alcohol consumption . The Dietary Approaches to Stop Hypertension ( DASH ) dietary pattern also lowers BP . The PREMIER r and omized trial tested multicomponent lifestyle interventions on BP in demographic and clinical subgroups . Participants with above-optimal BP through stage 1 hypertension were r and omized to an Advice Only group or one of two behavioural interventions that implement established recommendations ( Est ) or established recommendations plus DASH diet ( Est plus DASH ) . The primary outcome was change in systolic BP at 6 months . The study population was 810 individuals with an average age of 50 years , 62 % women , 34 % African American ( AA ) , 95 % overweight/obese , and 38 % hypertensive . Participants in all the three groups made lifestyle changes . Mean net reductions in systolic ( S ) BP in the Est intervention were 1.2 mmHg in AA women , 6.0 in AA men , 4.5 in non-AA women , and 4.2 in non-AA men . The mean effects of the  Est Plus DASH intervention were 2.1 , 4.6 , 4.2 , and 5.7 mmHg in the four race – sex subgroups , respectively . BP changes were consistently greater in hypertensives than in nonhypertensives , although interaction tests were nonsignificant . The Est intervention caused statistically significant BP reductions in individuals over and under age 50 . The Est Plus DASH intervention lowered BP in both age groups , and significantly more so in older individuals . In conclusion , diverse groups of people can adopt multiple lifestyle changes that can lead to improved BP control and reduced CVD risk AIMS To evaluate the effectiveness of Dietary Approaches to Stop Hypertension ( DASH ) by one-off dietary counselling on reducing cardiovascular risk factors among Chinese Grade 1 hypertensive patients in primary care . METHODS AND RESULTS A parallel-group , r and omized controlled trial ( ChiCTR-TRC-13003014 ) was conducted among patients ( 40 - 70 years old ) newly diagnosed with Grade 1 hypertension in primary care setting s in Hong Kong . Subjects were r and omized to usual care ( st and ard education , control )  ( n = 275 ) , or usual care plus DASH-based dietary counselling ( intervention ) ( n = 281 ) . The study endpoints included blood pressure ( BP ) , lipid profile , and body mass index ( BMI ) at 6- and 12-months . Outcome data were available for 504 ( 90.6 % ) and 485 ( 87.2 % ) patients at 6 and 12 months , respectively . Blood pressure levels reduced in both groups at follow-ups . However , the intervention group did not show a significantly greater reduction in either systolic BP ( -0.7 mmHg , 95%CI -3.0 - 1.5 at 6-month ; -0.1 mmHg , 95%CI -2.4 - 2.2 at 12-month ) or diastolic BP ( -1.0 mmHg , 95%CI -2.7 - 0.7 at 6-month ; -1.1 mmHg , 95%CI -2.9 - 0.6 at 12-month ) , when compared with the control group . The improvements in lipid profile and BMI were observed among all subjects , yet no significant differences were detected between intervention and control groups . CONCLUSION The DASH diet by one-off dietitian counselling which resembled the common primary care practice might confer no added long-term benefits on top of physician 's usual care in optimizing cardiovascular risk factors . Physicians may still practice st and ard usual care , yet further explorations on different DASH delivery models are warranted to inform best clinical practice The Dietary Approaches to Stop Hypertension ( DASH ) diet is perhaps the best example of how a nutrient dense dietary pattern can prevent chronic disease . In r and omized trials , DASH dietary patterns lowered blood pressure  in hypertensive individuals.1 Subsequent trials and observational studies have consistently found that DASH-type diets reduced cardiovascular and metabolic Elevated blood pressure arises from a combination of environmental and genetic factors and the interactions of these factors . A substantial body of evidence from animal studies , epidemiologic studies , meta-analyses , and r and omized controlled trials has demonstrated that certain dietary patterns and individual dietary elements play a prominent role in the development of hypertension . Changes in diet can lower blood pressure , prevent the development of hypertension , and reduce the risk of hypertension-related complications . Dietary strategies for the prevention of hypertension include reducing sodium intake , limiting alcohol consumption , increasing potassium intake , and adopting an overall dietary pattern such as the DASH ( Dietary Approaches to Stop Hypertension ) diet or a Mediterranean diet . In order to reduce the burden of blood pressure-related complications , efforts that focus on environmental and individual behavioral changes that encourage and promote healthier food choices are warranted We measured ambulatory blood pressure ( ABP ) in 354 participants in the Dietary Approaches to Stop Hypertension ( DASH ) Trial to determine the effect of dietary treatment on ABP ( 24-hour , day and night ) and to assess participants ' acceptance of and compliance with the ABP monitoring ( ABPM ) technique . After a 3-week run-in period on a control " typical " American diet , subjects ( diastolic blood pressure [ BP ] , 80 to 95 mm Hg ; systolic BP , < 160 mm Hg ; mean age , 45 years ) were r and omly assigned to 1 of 3 diets for an 8-week intervention period : a continuation of the control diet ; a diet rich in fruits and vegetables ; and a " combination " diet that emphasized fruits , vegetables , and low-fat dairy products . We measured ABP at the end of the run-in and intervention periods . Both the fruit/vegetable and combination diets lowered 24-hour ABP significantly compared with the control diet ( P<0 . 0001 for systolic and diastolic pressures on both diets : control diet , -0.2/+0.1 mm Hg ; fruit/vegetable diet , -3.2/-1.9 mm Hg ; combination diet , -4.6/-2 . 6 mm Hg ) . The combination diet  lowered pressure during both day and night .  Hypertensive subjects had a significantly greater response than normotensives to the combination diet ( 24-hour ABP , -10.1/-5.5 versus -2.3/-1.6 mm Hg , respectively ) . After correction for the control diet responses , the magnitude of BP lowering was not significantly different whether measured by ABPM or r and om-zero sphygmomanometry . Participant acceptance of ABPM was excellent : only 1 participant refused to wear the ABP monitor , and 7 subjects ( 2 % ) provided incomplete recordings . These results demonstrate that the DASH combination diet provides significant round-the-clock reduction in BP , especially in hypertensive participants To determine the impact of dietary patterns on the control of hypertension we studied the subgroup of 133 participants with systolic blood pressure ( BP ) of 140 to 159 mm Hg and /or diastolic BP of 90 to 95 mm Hg enrolled in the Dietary Approaches to Stop Hypertension ( DASH ) study . Participants were fed a control diet for a 3-week period and were then r and omized to receive for 8 weeks either the control diet ; a diet rich in fruits and vegetables , but otherwise similar to control ; or a combination diet rich in fruits , vegetables , and low-fat dairy products , including whole grains , fish , poultry , and nuts , and reduced in fats , red meats , sweets , and sugar-containing beverages .  Sodium intake and body weight were held constant throughout the study . The combination diet significantly reduced systolic BP ( -11.4 mm Hg , P < .001 ) and diastolic BP ( -5.5 mm Hg , P < .001 ) . The fruits- and -vegetables diet also significantly reduced systolic BP ( -7.2 mm Hg , P < .001 ) and diastolic BP ( -2.8 mm Hg , P = .013 ) . The combination diet produced significantly greater BP effects ( P < .05 ) than the fruits- and -vegetables diet .  Blood pressure changes were evident within 2 weeks of starting the intervention feeding . After the 8-week intervention period , 70 % of participants eating the combination diet had a normal BP ( systolic BP < 140 and diastolic BP < 90 mm Hg ) compared with 45 % on the fruits- and -vegetables diet and 23 % on the control diet . In patients with hypertension , the DASH combination diet effectively lowers BP and may be useful in achieving control of Stage 1 hypertension BACKGROUND Venous thromboembolism ( VTE ) and cardiovascular disease ( CVD ) share some risk factors , including obesity , but it is unclear how dietary patterns associated with reduced risk of CVD relate to risk of VTE . OBJECTIVE To compare the relationships of adherence to a Dietary Approaches to Stop Hypertension (DASH)-style diet with the risks of CVD and VTE . PATIENTS / METHODS We confirmed by medical record review 1094 incident cases of CVD and 675 incident VTEs during a mean follow-up of 14.6 years in 34 827 initially healthy participants in the Women 's Health Study who completed at baseline a 133-item food frequency question naire scored for adherence to a DASH diet .  We compared estimated associations of dietary patterns with CVD and VTE from proportional hazards models in a competing risk framework . RESULTS Initial analyses adjusted for age , energy intake and r and omized treatments showed 36 - 41 % reduced hazards of CVD among women in the top two quintiles of DASH score relative to those in the bottom quintile ( P(trend ) < 0.001 ) . In multivariate analysis , women in the top two quintiles had 12 - 23 % reduced hazards of CVD relative to women in the bottom quintile ( P(trend ) = 0.04 ) . Analyses restricted to coronary events showed more variable 10 - 33 % reduced hazards in the top two quintiles ( P(trend ) = 0.09 ) . In contrast , higher DASH scores were unrelated to risk of VTE , with a 1 % reduced hazard for the top vs. bottom quintile ( P(trend ) = 0.95 ) . CONCLUSION An apparently strong association of adherence to the DASH diet with incidence of CVD was attenuated upon control for confounding variables . Adherence to the DASH diet was not associated with risk of VTE in women BACKGROUND The Dietary Approaches to Stop Hypertension ( DASH ) diet , which emphasizes fruits , vegetables , and low fat dairy products , significantly lowers blood pressure ( BP ) . We conducted a clinical trial to assess the BP response to the DASH diet with an antihypertensive medication , losartan , in participants with essential hypertension . METHODS A total of 55 hypertensive participants were r and omly assigned to 8 weeks of controlled feeding with either a control diet or the DASH diet . Within each diet arm , participants received losartan 50 mg daily or placebo for 4 weeks each , in double blind , r and omized , cross-over fashion . Twenty-four-hour ambulatory BP ( ABP ) was measured at the end of a 2-week run-in period ( baseline ) and after each 4-week intervention period . RESULTS There was no significant change in ABP during the placebo period on the control diet ( n = 28 ) ( -2.3 + /- 1.5/-1.6 + /- 1.0 mm Hg ) , but there was a significant reduction in systolic ABP ( -5.3 + /- 1.5 mm Hg , P < .05 ) and no change in DBP ( -2.5 + /- 1.0 mm Hg ) on the DASH diet ( n = 27 ) . Losartan significantly reduced ABP on the control diet ( -6.7 + /- 1.5/-3.7 + /- 1.0 mm Hg , P < .05 ) and to a greater extent on the DASH diet ( -11.7 + /- 1.5/-6.9 + /- 1.0 mm Hg , P < .05 versus basal and control diet ) particularly in African Americans . On the DASH diet , DeltaSBP on losartan was inversely related to basal plasma renin activity ( n = -0.53 , P = .004 ) . CONCLUSIONS The DASH diet enhances the ABP response to losartan in essential hypertension . This effect is particularly marked in African Americans Hypertension is one of the leading causes of morbidity and mortality in Brazil .  Diet may play an important role in reducing blood pressure ( BP ) , as has been shown for diets high in fruits , vegetables and low-fat dairy products and low in salt ( Dietary Approaches to Stop Hypertension (DASH)-Na ) . A low-glycaemic index Brazilian diet combined with the principles of the DASH-Na diet was evaluated in a r and omised study of 206 individuals who were followed for 6 months . In the control group ( CG ) , counselling was based on st and ard care and mainly focused on salt intake reduction . An intention-to-treat analysis showed that , after 6 months , systolic BP was reduced by 14·4 mmHg and diastolic BP by 9·7 mmHg in the experimental group ( EG ) , compared with 6·7 and 4·6 mmHg , respectively , in the CG . After adjusting for body weight , BP at baseline and age , these changes were 12·1 and 7·9 mmHg , respectively . Urinary Na excretion was also reduced by 43·4 mEq/24 h in the EG . Food intake was modified accordingly during the intervention with an increase in the consumption of vegetables  ( 2·97 - 5·85 frequency of consumption measured in three non-consecutive days ) , fruits ( 4·09 - 7·18 ) , beans ( 1·94 - 3·13 ) and fish ( 1·80 - 2·74 ) by the EG . The present study showed the feasibility of a Brazilian dietary approach to treating hypertension by reducing urinary Na excretion and BP , changes that may have a great impact on public health and promote the benefits of controlling hypertension We tested whether lowering of blood pressure ( BP ) on the dietary approaches to stop hypertension ( DASH ) diet was associated with changes in peripheral vascular function : endothelial function , assessed by flow-mediated vasodilatation ( FMD ) of the brachial artery , and subcutaneous adipose tissue blood flow ( ATBF ) . We also assessed effects on heart rate variability ( HRV ) as a measure of autonomic control of the heart . We allocated 27 men and women to DASH diet and control groups .  We measured FMD , ATBF and HRV on fasting and after ingestion of 75 g glucose , before and after 30 days on dietary intervention , aim ing for weight maintenance . The control group did not change their diet . The DASH-diet group complied with the diet as shown by significant reductions in systolic ( P<0.001 ) and diastolic ( P=0.005 ) BP , and in plasma C-reactive protein ( P<0.01 ) , LDL-cholesterol ( P<0.01 ) and apolipoprotein B ( P=0.001 ) , a novel finding . Body weight changed by < 1 kg . There were no changes in the control group . We found no changes in FMD , or in ATBF , in the DASH-diet group , although heart rate fell ( P<0.05 ) . Glucose and insulin concentrations did not change . In this small-scale study , the DASH diet lowered BP independently of peripheral mechanisms BACKGROUND The effect of dietary composition on blood pressure is a subject of public health importance . We studied the effect of different levels of dietary sodium , in conjunction with the Dietary Approaches to Stop Hypertension ( DASH ) diet , which is rich in vegetables , fruits , and low-fat dairy products , in persons with and in those without hypertension . METHODS A total of 412 participants were r and omly assigned to eat either a control diet typical of intake in the United States or the DASH diet . Within the assigned diet , participants ate foods with high , intermediate , and low levels of sodium for 30 consecutive days each , in r and om order . RESULTS Reducing the sodium intake from the high to the intermediate level reduced the systolic blood pressure by 2.1 mm Hg ( P<0.001 ) during the control diet and by 1.3 mm Hg ( P=0.03 ) during the DASH diet . Reducing the sodium intake from the intermediate to the low level caused additional reductions of 4.6 mm Hg during the control diet ( P<0.001 ) and 1.7 mm Hg during the DASH diet ( P<0.01 ) . The effects of sodium were observed in participants with and in those without hypertension , blacks and those of other races , and women and men . The DASH diet was associated with a significantly lower systolic blood pressure at each sodium level ; and the difference was greater with high sodium levels than with low ones . As compared with the control diet with a high sodium level , the DASH diet with a low sodium level led to a mean systolic blood pressure that was 7.1 mm Hg lower in participants without hypertension , and 11.5 mm Hg lower in participants with hypertension . CONCLUSIONS The reduction of sodium intake to levels below the current recommendation of 100 mmol per day and the DASH diet both lower blood pressure substantially , with greater effects in combination than singly . Long-term health benefits will depend on the ability of people to make long-lasting dietary changes and the increased availability of lower-sodium foods
Changes in both systolic and diastolic BP were greater in participants with higher baseline BP or BMI .
The DASH diet improved cardiovascular risk factors and appeared to have greater beneficial effects in subjects with an increased cardiometabolic risk .
The DASH diet is an effective nutritional strategy to prevent CVD
The Dietary Approach to Stop Hypertension ( DASH ) is recommended to lower blood pressure ( BP ) , but its effects on cardiometabolic biomarkers are unclear .
A systematic review and meta- analysis of r and omised controlled trials ( RCT ) was conducted to determine the effects of the DASH diet on cardiovascular risk factors .