Appropriate prevention and management of hypertension

Ozemek et al. (2018) noted that appropriate prevention and management of hypertension was supported by adopting a diet rich in plant-based foods with whole grains, low-fat dairy products, and low sodium in accordance with the recommendations of the DASH diet. The Ozemek et al. (2018) review also found the DASH diet was more effective when paired with dietary counseling. In comparison, three studies found benefits from the DASH diet. In two studies, lifestyle modifications were added to the DASH diet intervention and found a greater reduction in the systolic and diastolic blood pressures. The original DASH study showed favorable effects on the reduction of BP but did not test diet adherence. All studies found the DASH diet to be effective in lowering blood pressure in participants. This was consistent with a meta-analysis conducted by Ndanuko et al. (2016), who compared several studies of dietary patterns in lowering blood pressure and concluded that the DASH diet lowers blood pressure.

In a recent RCT investigating the effects of the DASH diet on cardiovascular risk factors and providing information on the energy and macronutrient contents of both DASH and control interventions were included in the meta-analysis. The minimum duration of the RCT for inclusion in the meta-analysis was 2 weeks. An important inclusion criterion was that the DASH and control diet interventions had to be comparable in terms of energy intake and other lifestyle interventions, e.g. physical activity. In other words, RCT were included only if both control and DASH diet interventions involved a similar degree of energy restriction and/or physical activity to avoid the confounding effects of changes in body weight on cardiovascular risk factors. In addition, RCT were included if they altered minor components of the DASH interventions (e.g. modified DASH) but retained the core characteristics of the archetypical DASH dietary plan (Bricarello et al., 2018). Examples of DASH dietary plan modifications include reduction of salt intake, increased consumption of lean red meat, and combination with other interventions such as weight loss or physical activity. Similarly, RCT having either a typical dietary pattern or a healthier dietary pattern (healthy diet) as a control were included, provided that these patterns matched the DASH intervention in terms of both energy intake and physical activity level. Finally, RCT were not excluded according to dietary Na intake, as information regarding this variable was not consistently reported across trials; this approach was intended to minimize the risk of publication bias (Bricarello et al., 2018).

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In conclusion, the DASH diet interventions resulted in significant improvements in systolic and diastolic BP along with significant reductions in total cholesterol and LDL concentrations. However, these interventions did not affect TAG, glucose, and HDL concentrations (Bricarello et al., 2018). The responses of both systolic and diastolic BP to the DASH diet were greater in participants with higher BP or BMI at baseline. The responses appeared to be independent of differences in dietary Na intake. Importantly, measures of the effectiveness of the DASH diet were not modified by the type of study design or feeding protocol and the characteristics of control diet (Bricarello et al., 2018).

According to Challa et al., (2020), the DASH diet is an essential strategy for lowering blood pressure in patients with diabetes mellitus type 2. The American Diabetic Association recommends that patients with diabetes who are at risk should achieve the US Department of Agriculture’s Dietary Reference Intake (DRI) for fiber, whole grains, and macronutrients. Moreover, these patients should limit saturated fat to < 7% total daily calories, reduce trans-fat intake, reduce cholesterol to < 200 mg/day, and limit sugar-sweetened beverages. Because the DASH diet meets these recommendations, adherence in patients with diabetes mellitus should be advocated for adequate blood pressure control (Challa et al., 2020).

Based on these studies, it is safe to say that when combined with pharmacological intervention, DASH can be a very useful tool for physicians to tackle these diseases more efficiently (Challa et al., 2020). When compared to some other diet patterns, it has an added advantage of having clear guidelines on the serving sizes and food groups, which makes it easier for the physicians to prescribe and monitor their patient’s improvement (Challa et al., 2020).

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