Effects of the DASH Diet Alone and in Combination With Exercise and Weight Loss on Blood Pressure and Cardiovascular Biomarkers in Men and Women With High Blood Pressure

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Abstract
The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7)1 recommends that lifestyle modifications should be the initial treatment strategy for lowering blood pressure (BP). In addition to advocating weight reduction, physical activity, dietary sodium reduction, and moderation of alcohol consumption, as recommended by earlier guidelines,2 JNC-7 endorses the DASH (Dietary Approaches to Stop Hypertension) diet for patients with elevated BP. Evidence supporting the efficacy of this diet comes primarily from the DASH feeding trials, in which a diet high in low-fat dairy products, fruits, and vegetables; lower in fats; and rich in fiber significantly lowered clinic-measured BP with or without sodium reduction.3-5 The PREMIER study6 subsequently demonstrated that the “established”(JNC-6) lifestyle modifications and lifestyle modifications plus the DASH diet (JNC-7) were associated with larger BP reductions compared with “advice only” controls; however, the BP differences between the JNC-7 recommendations and the previously established (JNC-6) treatment recommendations were small (<1 mm Hg) and not statistically significant. Therefore, although the DASH diet has been shown to lower BP in short-term feeding studies, it has not been shown to lower BP independent of other lifestyle changes among free-living individuals. Because the clinical significance of high BP is derived from morbid events that are not directly caused by elevated BP, but rather the associated structural and functional changes in the heart and blood vessels, we also examined changes in cardiovascular biomarkers of risk.