A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure
Lawrence J. Appel, M.D., M.P.H., Thomas J. Moore, M.D., Eva Obarzanek, Ph.D., William M. Vollmer, Ph.D., Laura P. Svetkey, M.D., M.H.S., Frank M. Sacks, M.D., George A. Bray, M.D., Thomas M. Vogt, M.D., M.P.H., Jeffrey A. Cutler, M.D., Marlene M. Windhauser, Ph.D., R.D., Pao-Hwa Lin, Ph.D., Njeri Karanja, Ph.D., Denise Simons-Morton, M.D., Ph.D., Marjorie McCullough, M.S., R.D., Janis Swain, M.S., R.D., Priscilla Steele, M.S., R.D., Marguerite A. Evans, M.S., R.D., Edgar R. Miller, M.D., Ph.D., David W. Harsha, Ph.D., for The DASH Collaborative Research Group
Background It is known that obesity, sodium intake, and alcoholconsumption influence blood pressure. In this clinical trial,Dietary Approaches to Stop Hypertension, we assessed the effectsof dietary patterns on blood pressure.
Methods We enrolled 459 adults with systolic blood pressuresof less than 160 mm Hg and diastolic blood pressures of 80 to95 mm Hg. For three weeks, the subjects were fed a control dietthat was low in fruits, vegetables, and dairy products, witha fat content typical of the average diet in the United States.They were then randomly assigned to receive for eight weeksthe control diet, a diet rich in fruits and vegetables, or a"combination" diet rich in fruits, vegetables, and low-fat dairyproducts and with reduced saturated and total fat. Sodium intakeand body weight were maintained at constant levels.
Results At base line, the mean (±SD) systolic and diastolicblood pressures were 131.3±10.8 mm Hg and 84.7±4.7mm Hg, respectively. The combination diet reduced systolic anddiastolic blood pressure by 5.5 and 3.0 mm Hg more, respectively,than the control diet (P<0.001 for each); the fruits-and-vegetablesdiet reduced systolic blood pressure by 2.8 mm Hg more (P<0.001)and diastolic blood pressure by 1.1 mm Hg more (P = 0.07) thanthe control diet. Among the 133 subjects with hypertension (systolicpressure, >140 mm Hg; diastolic pressure, >90 mm Hg; orboth), the combination diet reduced systolic and diastolic bloodpressure by 11.4 and 5.5 mm Hg more, respectively, than thecontrol diet (P<0.001 for each); among the 326 subjects withouthypertension, the corresponding reductions were 3.5 mm Hg (P<0.001)and 2.1 mm Hg (P = 0.003).
Conclusions A diet rich in fruits, vegetables, and low-fat dairyfoods and with reduced saturated and total fat can substantiallylower blood pressure. This diet offers an additional nutritionalapproach to preventing and treating hypertension.
Source Information
From the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore (L.J.A.); the Department of Medicine, Brigham and Women's Hospital, Boston (T.J.M., F.M.S.); Merck and Company, Westwood, Mass. (T.J.M.); the Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md. (E.O., J.A.C.); Kaiser Permanente Center for Health Research, Portland, Oreg. (W.M.V., T.M.V., N.K.); Duke Hypertension Center (L.P.S.) and the Sarah W. Stedman Center for Nutritional Studies (P.-H.L.), Duke University Medical Center, Durham, N.C.; the Department of Nutrition, Harvard School of Public Health, Boston (F.M.S.); and the Pennington Biomedical Research Center, Baton Rouge, La. (G.A.B., M.M.W.). Other authors were Denise Simons-Morton, M.D., Ph.D. (National Heart, Lung, and Blood Institute, Bethesda, Md.); Marjorie McCullough, M.S., R.D., and Janis Swain, M.S., R.D. (Brigham and Women's Hospital, Boston); Priscilla Steele, M.S., R.D. (Beltsville Human Nutrition Research Center, U.S. Department of Agriculture, Beltsville, Md.); Marguerite A. Evans, M.S., R.D. (National Heart, Lung, and Blood Institute, Bethesda, Md.); Edgar R. Miller III, M.D., Ph.D. (Johns Hopkins University, Baltimore); and David W. Harsha, Ph.D. (Pennington Biomedical Research Center, Baton Rouge, La.).
Address reprint requests to Dr. Vollmer at the Kaiser Permanente Center for Health Research, 3800 N. Kaiser Center Dr., Portland, OR 97227-1098.
Dietary Patterns and Blood Pressure
McCarron D. A., Barzel U. S., Sharma A. M., Schorr U., Appel L. J., Moore T. J., Obarzanek E., The DASH Collaborative Research Group
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N Engl J Med 1997;
337:636-638, Aug 28, 1997.
Correspondence
Low-Fat Diets
Ornish D., Rudel L. L., Strain G. W., Connor W. E., Connor S. L., Katan M. B., Grundy S. M., Willett W. C.
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N Engl J Med 1998;
338:127-129, Jan 8, 1998.
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