Author + information
- James A. Blumenthal, PhD∗ (, )
- Andrew Sherwood, PhD,
- Patrick J. Smith, PhD and
- Alan Hinderliter, MD
- ↵∗Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3119, Trent Drive/Erwin Road, Durham, North Carolina 27710
Juraschek et al. (1) performed a secondary analysis of data from the Dietary Approaches to Stop Hypertension (DASH)-Sodium trial (2), in which they examined the effects of the DASH diet and different sodium levels according to baseline clinic systolic blood pressure (SBP), and reported that although reduced sodium and the DASH diet lowered SBP throughout the range of baseline SBP, the greatest reductions were observed among participants in the highest SBP stratum (≥150 mm Hg). These findings prompted us to reanalyze data from the ENCORE (Exercise and Nutrition interventions for CardiOvasculaR hEalth) trial, which randomized 144 unmedicated, overweight-obese, hypertensive adults to 1 of 3 4-month interventions: the DASH diet; the DASH diet plus a weight management program consisting of aerobic exercise and caloric restriction to promote weight loss; or usual diet control. Unlike the DASH-Sodium trial, which provided all foods to participants, participants in the ENCORE trial selected, prepared, and consumed foods on their own. We previously reported that the DASH diet alone resulted in blood pressure (BP) reductions and the DASH diet combined with weight management produced the largest BP reductions (3). In this further analysis, we observed a significant correlation between sodium reduction and lower post-treatment clinic SBP (r = 0.21; p = 0.009). Furthermore, we noted a baseline clinic SBP by sodium interaction (p = 0.045), in which greater reductions in sodium consumption were associated with larger clinic SBP reductions, especially among those participants with higher baseline clinic SBPs (Figure 1). Importantly, we also found that better adherence to the DASH diet (β = –0.24; p = 0.001), increased aerobic fitness (β = –0.30; p < 0.001), and reduced sodium consumption (β = –0.18; p = 0.012) independently predicted lower clinic SBP. These data support the findings by Juraschek et al., and also highlight the importance of exercise and weight loss, in addition to the DASH eating plan and reduced sodium, to lower BP through lifestyle modifications in unmedicated hypertensive adults.
Please note: This study was supported by National Heart, Lung, and Blood Institute grant HL122836. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2018 American College of Cardiology Foundation