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DASH Diet: A Review of Its Scientifically Proven Hypertension Reduction and Health Benefits

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Olutomiwa Omokore at Babcock University
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Oluwatobi Odunaike at Manchester Metropolitan University
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The Dietary Approach to Stop Hypertension (DASH) constitutes a nonpharmacological dietary strategy tailored with the primary objective of mitigating hypertension and averting its potential complications. Numerous clinical studies, such as the PREMIER trial, DASH sodium study, and OmniHeart trial, as well as other studies, substantiate the DASH diet's ability to manage hypertension. Beyond its profound impact on hypertension reduction, the DASH diet has exhibited notable efficacy in addressing an array of conditions such as heart failure, lipid homeostasis, dyslipidemia, and uric acid dysregulation. With its empirical foundation, the DASH diet emerges as an indispensable tool in the hypertension management toolkit, warranting its exploration and integration into various medical contexts. This review commences with an overview of both the DASH diet and the significance of hypertension as a prevailing health concern. The ensuing discussion meticulously examines the extensive body of clinical research, firmly establishing the DASH diet's prowess in hypertension management. Furthermore, this review delves into the strategic approaches necessary for the successful implementation of the DASH diet, outlining the roles of technology and governmental responsibilities in ensuring its widespread adoption. As a comprehensive examination of the DASH diet's efficacy and potential, this review underscores its significance in modern healthcare paradigms.
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DASH Diet: A Review of Its Scientifically Proven
Hypertension Reduction and Health Benefits
Chidera Onwuzo , John O. Olukorode , Olutomiwa A. Omokore , Oluwatobi S. Odunaike , Raymond
Omiko , Osadebamwen W. Osaghae , Walid Sange , Dolapo A. Orimoloye , Heritage O. Kristilere ,
Ehizobhen Addeh , Somtochukwu Onwuzo , Lisa Omoragbon
1. Internal Medicine, Benjamin S. Carson (Snr) College of Health and Medical Sciences, Ilishan-Remo, NGA 2. Internal
Medicine, General Hospital Lagos Island, Lagos, NGA 3. Internal Medicine, K. J. Somaiya Medical College and Research
Centre, Mumbai, IND 4. Internal Medicine, College of Medicine University of Lagos, Lagos, NGA 5. Internal Medicine,
Cleveland Clinic Foundation, Cleveland, USA
Corresponding author: Chidera Onwuzo, chionwuzo@gmail.com
Abstract
The Dietary Approach to Stop Hypertension (DASH) constitutes a nonpharmacological dietary strategy
tailored with the primary objective of mitigating hypertension and averting its potential complications.
Numerous clinical studies, such as the PREMIER trial, DASH sodium study, and OmniHeart trial, as well as
other studies, substantiate the DASH diet's ability to manage hypertension. Beyond its profound impact on
hypertension reduction, the DASH diet has exhibited notable efficacy in addressing an array of conditions
such as heart failure, lipid homeostasis, dyslipidemia, and uric acid dysregulation. With its empirical
foundation, the DASH diet emerges as an indispensable tool in the hypertension management toolkit,
warranting its exploration and integration into various medical contexts.
This review commences with an overview of both the DASH diet and the significance of hypertension as a
prevailing health concern. The ensuing discussion meticulously examines the extensive body of clinical
research, firmly establishing the DASH diet's prowess in hypertension management. Furthermore, this
review delves into the strategic approaches necessary for the successful implementation of the DASH diet,
outlining the roles of technology and governmental responsibilities in ensuring its widespread adoption. As
a comprehensive examination of the DASH diet's efficacy and potential, this review underscores its
significance in modern healthcare paradigms.
Categories: Cardiology, Internal Medicine, Preventive Medicine
Keywords: benefit of dash diet, approach to dash diet, clinical trials, dash diet, hypertension
Introduction And Background
The Dietary Approach to Stop Hypertension (DASH) diet, originally formulated by the National Institutes of
Health (NIH), highlights a comprehensive intake of nutrient-rich foods. Aligned with heart-healthy
guidelines, this dietary approach restricts saturated fat and cholesterol consumption. A central tenet of the
diet involves enhancing the intake of nutrient-dense foods recognized for their influence on reducing blood
pressure. These foods are typically high in minerals such as potassium, calcium, and magnesium, as well as
protein and dietary fiber. Notably, the DASH diet is designed to encompass a food spectrum that aligns with
the nutritional guidelines recommended by the Institute of Medicine [1].
With its foundation rooted in evidence-based research, the DASH diet encourages the intake of fruits,
vegetables, whole grains, lean proteins, and low-fat dairy products while reducing sodium, sugary
beverages, and processed foods. By adhering to these dietary principles, individuals are encouraged to
achieve and maintain optimal blood pressure levels [1].
Hypertension as a health concern
According to the guidelines provided by the American College of Cardiology (ACC) and the American Heart
Association (AHA), hypertension is diagnosed when blood pressure consistently measures ≥130 or ≥80
mmHg [3]. Approximately one in three American adults is hypertensive, consequently earning it the
ominous label of the silent killer due to its tendency to often manifest without obvious symptoms until
complications like heart disease, stroke, kidney disease, and even vision impairment arise [2].
Review
Scientific evidence of the benefit of the DASH diet in hypertension
management
The DASH diet has emerged as a prominent dietary strategy for managing hypertension and promoting
cardiovascular health. These pieces of scientific evidence serve to substantiate this claim.
1, 2 1 1 1
1 1 3 4 1
1 5 1
Open Access Review
Article DOI: 10.7759/cureus.44692
How to cite this article
Onwuzo C, Olukorode J O, Omokore O A, et al. (September 04, 2023) DASH Diet: A Review of Its Scientifically Proven Hypertension Reduction
and Health Benefits. Cureus 15(9): e44692. DOI 10.7759/cureus.44692
The PREMIER trial investigated the effects of lifestyle interventions, including the DASH diet, on blood
pressure reduction. This landmark study involved 810 participants with prehypertension (120-139/80-89
mmHg) and stage 1 hypertension (140-149/90-95 mmHg). The participants were assigned to different
groups: the Advice only group, the established group (consisting of weight loss, increased physical activity,
and reduced sodium and alcohol intake), and the established plus DASH diet group. Findings showed a
decrease in the systolic blood pressure of 6.6 mmHg in the Advice only group, 10.1 mmHg in the established
group, and 11.1 mmHg in the established plus DASH diet group [4].
The DASH-Sodium trial specifically examined the impact of sodium intake in combination with the DASH
diet on blood pressure. This trial included three groups: a control group on a typical American diet, a group
on the DASH diet with higher sodium intake, and a group on the DASH diet with lower sodium intake. The
results revealed that the DASH diet alone led to a significant reduction in blood pressure. However, when
combined with sodium reduction, the blood pressure reduction was even greater. Participants following the
DASH diet with low sodium intake experienced an average systolic blood pressure reduction of 7.1 mmHg in
those without hypertension and 11.5 mmHg in those with hypertension [5].
The OmniHeart trial aimed to evaluate the effects of three different diets, including a variation of the DASH
diet, on blood pressure and cardiovascular risk factors. This trial explored the impact of a protein,
unsaturated fats, and carbohydrate-rich diet on participants with hypertension or prehypertension. Results
indicated that all three diets contributed to improved blood pressure levels with greater reduction seen with
the modified DASH diet than the DASH diet alone [6].
Saneei et al. conducted a systematic review and random effects meta-analysis to evaluate the impact of the
DASH diet on blood pressure. Their study encompassed 17 randomized controlled trials (RCTs) involving
2,561 participants. The results of their meta-analysis indicated a statistically significant reduction in
systolic blood pressure by 6.74 mmHg and diastolic blood pressure by 3.54 mmHg. Moreover, subgroup
analysis revealed that RCTs incorporating energy restriction and hypertensive subjects exhibited more
pronounced reductions in blood pressure. Additionally, baseline blood pressure levels were identified as
significant contributors to inter-study variance. These findings show the potential of the DASH diet in
reducing blood pressure, albeit with varying degrees contingent upon factors such as energy intake and
participants' initial blood pressure levels [7].
Blumenthal et al. elucidated the combined effects of the DASH diet, exercise, and weight loss on blood
pressure and cardiovascular biomarkers. Participants in the ENCORE study were overweight individuals with
above-normal blood pressure. The study involved three groups: DASH diet alone, DASH diet with behavioral
weight management, and usual diet control. Clinic-measured blood pressure changes were substantial in the
active treatment groups, with the DASH diet combined with weight management showing the most
significant reductions. Adjusted changes in systolic blood pressure were 16.1, 11.2, and 3.4 mmHg for the
respective groups. Importantly, the combined approach demonstrated improvements in vascular and
autonomic functions, alongside a reduction in left ventricular mass, underscoring the added benefits of
incorporating exercise and weight management with the DASH diet for overweight individuals with high
blood pressure [8].
Furthermore, a study published in the American Heart Association Journal in 2001 investigated the efficacy of
the DASH diet in treating Stage 1 Isolated Systolic Hypertension (ISH). Among 459 participants from the
DASH trial, 72 individuals with ISH were identified. During the intervention period, the DASH diet group
experienced a significant decrease in systolic blood pressure by 11.8 ± 9.3 mmHg and a notable reduction in
diastolic blood pressure. While urinary sodium levels remained consistent across groups, urinary potassium
levels increased in the fruits/vegetables and DASH diet groups [9].
Other health benefits of the DASH diet
Beyond its renowned efficacy in reducing blood pressure, emerging evidence has unveiled a broader
spectrum of health benefits associated with the DASH diet. It has exhibited discernible effects on lipid
profiles, resulting in reductions in low-density lipoprotein (LDL) and triglyceride concentrations [10]. While
improvements in high-density lipoprotein (HDL) and total cholesterol were not statistically significant, the
diet showcased a reduction of approximately 13% in the estimated 10-year risk of cardiovascular disease
[11].
Moreover, adopting the DASH dietary pattern has been associated with a diminished incidence of heart
failure in individuals under 75 years of age [12], alongside a decrease in the prevalence of heart failure-
related hospitalization and mortality in men [13].
The amalgamation of the DASH diet and reduced sodium intake has exhibited complementary effects on
decreasing bone turnover, leading to improved bone mineral status. This effect was observed through
reductions in serum osteocalcin, C-terminal telopeptide of type 1 collagen, serum parathyroid hormone
(PTH) levels, and urinary calcium [14].
2023 Onwuzo et al. Cureus 15(9): e44692. DOI 10.7759/cureus.44692 2 of 6
The DASH diet extends to the reduction of uric acid levels. An RCT by Tang et al. showcased that the
introduction of the DASH diet led to notable decreases in uric acid levels at both 30 and 90 days. This implies
its potential recommendation for patients with hyperuricemia or gout [15]. Furthermore, multiple studies
have consistently demonstrated the DASH diet's association with lower all-cause mortality rates [16].
Approaches for effective DASH implementation
The significance of the DASH diet in managing hypertension and overall health is undeniable. It’s crucial to
recognize that effectively implementing the DASH diet goes beyond theoretical knowledge. It necessitates a
practical approach encompassing early presentations, counseling, technological integration, and
government support. These recommendations would be discussed under the following sections.
Early Presentation and Assessment
Practical considerations for implementing the DASH diet begin with the initial step of referring the patient
to a registered dietitian for an assessment of their suitability for the DASH diet plan. Subsequent steps
involve calculating the individual's caloric requirements and engaging in a detailed discussion about meal
planning benefits, setting weight goals, and utilizing shopping lists to achieve established targets. Further
enlightenment on healthy cooking habits and possible enrollment in such classes would be beneficial
(Figures 1-2) [17].
FIGURE 1: The daily nutrient goals for a 2,100-calorie eating plan used
in the DASH studies.
Source: [1].
DASH, Dietary Approach to Stop Hypertension
2023 Onwuzo et al. Cureus 15(9): e44692. DOI 10.7759/cureus.44692 3 of 6
FIGURE 2: A typical example of a DASH eating plan.
Source: [2].
DASH, Dietary Approach to Stop Hypertension
Counseling and Education
To further enhance the successful implementation of the DASH dietary plan for hypertensive adults, it
becomes imperative to incorporate effective counseling and education. The United States Preventive
Services Task Force classifies counseling into brief, medium-intensity, and high-intensity sessions. Brief
sessions, typically around five minutes during medical visits, propose achievable lifestyle changes. Medium-
intensity sessions, lasting at least 30 minutes, involve group or individual discussions, guided by trained
dietitians and primary care experts. These sessions encompass focused group discussions, motivational
interviewing, and motivational counseling. Taking intensity a step further, High-Intensity Sessions extend
over up to six years, delivering a profound impact. Noteworthy examples include organizing workshops,
seminars, and retreats, supplemented by vital follow-ups [18].
Technology Integration
In our society today, the impact of technology and digital revolution cannot be overstated in every aspect of
life. As such, a recent study outlines the innovation of technology in the application of the DASH diet. It
describes a system with relevant factors considered due to recommendations for the dietary plan. A mobile
application with data storage allows people to engage with user interface software and input data into the
system which then generates recommendations using DASH dietary guidelines. The convenience of use in
mobile phones, as they are integral to everyday life, makes it practical. Cloud-based database systems are
used for storage and authentication. The incorporation of user profiles and the development of a DASH Diet
Food Database are additional solutions made possible through technological innovation [19].
Governmental Support
Governmental policies have also been helpful to the propagation of the DASH diet in places where they are
optimally active. One of such priority policies that have been advocated for in the DASH studies is the
availability of its constituent components across multiple retail outlets and grocery stores. In addition, it is
consistent with many global recommendations on healthy and optimal living, which were declared by
several organizations that are world leaders. Some of these recommendations include the Dietary Guidelines
for Americans, the National Cancer Institute, and the National Cholesterol Education Program’s Step 2
Diet [20].
Conclusions
The DASH diet has been scientifically proven to be an antique but trenchant tool in the armamentarium
2023 Onwuzo et al. Cureus 15(9): e44692. DOI 10.7759/cureus.44692 4 of 6
used in the fight against hypertension. Collaterally, it is beneficial in lipid regulation, heart failure, bone
health, and uric acid homeostasis. Furthermore, its use in synergy with other pharmacological methods can
lead to even more profound results. We recommend that all general practitioners, internal medicine
specialists, dietitians, and government agencies incorporate the DASH diet into their management of
hypertension and policymaking while employing a practical approach.
Additional Information
Disclosures
Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the
following: Payment/services info: All authors have declared that no financial support was received from
any organization for the submitted work. Financial relationships: All authors have declared that they have
no financial relationships at present or within the previous three years with any organizations that might
have an interest in the submitted work. Other relationships: All authors have declared that there are no
other relationships or activities that could appear to have influenced the submitted work.
Acknowledgements
CO made substantial contributions to the study's conceptualization and article review regarding the Dietary
Approach to Stop Hypertension (DASH) diet's scientifically proven hypertension reduction and other health
benefits, playing a key role in developing the research foundation. JOO significantly contributed to the
study's design, particularly focusing on the DASH diet's health benefits for hypertension, enhancing the
research foundation. OAO involvement was crucial to abstract development, adding depth to exploring the
DASH diet's scientifically proven health benefits in hypertension. OSO played a key role in drafting the
article on the DASH diet's health benefits for hypertension, enriching our understanding of the topic. RO
was instrumental in the literature review, specifically in identifying successful DASH implementation
approaches. OWO participation in study coordination significantly bolstered scientific rigor, particularly in
exploring the DASH diet's health benefits for hypertension, enriching the research process. WS made
substantial contributions to the abstract, critically reviewing it for important intellectual content, and
strengthening the study. DAO's role in data acquisition and interpretation unveiled scientifically proven
health benefits of the DASH diet for hypertension, adding research depth. HOK review of the article ensured
robust conclusions drawn from the research. EA played a pivotal role in shaping the research direction,
ensuring a comprehensive understanding of the topic and literature review. SO role in material selection
and interpreting previous study findings was pivotal in uncovering the DASH diet's scientifically proven
health benefits for hypertension, contributing to research depth. LO's substantial contributions to the study
conception ensured a comprehensive approach to understanding the topic. All authors reviewed and
approved the final manuscript.
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Polycystic Ovary Syndrome (PCOS) is a common health condition related to a woman’s hormonal problems. Hormonal imbalance, metabolic disorders, and an increased insulin level mainly characterize the ailment. This detailed review focuses on dietary strategies, macromolecules, macromolecules, and herbal interventions that exception-ally work in PCOS treatment. Research has shown that Mediterranean, low-glycemic index, and ketogenic diets that are modified with individuals in mind are the best ways to resolve insulin resistance, obesity, and lack of ovulation. The other nutrients shown to affect glucose metabolism and play a role in hormone regulation are the macromolecules, such as increased protein and reduced refined carbs. Among the different micronutrients, vitamin D, omega-3 fatty acids, and inositol were shown to be the most vital supplements in the treatment of PCOS-induced oxidative damage, hyperandrogenism, and infertility. Not to mention, cinnamon, curcumin, sage, fennel, and traditional Chinese herbal medicine are among some of the herbal remedies that so far show good potential to be the perfect complementary therapy tools as they create better glycemic control, inflammation reduction, and menstrual cycle regularization. Even though the findings are promising, the current supply of clinical trials for standardizing these nutritional and herbal protocols is lacking. Overall, this report stresses the fact that a customized, holistic diet regime is the best treatment for women with PCOS to make them feel well and live a long and healthy life.
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... The DASH diet recommends healthy eating patterns accompanied by reduced sodium intake of between 1,500 and 2,300 mg per day in contrast to the typical American diet, where an individual may consume an average of 3,400 mg of sodium per day. 10, 11 Following the DASH diet recommendations may lead to a significant reduction in blood pressure, and there is a potential for weight reduction depending on overall energy consumption and level of physical activity. 10,12 A decrease in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels are associated with the DASH diet and may result in improved cardiac function, reduced risk of heart failure, and a reduced atherosclerotic CVD risk score (ASCVD). ...
Strategies to Manage Obesity: Lifestyle
Article
Full-text available
  • Feb 2025
The treatment of obesity and cardiovascular disease (CVD) is complex, and a variety of strategies are effective in the lifestyle interventions associated with these disease states. An interdisciplinary approach is the most effective treatment with the best results and outcomes. The lifestyle management of obesity includes interventions in nutrition, exercise, and behavioral health—all key components in managing most chronic illnesses. Effective nutrition interventions include the Mediterranean diet, DASH diet, and incorporation of more plant-based food options. Exercise is tailored to individual needs and emphasizes a gradual progression and incremental change with both aerobic and resistance training to manage weight and cardiovascular disease. Behavioral health focuses on practicing mindfulness, active self-awareness, sleep quality, stress management, and the use of therapy in overcoming barriers to success. These lifestyle factors are key in managing weight and cardiovascular disease.
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... [7] The Chinese modified termination of hypertension dietary therapy (DASH) diet is able to design the optimal dietary program for patients, improve the dietary pattern of DASH according to the dietary characteristics of Chinese residents, so as to improve the risk factors for the development of the disease, to ensure that the effect of the intervention is improved, and to restore the nutritional status of the patient's organism. [8] The Chinese modified DASH diet pays more attention to the rationality of diet and healthy nutritional balance. By learning the effects of a variety of foods on patients, which is conducive to controlling patients' blood glucose levels, comprehensively improving the DASH diet program, developing a diet plan more suitable for Chinese people, and conducting regular health education and follow-up visits to patients, changing the patients' lifestyles, enabling them to establish a positive and healthy state of mind, and promoting the improvement of patients' compliance with interventions, so as to improve the patients' health status. ...
Comparative study on blood pressure and metabolic improvements in hypertensive patients using copper bianstone scraping
Article
Full-text available
  • Jan 2025
  • MEDICINE
To evaluate the effectiveness and feasibility of the copper bianstone scraping combined with Chinese modified termination hypertension dietary therapy program by comparing and analyzing the improvement of blood pressure, blood lipids and blood glucose in hypertensive patients who received copper bianstone scraping combined with Chinese modified termination hypertension dietary therapy intervention. We selected 160 cases of hypertensive patients from July 2022 to March 2024 for the study. They were divided into 80 cases in the comparison group and 80 cases in the observation group according to whether or not they underwent copper bianstone scraping combined with Chinese modified dietary therapy for termination of hypertension. In the comparison group, conventional Chinese dietary therapy with improved termination of hypertension was used, and in the observation group, copper bianstone scraping combined with Chinese dietary therapy with improved termination of hypertension (DASH) was used on the basis of the comparison group. Differences in vitamin D, Homocysteine and serum calcium levels, blood pressure, blood glucose and lipid levels were compared between the 2 groups. The decreases of glycosylated hemoglobin, fasting blood glucose and 2-hour postprandial blood glucose in the observation group were greater than those in the comparison group; the decreases of blood pressure and BMI in the observation group were greater than those in the comparison group. The difference in comparison was statistically significant ( P -value < 0.05). After the intervention, the improvement of homocysteine, vitamin D, serum calcium, albumin, hemoglobin and transferrin in the observation group was greater than that in the comparison group, and the difference was statistically significant ( P -value < 0.05). Copper bianstone scraping combined with Chinese modified termination of hypertension dietary therapy in hypertensive patients has a better effect, can effectively improve the patient’s blood glucose and lipid levels, improve the nutritional status of the patient, can be promoted in the rehabilitation management of hypertension.
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Plant-Based Diet Quality Is Associated with Cardiometabolic Health in Adults: A Cross-Sectional Analysis of the Australian Health Survey
Article
  • May 2025
Background/Objectives: Evidence suggests that plant-based dietary patterns are beneficial for cardiometabolic health. However, it is unclear whether the quality of plant-based dietary patterns is differentially associated with cardiometabolic health. This study aimed to examine the association between three plant-based diet quality indices and cardiometabolic health among Australian adults. Methods: Data on 4877 adults (mean 45.1 years) from the cross-sectional Australian Health Survey 2011–2013 were used. Three plant-based diet quality indices (overall, healthful, and unhealthful) were derived from two 24 h dietary recalls. Anthropometric measures and blood pressure were assessed by trained interviewers. High-risk waist circumference was classified as ≥80 cm in females and ≥80 cm in males. Hypertension was defined as >140/90 mmHg. Fasting blood samples were used to estimate lipid profiles and diabetes status (based on plasma glucose or HbA1c). Multivariate logistic regression analyses were used to investigate the association between plant-based diet indices and cardiometabolic markers. Results: The healthy plant-based diet index was associated with lower odds of a high-risk waist circumference (OR 0.98; 95%CI 0.96–0.99), and the unhealthy plant-based diet index was associated with increased odds of having hypertension (OR 1.02; 95%CI 1.00–1.04). No other significant associations were identified between the plant-based diet quality indices and cardiometabolic outcomes. Conclusions: There was some evidence that the quality of plant-based dietary patterns was differentially associated with cardiometabolic health, with healthier plant-based dietary patterns associated with lower odds of a high-risk waist circumference, and less healthy plant-based dietary patterns associated with increased odds of hypertension. These findings support the consideration of the quality of plant foods consumed, and the need for targeted advice for optimising cardiometabolic health among adults.
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Evaluating the impact of the Dietary Approaches to Stop Hypertension diet versus a calorie‐restricted diet on metabolic dysfunction‐associated steatotic liver disease: A meta‐analysis of randomized controlled trials
Article
  • Dec 2024
  • HEPATOL RES
Aim Metabolic dysfunction‐associated steatotic liver disease (MASLD) can lead to increased morbidity and mortality. Diets high in refined carbohydrates and saturated fats elevate MASLD risk. The Dietary Approaches to Stop Hypertension (DASH) diet has shown metabolic benefits. This meta‐analysis evaluates the impact of the DASH diet on MASLD progression. Methods A systematic search from 2016 to 2023 across PubMed, Embase, Web of Science, and Cochrane databases was conducted to identify studies reporting on the role of the DASH diet in MASLD. Standard meta‐analysis methods were employed using a random‐effects model. Heterogeneity was assessed by I ² statistics. Results We identified five randomized controlled trials meeting inclusion criteria, involving 280 participants (140 in the DASH group and 140 in the control group). Mean ages were approximately 41 years, and the proportions of women were similar between groups. Compared with controls, the DASH diet group had a significantly reduced risk of grade 0 and 1 liver fibrosis (RR 1.21, 95% CI 1.04–1.41, p = 0.01). They also showed lower levels of aspartate aminotransferase (MD −4.81, 95% CI −6.98 to −2.64, p < 0.0001), alanine aminotransferase (MD −10.31, 95% CI −13.82 to −6.80, p < 0.00001), body mass index (MD −0.74, 95% CI −1.45 to −0.03, p = 0.04), and cholesterol‐to‐high‐density lipoprotein ratio (MD −0.40, 95% CI −0.68 to −0.11, p = 0.006). No significant differences were found for weight, waist and hip circumference, total cholesterol, low‐density lipoprotein, or high‐density lipoprotein levels. Heterogeneity was low for most outcomes ( I ² = 0%). Conclusion Based on our meta‐analysis of five randomized controlled trials, the DASH diet may reduce MASLD progression. These findings suggest it could be an effective dietary intervention for MASLD management.
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Variation in the estimated costs of pivotal clinical benefit trials supporting the US approval of new therapeutic agents, 2015–2017: a cross-sectional study
Article
Full-text available
  • Jun 2020
Objectives Little is routinely disclosed about the costs of the pivotal clinical trials that provide the key scientific evidence of the treatment benefits of new therapeutic agents. We expand our earlier research to examine why the estimated costs may vary 100-fold. Design A cross-sectional study of the estimated costs of the pivotal clinical trials supporting the approval of 101 new therapeutic agents approved by the US Food and Drug Administration from 2015 to 2017. Methods We licensed a software tool used by the pharmaceutical industry to estimate the likely costs of clinical trials to be conducted by contract research organisations. For each trial we collected 52 study characteristics. Linear regression was used to assess the most important factors affecting costs. Primary and secondary outcome measures The mean and 95% CI of 225 pivotal clinical trials using varying assumptions. We also assessed median estimated costs per patient, per clinic visit and per drug. Results Measured as pivotal trials cost per approved drug, the 101 new molecular entities had an estimated median cost of US48million(IQRUS48 million (IQR US20 million–US102million).The225individualclinicaltrialshadamedianestimateofUS102 million). The 225 individual clinical trials had a median estimate of US19 million (IQR US12million–US12 million–US33 million) per trial and US41413(IQR,US41 413 (IQR, US29 894–US$75 047) per patient. The largest single factor driving cost was the number of patients required to establish the treatment effects and varied from 4 patients to 8442. Next was the number of trial clinic visits, which ranged from 2 to 166. Our statistical model showed trial costs rose exponentially with these two variables (R ² =0.696, F=257.9, p<0.01). Conclusions The estimated costs are modest for measuring the benefits of new therapeutic agents but rise exponentially as more patients and clinic visits are required to establish a drug effect.
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Adherence to the dietary approaches to stop hypertension (DASH) diet in relation to all-cause and cause-specific mortality: A systematic review and dose-response meta-analysis of prospective cohort studies
Article
Full-text available
  • Apr 2020
  • Nutr J
Background Although previous investigations have proposed an association between Dietary Approaches to Stop Hypertension (DASH)-style diet and lower mortality from chronic diseases, the exposure-response relationship is not clear. The present systematic review and meta-analysis aimed to explore the linear and non-linear dose-response association between adherence to the DASH diet and all-cause and cause-specific mortality . Methods Database search was performed in PubMed, Scopus, and EMBASE for prospective cohort studies investigating the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and risk of mortality. Summary hazard ratios (HRs) and 95% confidence intervals (CI) were estimated with the use of a random-effects model for the linear and nonlinear relationships. The two-stage hierarchical regression model was applied to test the potential non-linear dose-response associations. Results The inclusion criteria were met by 17 studies (13 publications). The scores reported for adherence to the DASH diet in different studies were converted to a conventional scoring method in which the adherence score might range between 8 to 40. The linear analysis revealed that summary HRs were 0.95 (95% CI: 0.94–0.96, I ² = 91.6%, n = 14) for all-cause, 0.96 (95% CI: 0.95–0.98, I ² = 82.4%, n = 12) for CVD, 0.97 (95% CI: 0.96–0.98, I ² = 0.00%, n = 2) for stroke, and 0.97 (95% CI: 0.95–0.98, I ² = 63.7%, n = 12) for cancer mortality per each 5-point increment of adherence to the DASH diet. There was also evidence of non-linear associations between the DASH diet and all-cause and cause-specific mortality as the associations became even more evident when the adherence scores were more than 20 points ( P < 0.005). Conclusion Even the modest adherence to the DASH diet is associated with a lower risk of all-cause and cause-specific mortality. The higher adherence to the diet also strengthens the risk-reducing association. Registration This review was registered in the international prospective register of systematic reviews (PROSPERO) database (registration ID: CRD42018086500).
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Blood pressure and the new ACC/AHA hypertension guidelines
Article
Full-text available
  • May 2019
  • TRENDS CARDIOVAS MED
The ACC/AHA hypertension guidelines cover virtually all aspects of the diagnosis, evaluation, monitoring, secondary causes as well as drug and non-drug treatment of hypertension. Substantial and appropriate emphasis has been given to the strategies necessary for accurate measurement of blood pressure in any setting where valid blood pressure measurements are desired. Most "errors" made during blood pressure measurement bias readings upwards resulting in over-diagnosis of hypertension and, amongst those already on drug therapy, underestimating the true magnitude of blood pressure lowering resulting in over-treatment. Hypertension is diagnosed when blood pressure is consistently ≥130 and/or ≥80 mm Hg. However, the majority of patients with hypertension between 130-139/80-89 mm Hg (stage 1 hypertension) do not qualify for immediate drug therapy. The guideline breaks new ground with some of its recommendations. Absolute cardiovascular risk is utilized, for the first time, to determine high-risk status when BP 130-139/80-89 mm Hg (Stage 1 hypertension) and high-risk patient characteristics/co-morbidities are absent including age 65 and older, diabetes, chronic kidney disease, known cardiovascular disease; high-risk individuals initiate drug therapy when BP ≥ 130/80 mm Hg. The exception amongst high-risk individuals is for secondary stroke prevention in drug naïve individuals as drug therapy is initiated when blood pressure ≥140/90 mm Hg. Non-high risk individuals will initiate drug therapy when BP is ≥140/90 mm Hg. Irrespective of blood pressure threshold for initiation of drug therapy, the target BP is minimally <130/80 mm Hg in most. However, target BP is <130 systolic amongst those 65 and older as the committee made no recommendation for a DBP target. Treatment should be initiated with two drugs having complementary mechanisms of action when blood pressure is >20/10 mm Hg above goal.
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DASH Eating Plan: An Eating Pattern for Diabetes Management
Article
Full-text available
  • May 2017
The DASH (Dietary Approaches to Stop Hypertension) eating plan is an acceptable eating pattern for people who have diabetes. In addition to promoting blood pressure control, this eating pattern has been shown to improve insulin resistance, hyperlipidemia, and even overweight/obesity. This balanced approach promotes consumption of a variety of foods (whole grains, fat-free or low-fat dairy products, fruits, vegetables, poultry, fish, and nuts) and is appropriate for the entire family.
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DASH diet and change in serum uric acid over time
Article
Full-text available
  • Mar 2017
  • CLIN RHEUMATOL
The Dietary Approaches to Stop Hypertension (DASH) diet lowers serum uric acid (SUA) levels compared to the typical American (control) diet. However, the time required for the DASH diet to take effect is unknown. We analyzed data from a parallel arm, randomized-controlled trial in pre-hypertensive or hypertensive adults (N?=?103), comparing the effects of DASH or a control diet on SUA measured at 30, 60, and 90?days. Effects were examined overall and within stratified subgroups based on baseline SUA status (SUA ?6?mg/dL vs <6?mg/dL). The mean age of participants was 51.5???9.7?years, 55% were women, 75% were black, 42% were obese, and 34% had hypertension. Twenty-four of the 103 (23%) participants had a baseline SUA ?6?mg/dL. Overall, compared to the control, DASH lowered SUA by 0.5?mg/dL at 30 and 90?days. Among participants with baseline SUA ?6?mg/dL, DASH lowered SUA by 0.8 and 1.0?mg/dL at 30 and 90?days, respectively. These findings demonstrate that the DASH diet reduces SUA within 30?days, with a sustained effect at 90?days, which is informative for healthcare providers counseling patients on time course expectations for uric acid reduction in response to dietary modification.
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The Efficacy of Dietary Approaches to Stop Hypertension (DASH) Diet on Lipid Profile: A Systematic Review and Meta-analysis of Clinical Controlled Trials
Article
  • Jul 2023
  • CURR MED CHEM
Background: Dyslipidemia is considered a causal risk factor for coronary heart disease and stroke. Plant-based diets such as dietary approaches to stop hypertension (DASH) have beneficial effects on cardiovascular health. This meta-analysis was conducted to assess the effects of the DASH diet on lipid profiles based on clinical controlled trials. Methods: An inclusive online search was performed in medical databases including Web of Science, PubMed, Scopus, and Google Scholar up to October 2021 to identify trials assessing the effect of the DASH diet on lipid profiles. Results: Seventeen studies comprising 2218 individuals were included in this meta-analysis. In comparison to the control group, following the DASH diet resulted in a significant reduction in serum triglycerides (WMD: -5.539 mg/dl; 95% CI: -8.806, -2.272) and low-density lipoprotein cholesterol (WMD: -6.387 mg/dl; 95% CI: -12.272, -0.501). However, DASH diet could not reduce serum total cholesterol (WMD: -5.793 mg/dl; 95% CI: -12.84, 1.254), high-density lipoprotein cholesterol (WMD: 0.631 mg/dl; 95% CI: -0.749, 2.011), and total cholesterol/high-density lipoprotein cholesterol ratio (WMD: -0.11 mg/dl; 95% CI: -0.27, 0.05). Conclusion: Findings of this meta-analysis showed that following the DASH diet had beneficial effects on serum triglycerides and low-density lipoprotein cholesterol, however, it had no effect on serum total cholesterol and high-density lipoprotein cholesterol levels. Based on these results, the DASH diet can be considered a strategy for the prevention and complementary management of dyslipidemia.
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The Dietary Approaches to Stop Hypertension (DASH) Diet Pattern and Incident Heart Failure
Article
  • May 2021
Background: The Dietary Approaches to Stop Hypertension (DASH) diet pattern has shown some promise for preventing heart failure (HF), but studies have been conflicting. Objective: To determine whether the DASH diet pattern was associated with incident HF in a large biracial and geographically diverse population. Methods and results: Among participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study of adults aged ≥45 years who were free of suspected HF at baseline in 2003-2007, the DASH diet score was derived from the baseline food frequency questionnaire. The main outcome was incident HF defined as the first adjudicated HF hospitalization or HF death through December 31, 2016. We estimated hazard ratios for the associations of DASH diet score quartiles with incident HF, and incident HF with reduced ejection fraction and HF with preserved ejection fraction using the Lunn-McNeil extension to the Cox model. We tested for several prespecified interactions, including with age. Compared with the lowest quartile, individuals in the second to fourth DASH diet score quartiles had a lower risk for incident HF after adjustment for sociodemographic and health characteristics: quartile 2 hazard ratio, 0.69 (95% confidence interval [CI], 0.56-0.85); quartile 3 hazard ratio, 0.71 (95% CI, 0.58-0.87); and quartile 4 hazard ratio, 0.73 (95% CI, 0.58-0.92). When stratifying results by age, quartiles 2-4 had a lower hazard for incident HF among those age <65 years, quartiles 3-4 had a lower hazard among those age 65-74, and the quartiles had similar hazard among those age ≥75 years (Pinteraction = .003). We did not find a difference in the association of DASH diet with incident HF with reduced ejection fraction vs HF with preserved ejection fraction (P = .11). Conclusions: DASH diet adherence was inversely associated with incident HF, specifically among individuals <75 years old.
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Dietary Interventions on Blood Pressure: The Dietary Approaches to Stop Hypertension (DASH) Trials
Conference Paper
  • Feb 2006
The Dietary Approaches to Stop Hypertension (DASH) diet may improve health in new ways other than the obviously beneficial cardiovascular effects. The DASH diet may also reduce the risk of some cancers, and the calcium in the dairy products would help to lower the risk of osteoporosis. One of the key things that has been promoted in the DASH studies is that it is made up of regular foods that are available at most grocery stores. Additionally, the DASH diet is consistent with many of the recommendations made by organizations in the United States: the Dietary Guidelines for Americans, the National Cholesterol Education Program's Step 2 Diet, and the National Cancer Institute.
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Effects of Dietary Approaches to Stop Hypertension (DASH) diet on cardiovascular risk factors: a systematic review and meta-analysis
Article
  • Nov 2014
The Dietary Approach to Stop Hypertension (DASH) is recommended to lower blood pressure (BP), but its effects on cardiometabolic biomarkers are unclear. A systematic review and meta-analysis of randomised controlled trials (RCT) was conducted to determine the effects of the DASH diet on cardiovascular risk factors. Medline, Embase and Scopus databases were searched from inception to December 2013. Inclusion criteria were as follows: (1) DASH diet; (2) RCT; (3) risk factors including systolic and diastolic BP and glucose, HDL, LDL, TAG and total cholesterol concentrations; (4) control group. Random-effects models were used to determine the pooled effect sizes. Meta-regression analyses were carried out to examine the association between effect sizes, baseline values of the risk factors, BMI, age, quality of trials, salt intake and study duration. A total of twenty articles reporting data for 1917 participants were included in the meta-analysis. The duration of interventions ranged from 2 to 24 weeks. The DASH diet was found to result in significant decreases in systolic BP ( − 5·2 mmHg, 95 % CI − 7·0, − 3·4; P < 0·001) and diastolic BP ( − 2·6 mmHg, 95 % CI − 3·5, − 1·7; P < 0·001) and in the concentrations of total cholesterol ( − 0·20 mmol/l, 95 % CI − 0·31, − 0·10; P < 0·001) and LDL ( − 0·10 mmol/l, 95 % CI − 0·20, − 0·01; P = 0·03). Changes in both systolic and diastolic BP were greater in participants with higher baseline BP or BMI. These changes predicted a reduction of approximately 13 % in the 10-year Framingham risk score for CVD. The DASH diet improved cardiovascular risk factors and appeared to have greater beneficial effects in subjects with an increased cardiometabolic risk. The DASH diet is an effective nutritional strategy to prevent CVD.
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