Dietary approaches to stop hypertension (DASH) in clinical practice: A primary care experience

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Abstract
Background: The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure placed increased emphasis on lifestyle modification for the prevention and management of hypertension. The Dietary Approaches to Stop Hypertension (DASH) diet, rich in fruits, vegetables, nuts, and low-fat dairy foods, with reduced saturated and total fats, was found in clinical trials to lower blood pressure substantially and significantly. The DASH diet appears appropriate for use in the primary care setting, although it is unknown whether results will mirror those found in clinical trial. Methods: A review of the literature of successful physician-based dietary interventions and of the Stages of Change model as it applies to dietary behavior was completed. Some changes needed to adapt the DASH diet to the outpatient family practice setting were identified and implemented among a predominantly non-Caucasian (56%), female (61%) population. The most common concerns and diagnoses among this population are essential hypertension, diabetes, and general medical examination. Results: Under study conditions, DASH reported that patients experienced an average reduction of 6 mmHg systolic and 3 mmHg diastolic blood pressure. Results were better in those with high blood pressure—systolic dropped by 11 mmHg and diastolic dropped by 6 mmHg. This reduction occurred within 2 weeks of starting the plan. Our clinical experience matches these published results. Conclusions: The DASH diet can be used successfully by patients in the primary care setting to lower blood pressure. The challenge of incorporating this intervention into primary care by more practitioners remains. The challenges for the patient and provider to sustain lifestyle modifications are formidable and also continuing.