Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet
Frank M. Sacks, M.D., Laura P. Svetkey, M.D., William M. Vollmer, Ph.D., Lawrence J. Appel, M.D., George A. Bray, M.D., David Harsha, Ph.D., Eva Obarzanek, Ph.D., Paul R. Conlin, M.D., Edgar R. Miller, M.D., Ph.D., Denise G. Simons-Morton, M.D., Ph.D., Njeri Karanja, Ph.D., Pao-Hwa Lin, Ph.D., for The DASH–Sodium Collaborative Research Group
Background The effect of dietary composition on blood pressureis a subject of public health importance. We studied the effectof different levels of dietary sodium, in conjunction with theDietary Approaches to Stop Hypertension (DASH) diet, which isrich in vegetables, fruits, and low-fat dairy products, in personswith and in those without hypertension.
Methods A total of 412 participants were randomly assigned toeat either a control diet typical of intake in the United Statesor the DASH diet. Within the assigned diet, participants atefoods with high, intermediate, and low levels of sodium for30 consecutive days each, in random order.
Results Reducing the sodium intake from the high to the intermediatelevel 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 theDASH diet. Reducing the sodium intake from the intermediateto the low level caused additional reductions of 4.6 mm Hg duringthe control diet (P<0.001) and 1.7 mm Hg during the DASHdiet (P<0.01). The effects of sodium were observed in participantswith and in those without hypertension, blacks and those ofother races, and women and men. The DASH diet was associatedwith a significantly lower systolic blood pressure at each sodiumlevel; and the difference was greater with high sodium levelsthan with low ones. As compared with the control diet with ahigh sodium level, the DASH diet with a low sodium level ledto a mean systolic blood pressure that was 7.1 mm Hg lower inparticipants without hypertension, and 11.5 mm Hg lower in participantswith hypertension.
Conclusions The reduction of sodium intake to levels below thecurrent recommendation of 100 mmol per day and the DASH dietboth lower blood pressure substantially, with greater effectsin combination than singly. Long-term health benefits will dependon the ability of people to make long-lasting dietary changesand the increased availability of lower-sodium foods.
Source Information
From the Endocrine–Hypertension Division and the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.S., P.R.C.); the Duke Hypertension Center and the Sarah W. Stedman Center for Nutritional Studies, Duke University School of Medicine, Durham, N.C. (L.P.S., P.-H.L.); the Kaiser Permanente Center for Health Research, Portland, Oreg. (W.M.V., N.K.); the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore (L.J.A., E.R.M.); the Pennington Biomedical Research Center, Baton Rouge, La. (G.A.B., D.H.); and the Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md. (E.O., D.G.S.-M.).
Other authors were Mikel Aickin, Ph.D., Kaiser Permanente Center for Health Research, Portland, Oreg.; Marlene M. Most-Windhauser, Ph.D., Pennington Biomedical Research Center, Baton Rouge, La.; Thomas J. Moore, M.D., Merck, West Point, Pa.; and Michael A. Proschan, Ph.D., and Jeffrey A. Cutler, M.D., National Heart, Lung, and Blood Institute, Bethesda, Md.
Address reprint requests to Dr. Sacks at the Nutrition Department, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115, or at fsacks{at}hsph.harvard.edu.
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(2006). Influence of Saturated Fat and Linolenic Acid on the Association Between Intake of Dairy Products and Blood Pressure. Hypertension
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Matsui, H., Shimosawa, T., Uetake, Y., Wang, H., Ogura, S., Kaneko, T., Liu, J., Ando, K., Fujita, T.
(2006). Protective Effect of Potassium Against the Hypertensive Cardiac Dysfunction: Association With Reactive Oxygen Species Reduction. Hypertension
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Chiuve, S. E., McCullough, M. L., Sacks, F. M., Rimm, E. B.
(2006). Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men: Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications. Circulation
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Estruch, R., Martinez-Gonzalez, M. A., Corella, D., Salas-Salvado, J., Ruiz-Gutierrez, V., Covas, M. I., Fiol, M., Gomez-Gracia, E., Lopez-Sabater, M. C., Vinyoles, E., Aros, F., Conde, M., Lahoz, C., Lapetra, J., Saez, G., Ros, E., for the PREDIMED Study Investigators*,
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Lichtenstein, A. H., Appel, L. J., Brands, M., Carnethon, M., Daniels, S., Franch, H. A., Franklin, B., Kris-Etherton, P., Harris, W. S., Howard, B., Karanja, N., Lefevre, M., Rudel, L., Sacks, F., Van Horn, L., Winston, M., Wylie-Rosett, J.
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Goldstein, L. B., Adams, R., Alberts, M. J., Appel, L. J., Brass, L. M., Bushnell, C. D., Culebras, A., DeGraba, T. J., Gorelick, P. B., Guyton, J. R., Hart, R. G., Howard, G., Kelly-Hayes, M., Nixon, J.V., Sacco, R. L.
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Dobesh, P. P.
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Chang, H.-Y., Hu, Y.-W., Yue, C.-S. J., Wen, Y.-W., Yeh, W.-T., Hsu, L.-S., Tsai, S.-Y., Pan, W.-H.
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Zillich, A. J., Haines, S. T.
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Goldstein, L. B., Adams, R., Alberts, M. J., Appel, L. J., Brass, L. M., Bushnell, C. D., Culebras, A., DeGraba, T. J., Gorelick, P. B., Guyton, J. R., Hart, R. G., Howard, G., Kelly-Hayes, M., Nixon, J.V., Sacco, R. L.
(2006). Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline.. Stroke
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Hollenberg, N. K.
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Morris, R. C. Jr., Schmidlin, O., Frassetto, L. A., Sebastian, A.
(2006). Relationship and Interaction between Sodium and Potassium.. J. Am. Coll. Nutr.
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Giampaoli, S., Palmieri, L., Panico, S., Vanuzzo, D., Ferrario, M., Chiodini, P., Pilotto, L., Donfrancesco, C., Cesana, G., Sega, R., Stamler, J.
(2006). Favorable Cardiovascular Risk Profile (Low Risk) and 10-Year Stroke Incidence in Women and Men: Findings from 12 Italian Population Samples. Am J Epidemiol
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