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DASH Diet in Preventing Hypertension

  • January 2014
DOI:10.5829/idosi.abr.2014.8.2.8272
Authors:
V. Padma at Bharath University
V. Padma
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DASH stands for Dietary Approaches to Stop Hypertension. It is a dietary pattern promoted by National Heart, Lung and Blood Institute, United States to control and prevent hypertension. It is a healthy way in which hypertension can be prevented. It encourages you to take a diet rich in potassium, calcium and magnesium and reduce intake of sodium in your diet. DASH diet is rich in vegetables, whole grains, fruits, fish, meat, poultry, nuts, beans and low fat dairy products. DASH diet helps you to reduce your systolic blood pressure by 8 mmHg and diastolic blood pressure by 3 mmHg, which could make a lot of difference in reducing morbidity and mortality in hypertensive patients.DASH diet also prevents osteoporosis, cancer, heart disease, stroke and diabetes as it has a high quotient of antioxidant rich food. DASH diet pattern is adjusted to have a daily caloric intake from 1699 to 3100 calories.
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Advances in Biological Research 8 (2): 94-96, 2014
ISSN 1992-006
© IDOSI Publications, 2014
DOI: 10.5829/idosi.abr.2014.8.2.8272
Corresponding Author: V. Padma, Professor of Medicine, Sree Balaji Medical College,
Chrompet, Chennai-600044. Tamilnadu, India.
94
DASH Diet in Preventing Hypertension
V. Padma
Professor of Medicine, SreeBalaji Medical College, Chrompet, Chennai, India
Abstract: DASH stands for Dietary Approaches to Stop Hypertension. It is a dietary pattern promoted by
National Heart, Lung and Blood Institute, United States to control and prevent hypertension. It is a healthy way
in which hypertension can be prevented. It encourages you to take a diet rich in potassium, calcium and
magnesium and reduce intake of sodium in your diet. DASH diet is rich in vegetables, whole grains, fruits, fish,
meat, poultry, nuts, beans and low fat dairy products. DASH diet helps you to reduce your systolic blood
pressure by 8 mmHg and diastolic blood pressure by 3 mmHg, which could make a lot of difference in reducing
morbidity and mortality in hypertensive patients.DASH diet also prevents osteoporosis, cancer, heart disease,
stroke and diabetes as it has a high quotient of antioxidant rich food. DASH diet pattern is adjusted to have
a daily caloric intake from 1699 to 3100 calories.
Key words: DASH diet Hypertension Blood Pressure
INTRODUCTION
Hypertension is thought to affect around 1 billion
population world wide [1]. The relationship between
blood pressure and risk of cardiovascular disease events
is continuous, consistent and independent of other risk
factors [2].
DASH diet also prevents osteoporosis, cancer [3][4],
heart disease, stroke and diabetes[5] as it has a high
quotient of antioxidant rich food.
DASH diet [6] emphasises intake of diet rich in
fruits and vegetables and low fat dairy products,
moderate intake of poultry, fish, wholegrains and nuts.
Standard DASH Diet: DASH diet with intake of 2300
milligrams(mg) of sodium per day.
Lower Sodium DASH Diet: DASH diet with around 1500
milligram of sodium per day.
Normal diet has more than 3500 mg of sodium per
day. Both the DASH diets have lower sodium in their
regimen. The low sodium regimen is mainly used for
patients who are more than 51 years, blacks, patients with
hypertension, diabetes and chronic kidney disease.
To reduce weight the total calories should be less than
1600 per day. DASH diet has a calorie of 2000 per day.
Table 1:
Modification Approximate SBP Reduction (range)
Weight reduction 5-20mmHg/ 10kg weight loss
Adopt DASH eating plan 8-14 mmHg
Dietary sodium reduction 2-8 mmHg
Physical activity 2-9 mmHg
Moderation of alcohol consumption 2-4 mmHg
DASH diet [9],[10]:
One teaspoon of salt has 2300 mg sodium. For a low
sodium DASH diet 2/3 teaspoon of table salt would give
1500 mg of sodium.
The table below shows the changes that occurs in
bloodpressure on adopting one of the lifestyle
modification programmes for control of hypertension
[7],[8].
Recommended serving from each food group for a DASH
diet of 2000 calories:
Grains:6-8 servings per day:
One serving of grains include one ounce of dry
cereal,1/2 cup of cooked cereal, one slice whole wheat
bread,1/2 cup cooked rice and ½ cup pasta. Focus should
be on whole wheat pasta, brown rice, whole grain
bread.Avoid using cheese, cream or butter.
Advan. Biol. Res., 8 (2): 94-96, 2014
95
Fruits:4-5 servings per day. Sweets:5 or fewer per week.
Except avocado and coconut all fruits are rich in One serving is one tablespoon of sugar,one cup
fibre,potassium,magnesium and low in fat.One serving lemonade,one tablespoon jelly or jam and ½ cup sorbet.
includes one medium fruit,4 ounces of juice and ½ cup of Choose sweets with low fat like hard candy, sorbet,
frozen or canned fruits. Do not leave edible peel of fruits jelly bean etc.
like apple, pears etc. which are rich in nutrients and fibre. Reduce intake of cola or other soft drinks and replace
If you choose canned fruits and juice see to it that no them with butter milk, coconut water, low fat milk and
sugar is added. plain water.
Diary:2-3 servings per day calories but is of no nutritive value.
Diary products like milk, yogurt and cheese are rich Alcohol and caffeine:
in calcium,protein and vitamin D.One serving includes one
cup yogurt,one cup skimmed or one percent milk or half Recommended allowance is one drink per day for
ounce of cheese. Fat free cheeses are high in sodium, women and two or fewer drinks per day for men.
so be careful. Patients having lactose intolerance lactose Caffeine can cause an increase in blood pressure
free diary products are recommended. temporarily hence hypertensive patients should take
Leanmeat,fish and poultry:6 or fewer servings per
day CONCLUSION
Meat is a rich source of iron, proteins, B vitamins and DASH diet[11] is not only for control of blood
zinc. One serving includes one egg, one ounce of skinless pressure but it also helps in reduction of weight and also
poultry and one ounce of seafood. Eat more of fishes high for good health.DASH eating plan lowers blood pressure
in omega 3 fatty acids like salmon, herring and tuna. in 14 days.It has been proven that this change occurs
Instead of frying in fat, trim away skin and fat from poultry even without reducing salt intake. DASH diet with low
and meat and bake, broil, grill or roast poultry and meat. sodium helps you to reduce your systolic blood pressure
Soyabean products like tofu have all aminoacids and can by 8.9 mm Hg and diastolic blood pressure by 4.5 mmHg,
be an alternative to meat. which could make a lot of difference in reducing
Nuts,seeds and legumes:4 to 5 servings per week Hypertensive subjects experience an average reduction of
Seeds like almonds, kidney beans, peas, lentils, cancer, heart disease, stroke, kidney stones [12]
sunflower seeds and other foods are a good source of and diabetes as it has a high quotient of antioxidant
magnesium, protein and potassium. These seeds have rich food.
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... [12] Dietary Approach Stops Hypertension (DASH) gives priority to an increased intake of carbohydrate rich fruits, vegetables, low fat dairy products, moderate intake of fish, wholegrain and decrease andintake of fat cholesterol red meat, sweets [31] low sodium and high potassium, magnesium, and calcium. [15] Omega 3 poly saturated fatty acid intake of high dose because may be lower the blood pressure in hypertensive patients. [32] According to DASH standards, the diet intake of sodium should be 2300 mg/day. ...
... DASH therapy plays a main role in controlling high blood pressure and also in preventing heart diseases, stroke, diabetes, weight reduction and finally promote good health. [15] Some data suggest the prevalence a hypertension decreases according to the income of the country. Decrease in prevalence of hypertension with increase in income was observed due to increase in facilities and preventive management strategies. ...
... So proper education and awareness should be developed according to the need of the society. [15] Patient counselling suggests that increase in the physical activity, reduce stress and salt intake will ultimately lead to blood pressure control. [17] This study showed the important role of pharmacists in providing counselling to hypertensive patients to deliver a positive effect in improving the patient's understanding about medication, disease and life style changes to ultimately achieve the maximum therapeutic effect and improve the quality of life of hypertensive patients. ...
EFFECT OF PATIENTS COUNSELLING ON MEDICATION ADHERENCE AND QUALITY OF LIFE IN HYPERTENSIVE PATIENTS -A REVIEW
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Hypertension is a common non communicable chronic disease that requires monitoring regularly with a time interval to prevent complications leading to cardiovascular disease. Hypertension is a silent killer disorder and is a main public health problem. There is rapid increase in the prevalence of hypertension in rural and urban area as well as economically developed and developing countries. Objective: To develop the levels of treatment satisfaction and medication adherence through patient counselling. To review and evaluate the effect of patient counselling in hypertensive patient on medication adherence and quality of life. Method: The latest review literature and research articles on medication adherence and life style changes in hypertensive patients has been done by screening different publications such as PUB-Med, Elsevier, Scopus, Clarivate, Springer and Wiley. Result: To enhance the better knowledge of hypertension which increases medication adherence to hypertension treatment and ultimately improve general health related quality of life. Conclusion: After reviewing the different articles and research papers on the basis of patient counselling to deliver hypertensive patients that influences positive effect in improving the patient’s understanding about medication, disease, life style changes to achieve the maximum therapeutic effect, improve the quality of life of hypertensive patients and ultimately to help control high blood pressure.
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... The DASH diet is considered one of the healthiest diets in the world and was initially only used in patients with arterial hypertension and for preventing the development of arterial hypertension [9,10]. The main principles of the DASH diet plan are based on choosing foods that are low in saturated fatty acids and trans fats, high in potassium, magnesium, calcium, fiber, and protein, and low in sodium [11,12]. ...
... In a systematic review and meta-analysis of the prospective studies, Soltani et al. [20] found that even modest adherence to the DASH diet was associated with a lower risk of all-cause and cause-specific mortality, including CVD, cancer, and stroke. The health benefits associated with the DASH diet, or a similar diet, may be related to the inclusion of a large number of antioxidants in the diet [9]. The DASH diet is currently used in the treatment of overweight and obese people, as well as individuals with MetS [21,22]. ...
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The current study was designed to examine the relationship between diet quality, as measured by the Dietary Approaches to Stop Hypertension (DASH) score, and the prevalence of metabolic syndrome (MetS) and its components. The study was cross-sectional in design and enrolled 535 people, including 215 with MetS and 320 without MetS. Using a validated food frequency questionnaire, the DASH diet quality score was counted. The mean age of the MetS group and control subjects was 58.48 ± 14.65 and 58.33 ± 9.26 years, respectively. The study showed that the MetS group had a significantly lower mean total DASH score than the control group (23.13 ± 5.44 vs. 24.62 ± 5.07, p = 0.0023). In addition, it was found that an increase in the total DASH score was associated with a lower risk of MetS (odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.91–0.99, p = 0.009). In the correlation analysis of the total population, a better-quality diet (higher DASH score) was positively correlated with high-density lipoprotein cholesterol (HDL-c), and negatively correlated with triglyceride (TG) concentration and waist circumference. It was also found that an increase in the total DASH score was associated with a lower risk of abdominal obesity (OR = 0.93, 95% CI = 0.88–0.99, p = 0.017). The results from the analyzed data highlight the potential benefits of following a healthy diet such as DASH.
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... Biorąc pod uwagę wpływ orzechów na profil lipidowy krwi i na układ sercowo--naczyniowy, należy stwierdzić, że są one grupą produktów rekomendowanych do spożycia w diecie obniżającej ciśnienie tętnicze krwi -DASH (Dietary Approaches to Stop Hypertension) -w ilościach 4-5 porcji tygodniowo przy diecie 2000 kcal (Padma, 2014). ...
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... Hal ini disebabkan karena kurangnya pengetahuan dan edukasi kepada pasien mengenai perilaku diet konsumsi makanan tertentu selama menjalankan terapi pengobatan untuk menjaga kualitas hidup serta mengontrol tekanan darah pasien melalui perilaku sehari-hari. Penting dilakukan untuk meningkatkan kualitas hidup pasien dengan tercapainya outcome terapi disamping menjalani pengobatan rutin yang dilakukan, penelitian lain menyatakan bahwa perilaku diet bagi penderita hipertensi dapat menurunkan tekanan darah sistolik sebanyak 8 mmHg dan tekanan darah diastolik sebanyak 3 mmHg dalam waktu 14 hari (Padma, 2015). Kedua kelompok didominasi oleh perilaku tidak adanya kebiasaan merokok. ...
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Full-text available
  • Dec 2018
Olahraga teratur adalah cara yang baik untuk menjadikan tubuh agar tetap sehat dan bugar. Banyak penelitian yang menunjukkan bahwa olahraga secara konsisten dapat meningkatkan fungsi fisik dan mengurangi risiko terkena berbagai jenis penyakit. Akan tetapi, sebagian besar orang tidak menjadikan olahraga sebagai suatu kebiasaan. Alasan terbesar tampaknya adalah ketidaknyamanan otot dan kelelahan yang dirasakan selama latihan serta nyeri pasca-olahraga. Jika kelelahan otot bisa berkurang, diharapkan akan lebih banyak orang akan berkomitmen untuk mengikuti program latihan secara teratur. Tomat (Solanum lycopersicum) adalah salah satu sayuran yang paling banyak dikonsumsi di dunia dan mengandung banyak komponen bermanfaat, termasuk gula, asam amino, mineral, vitamin, karotenoid seperti likopen, flavonoid, dan asam hidroksinamat. Beberapa penelitian telah membuktikan kemampuan tomat untuk mengurangi efek kelelahan pasca latian fisik baik pada hewan percobaan maupun pada manusia. Tujuan dari penelitian ini untuk mengulas literatur mengenai kandungan kimia, dan efektivitas tomat dalam mengurangi kelelahan pasca olahraga melalui. Ulasan ini diharapkan bisa memberikan bibliografi yang berguna untuk penyelidikan lebih lanjut, produksi maupun aplikasi tomat sebagai suplemen makanan saat olahraga.
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... Simply, the key to the success of the DASH diet is to eat more fruits and vegetables, reduce foods that are high in saturated fat, cholesterol, and trans fats, eat more whole grain foods, fish, poultry, and nuts, limit the use of salt, sweets, sweet drinks, and red meat. The portion of the DASH diet that can be applied to the daily menu includes whole grains: 7-8 servings daily, vegetables: 4-5 servings daily, fruit: 4-5 servings daily, low-fat or fat-free dairy products: 2 -3 servings per day, meat, poultry and fish: 2 or less servings daily, nuts, seeds, and dried beans: 4-5 servings per week, fat and oil: 2-3 servings per days, and sweet foods limit to less than 5 servings per week [24]. ...
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Perilaku diet, Aktivitas Fisik dan Tekanan Darah Pasien Hipertensi di Klinik Pratama Widuri Kabupaten Sleman: Perlukah Program Lifestyle Modification?
Article
Full-text available
  • May 2018
Hipertensi adalah suatu keadaan dimana tekanan darah sistolik ≥140 mmHg dan tekanan darah diastolik ≥90 mmHg, dengan lifestyle modification sebagai salah satu tatalaksana non farmakologis utama yang dapat meningkatkan keberhasilan terapi. Penelitian ini mempunyai tujuan untuk mengetahui gambaran perilaku diet dan aktivitas fisik pasien hipertensi di Klinik Pratama Widuri Kabupaten Sleman. Penelitian ini menggunakan desain cross sectional dengan pemilihan sampel menggunakan metode simple random sampling. Total sampel sebanyak 84 responden. Kategori perilaku diet dihitung menggunakan kuesioner yang diadopsi dari Pennington Biomedical Research Center (2014), kategori aktivitas fisik dihitung menggunakan Kuesioner Baecke dan tekanan darah dihitung menggunakan spymomanometer yang telah dikalibrasi. Hasil penelitian menunjukkan pada kategori perilaku diet, responden yang memiliki perilaku diet baik sebanyak 13.1% dan responden yang memiliki perilaku diet kurang sebanyak 86.9%. Pada kategori aktivitas fisik, responden yang mempunyai aktivitas fisik ringan 70.2% dan responden yang aktivitas fisik sedang sebanyak 29,8%. Kemudian pada kategori tekanan darah, secara keseluruhan rata-rata tekanan darah pada responden adalah 153.59/90.71 mmHg yang terbagi menjadi 2 derajat yaitu hipertensi grade I (sistolik 140-159 dan/atau diastolik 90-99), hipertensi grade II (sistolik ≥160 dan/atau diastolik ≥100). Responden yang mempunyai tekanan darah tinggi grade II lebih banyak (52.4%) dibandingkan grade I (47.6%). Hasil penelitian menunjukkan bahwa perilaku diet dan aktivitas fisik pada pasien hipertensi di Klinik Pratama Widuri masih kurang dan memerlukan program Lifestyle Modification untuk meningkatkan lifestyle behavior dan keberhasilan terapi pada pasien hipertensi.
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Diet-Quality Scores and the Risk of Type 2 Diabetes in Men
Article
Full-text available
  • Apr 2011
To 1) compare associations of diet-quality scores, which were inversely associated with cardiovascular disease, with incident type 2 diabetes and 2) test for differences in absolute-risk reduction across various strata. Men from the Health Professionals Follow-Up Study, who were initially free of type 2 diabetes, cardiovascular disease, or cancer (n = 41,615), were followed for ≤ 20 years. The Healthy Eating Index (HEI) 2005, the alternative HEI (aHEI) the Recommended Food Score, the alternative Mediterranean Diet (aMED) Score, and the Dietary Approaches to Stop Hypertension (DASH) Score were calculated from food-frequency questionnaires. Cox proportional hazard models with time-varying covariates were used to assess risk by quintiles and continuous intervals. There were 2,795 incident cases of type 2 diabetes. After multivariate adjustment, the aHEI, aMED, and DASH scores were significantly associated with reduced risk. A 1-SD increase was associated with 9-13% reduced risk (P < 0.01), and the DASH score was associated with lower risk independent of other scores. These scores were associated with lower absolute risk among those who were overweight or obese compared with normal weight (P for interaction < 0.01). Several diet-quality scores were associated with a lower risk of type 2 diabetes and reflect a common dietary pattern characterized by high intakes of plant-based foods such as whole grains; moderate alcohol; and low intakes of red and processed meat, sodium, sugar-sweetened beverages, and trans fat. High-quality diets may yield the greatest reduction in diabetes cases when followed by those with a high BMI.
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Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies
Article
  • Jan 2002
The age-specific relevance of blood pressure to cause-specific mortality is best assessed by collaborative meta-analysis of individual participant data from the separate prospective studies. Methods Information was obtained on each of one million adults with no previous vascular disease recorded at baseline in 61 prospective observational studies of blood pressure and mortality. During 12.7 million person-years at risk, there were about 56 000 vascular deaths (12 000 stroke, 34000 ischaemic heart disease [IHD], 10000 other vascular) and 66 000 other deaths at ages 40-89 years. Meta-analyses, involving "time-dependent" correction for regression dilution, related mortality during each decade of age at death to the estimated usual blood pressure at the start of that decade. Findings Within each decade of age at death, the proportional difference in the risk of vascular death associated with a given absolute difference in usual blood pressure is about the same down to at least 115 mm Hg usual systolic blood pressure (SBP) and 75 mm Hg usual diastolic blood pressure (DBP), below which there is little evidence. At ages 40-69 years, each difference of 20 mm Hg usual SBP (or, approximately equivalently, 10 mm Hg usual DBP) is associated with more than a twofold difference in the stroke death rate, and with twofold differences in the death rates from IHD and from other vascular causes. All of these proportional differences in vascular mortality are about half as extreme at ages 80-89 years as at,ages 40-49 years, but the annual absolute differences in risk are greater in old age. The age-specific associations are similar for men and women, and for cerebral haemorrhage and cerebral ischaemia. For predicting vascular mortality from a single blood pressure measurement, the average of SBP and DBP is slightly more informative than either alone, and pulse pressure is much less informative. Interpretation Throughout middle and old age, usual blood pressure is strongly and directly related to vascular (and overall) mortality, without any evidence of a threshold down to at least 115/75 mm Hg.
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Acceptability of Sodium-Reduced Research Diets, Including the Dietary Approaches to Stop Hypertension Diet, among Adults with Prehypertension and Stage 1 Hypertension
Article
Examine the acceptability of sodium-reduced research diets. Randomized crossover trial of three sodium levels for 30 days each among participants randomly assigned to one of two dietary patterns. Three hundred fifty-four adults with prehypertension or stage 1 hypertension who were participants in the Dietary Approaches to Stop Hypertension (DASH-Sodium) outpatient feeding trial. Participants received their assigned diet (control or DASH, rich in fruits, vegetables, and low-fat dairy products), each at three levels of sodium (higher, intermediate, and lower) corresponding to 3,500, 2,300, and 1,200 mg/day (150, 100, and 50 mmol/day) per 2,100 kcal. Nine-item questionnaire on liking and willingness to continue the assigned diet and its level of saltiness using a nine-point scale, ranging from one to nine. Generalized estimating equations to test participant ratings as a function of sodium level and diet while adjusting for site, feeding cohort, carryover effects, and ratings during run-in. Overall, participants rated the saltiness of the intermediate level sodium as most acceptable (DASH group: 5.5 for intermediate vs 4.5 and 4.4 for higher and lower sodium; control group: 5.7 for intermediate vs 4.9 and 4.7 for higher and lower sodium) and rated liking and willing to continue the DASH diet more than the control diet by about one point (ratings range from 5.6 to 6.6 for DASH diet and 5.2 to 6.1 for control diet). Small race differences were observed in sodium and diet acceptability. Both the intermediate and lower sodium levels of each diet are at least as acceptable as the higher sodium level in persons with or at risk for hypertension.
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DASH) diets and colorectal cancer. The American V
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Adherence to a DASH style diet approaches to stop hypertension diet and incidence and risk of coronary heart disease and stroke in of heart failure in men aged 45 to 79 years. American women. Archieves of Internal medicine
  • Jan 2008
  • J Cardiol
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Fung, T.T., 2008. Adherence to a DASH style diet approaches to stop hypertension diet and incidence and risk of coronary heart disease and stroke in of heart failure in men aged 45 to 79 years. American women. Archieves of Internal medicine, 168: 713. Journal of Cardiology, 15,104(10): 1416-20.
The Mediterranean T (DASH) diets and colorectal cancer. The American V
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Lien, L.F., A.J. Brown, J.D. Ard, C. Loria, and E. Giovannucci, Dec 2010. The Mediterranean T.P. Erlinger, A.C. Feldstein, P.H. Lin, and Dietary Approaches to Stop Hypertension C.M. Champagne, A.C. King, H.L. McGuire, (DASH) diets and colorectal cancer. The American V.J. Stevens, P.J. Brantley, D.W. Harsha, Journal of Clinical Nutrition, 92(6): 1429-35.
reduces risk of colorectal adenoma
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DASH Eating Plan and Mediterranean dietary pattern 9. Dauchet, L., E. Kesse-Guyot, S. Czernichow, reduces risk of colorectal adenoma. J. Nutr., S. Bertrais, C. Estaquio, S. Péneau, A.C. Vergnaud, 137(11): 2443-50.
American Dietetic Association. Position of the Diet-quality scores and the risk of type 2 diabetes in American Dietetic Association: total diet approach to men
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E.B. Rimm and F.B. Hu, May, 2011. American Dietetic Association. Position of the Diet-quality scores and the risk of type 2 diabetes in American Dietetic Association: total diet approach to men. Diabetes Care, 34(5): 1150-6. communicating food and nutrition information.