Clinical Edge

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Can Sodium Reduction & DASH Diet Reduce BP?

J Am Coll Cardiol; ePub 2017 Nov 12; Juraschek, et al

The combination of reduced sodium intake and the DASH (Dietary Approaches to Stop Hypertension) diet—a diet rich in fruits, vegetables, and low-fat dairy products, and reduced in saturated fat and cholesterol—lowered systolic blood pressure (SBP) in adults throughout the range of pre- and stage 1 hypertension, with progressively greater reductions at higher levels of SBP, a recent study found. The study included 412 adults (57% women, 57% black, mean age 48 years) with a mean SBP/diastolic BP of 135/86 mm Hg. Participants were randomized to either a DASH or a control diet and were fed each of 3 sodium levels in random order over 4 weeks, separated by 5-day breaks. Researchers found:

  • In the control diet, reducing sodium (from high to low) was associated with mean SBP differences of –3.20, –8.56, –8.99, and –7.04 mm Hg across the respective baseline SBP strata listed.
  • In the context of high sodium, consuming the DASH compared with the control diet was associated with mean SBP differences of –4.5, –4.3, –4.7, and –10.6 mm Hg, respectively.
  • The combined effects of the low-sodium DASH diet vs the high sodium-control diet on SBP were –5.3, –7.5, –9.7, and –20.8 mm Hg, respectively.

Citation:

Juraschek SP, Miller ER, Weaver CM, Appel LJ. Effects of sodium reduction and the DASH diet in relation to baseline blood pressure. [Published online ahead of print November 12, 2017]. J Am Coll Cardiol. doi:10.1016/j.jacc.2017.10.011.

Commentary:

This study shows that impressive results can be achieved through the correct dietary interventions. That the low-sodium DASH diet can lower blood pressure by up to 20 mm Hg means that people who are diagnosed with both Stage 1 hypertension (systolic BP 130-139) and the lower levels of Stage 2 hypertension can adequately treat their blood pressure elevation through dietary change. Additional blood pressure lowering can be achieved though weight loss (about 5 mm Hg) and with exercise (about 5-8 mm Hg).1 The benefits of lifestyle modification are clear and robust. We now need to figure out a way to effectively talk with our patients about this in the office and insurance companies need to understand that it is important to reimburse for these discussions. —Neil Skolnik, MD

  1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. [Published online ahead of print November 13, 2017]. Hypertension. doi:10.1161/HYP.0000000000000066.

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