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Diet as effective as drugs in hypertension control
December 3, 2017, 3:17 pm

Combining dietary approaches to stop hypertension (DASH) with a low-salt diet has been found to substantially lower systolic blood pressure — the top number in a blood pressure test — especially in people with higher baseline readings.

A study of over 400 adult participants with prehypertension, or stage 1 high blood pressure, by researchers at the John Hopkins University in the US found clear evidence that dietary interventions were as effective as — or in some cases, more effective than — antihypertensive drugs, especially in people at highest risk for high blood pressure. The researchers suggest that this should be a routine first-line treatment option for such patients.

The Dietary Approaches to Stop Hypertension (DASH) diet, is rich in fruits, vegetables and whole grains, along with low-fat or fat-free dairy, fish, poultry, beans, seeds and nuts. While both low-sodium and DASH diets have long been known to prevent or lower high blood pressure, the new study shows the effect of combining the two diets in adults with early or modest forms of high blood pressure.

Investigators put all participants on the DASH diet or a control diet for 12 weeks. All participants were also fed 1,150mg, 2,300mg and 3,450mg of sodium in random order over four-week periods. For reference, a teaspoon of salt is equal to 2,400mg of sodium and is the maximum level of sodium intake that doctors recommend, in particular if you are susceptible to hypertension. Participants were sorted into four groups based on their baseline systolic blood pressure: 120-129, 130-139, 140-149 and 150 or greater, baseline systolic blood pressure.

After four weeks, the investigators found that the group with 150 or greater baseline systolic blood pressure on just the DASH diet had an average of 11mm Hg reduction in systolic blood pressure compared to a 4mm Hg reduction in those solely on the DASH diet, but whose baseline systolic pressures were less than 130.

When the researchers combined the DASH diet with the low-sodium diet and compared participants' blood pressures to those on the high-sodium control diet, they found that the group with less than 130 systolic blood pressure at baseline had a 5 mm Hg reduction in systolic blood pressure; the group with 130-139 mm Hg baseline systolic blood pressure had a 7 mm Hg reduction; and the group with baseline systolic blood pressure between 140-149 had a 10 mm Hg reduction.

Most surprisingly, a participant who had a baseline systolic blood pressure of 150 or greater and was consuming the combination low-sodium/DASH diet had an average reduction of 21 mm Hg in systolic blood pressure compared to the high-sodium control diet.

To put the potential impact of the findings into context, the FDA requires any new antihypertensive agent submitted for approval to lower systolic blood pressure by 3-4mm Hg. Most established medications on the market, such as ACE inhibitors, beta-blockers, or calcium channel blockers, on average reduce systolic blood pressure by 10-15mm Hg. The combined dietary intervention resulted in a reduction in systolic blood pressure as high as, if not greater than, that achieved with prescription drugs," said a researcher.

The researchers caution that further studies with larger sample sizes are needed to investigate the impact of the low-sodium/DASH diet on people with higher baseline figures and on those with cardiovascular diseases.

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