title: The DASH diet enhances the blood pressure response to losartan in hypertensive patients. The Effect of Dietary Patterns on Estimated Coronary Heart Disease Risk: Results From the Dietary Approaches to Stop Hypertension (DASH) Trial Blood pressure change with weight loss is affected by diet type in men. Blood pressure response to dietary modifications in free-living individuals. Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2 Effects of the Dietary Approaches to Stop Hypertension Diet Alone and in Combination With Exercise and Caloric Restriction on Insulin Sensitivity and Lipids Effects of the Dietary Approaches to Stop Hypertension (DASH) Eating Plan on Cardiovascular Risks Among Type 2 Diabetic Patients DASH Diet Lowers Blood Pressure and Lipid-Induced Oxidative Stress in Obesity DASH Lowers Blood Pressure in Obese Hypertensives Beyond Potassium, Magnesium and Fiber DASH for asthma: a pilot study of the DASH diet in not-well-controlled adult asthma. Effect of the DASH Diet on Pre- and Stage 1 Hypertensive Individuals in a Free-Living Environment A randomized controlled clinical trial investigating the effect of DASH diet on insulin resistance, inflammation, and oxidative stress in gestational diabetes. Effects of the Dietary Approaches to Stop Hypertension (DASH) Diet on the Pressure-Natriuresis Relationship A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. Blood Pressure-Lowering Mechanisms of the DASH Dietary Pattern Low Sodium DASH Reduces Oxidative Stress and Improves Vascular Function in Salt-Sensitive Humans Low-sodium Dietary Approaches to Stop Hypertension-type diet including lean red meat lowers blood pressure in postmenopausal women. Does the DASH diet lower blood pressure by altering peripheral vascular function? 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: the ENCORE study. Favourable effects of the Dietary Approaches to Stop Hypertension diet on glucose tolerance and lipid profiles in gestational diabetes: a randomised clinical trial. Dietary Approaches to Stop Hypertension (DASH) diet: applicability and acceptability to a UK population. Effect of Dietary Sodium Intake on Blood Lipids: Results From the DASH–Sodium Trial Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. The Dietary Approaches to Stop Hypertension eating plan affects C-reactive protein, coagulation abnormalities, and hepatic function tests among type 2 diabetic patients.
abstract: BACKGROUND The Dietary Approaches to Stop Hypertension ( DASH ) diet , which emphasizes fruits , vegetables , and low fat dairy products , significantly lowers blood pressure ( BP ) . We conducted a clinical trial to assess the BP response to the DASH diet with an antihypertensive medication , losartan , in participants with essential hypertension . METHODS A total of 55 hypertensive participants were r and omly assigned to 8 weeks of controlled feeding with either a control diet or the DASH diet . Within each diet arm , participants received losartan 50 mg daily or placebo for 4 weeks each , in double blind , r and omized , cross-over fashion . Twenty-four-hour ambulatory BP ( ABP ) was measured at the end of a 2-week run-in period ( baseline ) and after each 4-week intervention period . RESULTS There was no significant change in ABP during the placebo period on the control diet ( n = 28 ) ( -2.3 + /- 1.5/-1.6 + /- 1.0 mm Hg ) , but there was a significant reduction in systolic ABP ( -5.3 + /- 1.5 mm Hg , P < .05 ) and no change in DBP ( -2.5 + /- 1.0 mm Hg ) on the DASH diet ( n = 27 ) . Losartan significantly reduced ABP on the control diet ( -6.7 + /- 1.5/-3.7 + /- 1.0 mm Hg , P < .05 ) and to a greater extent on the DASH diet ( -11.7 + /- 1.5/-6.9 + /- 1.0 mm Hg , P < .05 versus basal and control diet ) particularly in African Americans . On the DASH diet , DeltaSBP on losartan was inversely related to basal plasma renin activity ( n = -0.53 , P = .004 ) . CONCLUSIONS The DASH diet enhances the ABP response to losartan in essential hypertension . This effect is particularly marked in African Americans Background —The Dietary Approaches to Stop Hypertension ( DASH ) diet is recommended in the 2005 US Dietary Guidelines . To underst and the potential benefits of DASH on coronary heart disease ( CHD ) , we applied the Framingham risk equations to calculate 10-year risk of developing CHD using data from the DASH trial . Methods and Results —In the DASH trial , 459 individuals with prehypertension or stage-1 hypertension not taking antihypertensive medication were r and omly assigned to 1 of 3 diets : control , fruits and vegetables ( F/V ) , or DASH ( rich in fruits , vegetables , low-fat dairy , and reduced in fats and cholesterol ) . Weight was held constant . Estimated 10-year CHD risk was the primary outcome of this secondary analysis . Among 436 participants with complete data , mean ( SD ) age was 44.7 ( 10.7 ) years , 51 % were male , and 60 % were African-American .  Median 10-year CHD risk was 0.98 % at baseline and decreased in all groups . Compared with control , the relative risk ratio comparing 8-week with baseline 10-year CHD risk was 0.93 ( 95 % confidence interval , 0.85 to 1.02 ; P=0.12 ) for F/V and 0.82 ( 95 % confidence interval , 0.75 to 0.90 ; P<0.001 ) for DASH . Comparing DASH with F/V , the relative risk ratio was 0.89 ( 95 % confidence interval , 0.81 to 0.97 ; P=0.012 ) . With the exception of an interaction between dietary pattern and race suggesting a greater risk reduction in blacks than whites ( P for interaction=0.038 ) , results were similar across subgroups . Conclusions —Compared with control and F/V , the DASH diet reduced estimated 10-year CHD risk by 18 % and 11 % , respectively . In addition to reducing blood pressure , the DASH diet should substantially reduce the risk of CHD . Clinical Trial Registration —URL : http:// clinical trials.gov . Unique identifier : NCT00000544 BACKGROUND Weight loss reduces blood pressure , and the Dietary Approaches to Stop Hypertension ( DASH ) diet has also been shown to lower blood pressure . OBJECTIVE Our goal was to assess the effect on blood pressure of 2 weight-reduction diets : a low-fat diet ( LF diet ) and a moderate-sodium , high-potassium , high-calcium , low-fat DASH diet ( WELL diet ) . DESIGN After baseline measurements , 63 men were r and omly assigned to either the WELL or the LF diet for 12 wk , and both diet groups undertook 0.5 h of moderate physical activity on most days of the week . RESULTS Fifty-four men completed the study . Their mean ( + /-SD ) age was 47.9 + /- 9.3 y ( WELL diet  , n = 27 ; LF diet , n = 27 ) , and their mean baseline home systolic and diastolic blood pressures were 129.4 + /- 11.3 and 80.6 + /- 8.6 mm Hg , respectively . Body weight decreased by 4.9 + /- 0.6 kg ( + /-SEM ) in the WELL group and by 4.6 + /- 0.6 kg in the LF group ( P < 0.001 for both ) . There was a greater decrease in blood pressure in the WELL group than in the LF group [ between-group difference ( week 12 -baseline ) in both SBP ( 5.5 + /- 1.9 mm Hg ; P = 0.006 ) and DBP ( 4.4 + /- 1.2 mm Hg ; P = 0.001 ) ] . CONCLUSIONS For a comparable 5-kg weight loss , a diet high in low-fat dairy products , vegetables , and fruit ( the WELL diet ) result ed in a greater decrease in blood pressure than did the LF diet . This dietary approach to achieving weight reduction may confer an additional benefit in reducing blood pressure in those who are overweight A diet rich in fruits , vegetables , and low-fat dairy foods has been shown to lower blood pressure ( BP ) when all foods are provided . We compared the effect on BP ( measured at home ) of 2 different self-selected diets : a low-sodium , high-potassium diet , rich in fruit and vegetables ( LNAHK ) and a high-calcium diet rich in low-fat dairy foods ( HC ) with a moderate-sodium , high-potassium , high-calcium DASH-type diet , high in fruits , vegetables and low-fat dairy foods ( OD ) . Subjects were r and omly allocated to 2 test diets for 4 wk , the OD and either LNAHK or HC diet , each preceded by a 2 wk control diet ( CD ) . The changes in BP between the preceding CD period and the test diet period ( LNAHK or HC ) were compared with the change between the CD and the OD periods . Of the 56 men and 38 women that completed the OD period , 43 completed the LNAHK diet period and 48 the HC diet period . The mean age was 55.6 + /- 9.9 ( + /-SD ) years . There was a fall in systolic pressure between and the CD and OD [ -1.8 + /- 0.5 mm Hg ( P < 0.001 ) ] . Compared with OD , systolic and diastolic BPs fell during the LNAHK diet period [ -3.5 + /- 1.0 ( P < 0.001 ) and -1.9 + /- 0.7 ( P < 0.05 ) mmHg , respectively ] and increased during the HC diet period [ + 3.1 + /- 0.9 ( P < 0.01 ) and + 0.8 + /- 0.6 ( P = 0.15 ) mm Hg , respectively ] . A self-selected low-sodium , high-potassium diet result ed in a greater fall in BP than a multifaceted OD , confirming the beneficial effect of dietary intervention on BP in a community setting Objective To develop and vali date version two of the QRISK cardiovascular disease risk algorithm ( QRISK2 ) to provide accurate estimates of cardiovascular risk in patients from different ethnic groups in Engl and and Wales and to compare its performance with the modified version of Framingham score recommended by the National Institute for Health and Clinical Excellence ( NICE ) . Design Prospect i ve open cohort study with routinely collected data from general practice , 1 January 1993 to 31 March 2008 . Setting 531 practice s in Engl and and Wales contributing to the national Q RESEARCH data base . Participants 2.3 million patients aged 35 - 74 ( over 16 million person years ) with 140 000 cardiovascular events . Overall population ( derivation and validation cohorts ) comprised 2.22 million people who were white or whose ethnic group was not recorded , 22 013 south Asian , 11 595 black African , 10 402 black Caribbean , and 19 792 from Chinese or other Asian or other ethnic groups . Main outcome measures First ( incident ) diagnosis of cardiovascular disease ( coronary heart disease , stroke , and transient ischaemic attack ) recorded in general practice records or linked Office for National Statistics death certificates . Risk factors included self assigned ethnicity , age , sex , smoking status , systolic blood pressure , ratio of total serum cholesterol : high density lipoprotein cholesterol , body mass index , family history of coronary heart disease in first degree relative under 60 years , Townsend deprivation score , treated hypertension , type 2 diabetes , renal disease , atrial fibrillation , and rheumatoid arthritis . Results The validation statistics indicated that QRISK2 had improved discrimination and calibration compared with the modified Framingham score . The QRISK2 algorithm explained 43 % of the variation in women and 38 % in men compared with 39 % and 35 % , respectively , by the modified Framingham score . Of the 112 156 patients classified as high risk ( that is , ≥20 % risk over 10 years ) by the modified Framingham score , 46 094 ( 41.1 % ) would be reclassified at low risk with QRISK2 . The 10 year observed risk among these reclassified patients was 16.6 % ( 95 % confidence interval 16.1 % to 17.0%)—that is , below the 20 % treatment threshold . Of the 78 024 patients classified at high risk on QRISK2 , 11 962 ( 15.3 % ) would be reclassified at low risk by the modified Framingham score . The 10 year observed risk among these patients was 23.3 % ( 22.2 % to 24.4%)—that is , above the 20 % threshold . In the validation cohort , the annual incidence rate of cardiovascular events among those with a QRISK2 score of ≥20 % was 30.6 per 1000 person years ( 29.8 to 31.5 ) for women and 32.5 per 1000 person years ( 31.9 to 33.1 ) for men . The corresponding figures for the modified Framingham equation were 25.7 per 1000 person years ( 25.0 to 26.3 ) for women and 26.4 ( 26.0 to 26.8 ) for men ) . At the 20 % threshold , the population identified by QRISK2 was at higher risk of a CV event than the population identified by the Framingham score . Conclusions Incorporating ethnicity , deprivation , and other clinical conditions into the QRISK2 algorithm for risk of cardiovascular disease improves the accuracy of identification of those at high risk in a nationally representative population . At the 20 % threshold , QRISK2 is likely to be a more efficient and equitable tool for treatment decisions for the primary prevention of cardiovascular disease . As the validation was performed in a similar population to the population from which the algorithm was derived , it potentially has a “ home advantage . ” Further validation in other population s is therefore advised This study examined the effects of the Dietary Approaches to Stop Hypertension ( DASH ) diet on insulin sensitivity and lipids . In a r and omized control trial , 144 overweight ( body mass index : 25 to 40 ) men ( n=47 ) and women ( n=97 ) with high blood pressure ( 130 to 159/85 to 99 mm Hg ) were r and omly assigned to one of the following groups : ( 1 ) DASH diet alone ; ( 2 ) DASH diet with aerobic exercise and caloric restriction ; or ( 3 ) usual diet controls ( UC )  . Body composition , fitness , insulin sensitivity , and fasting lipids were measured before and after 4 months of treatment . Insulin sensitivity was estimated on the basis of glucose and insulin levels in the fasting state and after an oral glucose load . Participants in the DASH diet with aerobic exercise and caloric restriction condition lost weight ( −8.7 kg [ 95 % CI : −2.0 to −9.7 kg ] ) and exhibited a significant increase in aerobic capacity , whereas the DASH diet alone and UC participants maintained their weight ( −0.3 kg [ 95 % CI : −1.2 to 0.5 kg ] and + 0.9 kg [ 95 % CI : 0.0 to 1.7 kg ] , respectively ) and had no improvement in exercise capacity . DASH diet with aerobic exercise and caloric restriction demonstrated lower glucose levels after the oral glucose load , improved insulin sensitivity , and lower total cholesterol and triglycerides compared with both DASH diet alone and UC , as well as lower fasting glucose and low-density lipoprotein cholesterol compared with UC . DASH diet alone participants generally did not differ from UC in these measures . Combining the DASH diet with exercise and weight loss result ed in significant improvements in insulin sensitivity and lipids . Despite clinical ly significant reductions in blood pressure , the DASH diet alone , without caloric restriction or exercise , result ed in minimal improvements in insulin sensitivity or lipids OBJECTIVE To determine the effects of the Dietary Approaches to Stop Hypertension ( DASH ) eating pattern on cardiometabolic risks in type 2 diabetic patients . RESEARCH DESIGN AND METHODS A r and omized crossover clinical trial was undertaken in 31 type 2 diabetic patients . For 8 weeks , participants were r and omly assigned to a control diet or the DASH eating pattern . RESULTS After following the DASH eating pattern , body weight ( P = 0.007 ) and waist circumference ( P = 0.002 ) reduced significantly . Fasting blood glucose levels and A1C decreased after adoption of the DASH diet ( −29.4 ± 6.3 mg/dl ; P = 0.04 and −1.7 ± 0.1 % ; P = 0.04 , respectively ) . After the DASH diet , the mean change for HDL cholesterol levels was higher ( 4.3 ± 0.9 mg/dl ; P = 0.001 ) and LDL cholesterol was reduced ( −17.2 ± 3.5 mg/dl ; P = 0.02 ) . Additionally , DASH had beneficial effects on systolic ( −13.6 ± 3.5 vs. −3.1 ± 2.7 mmHg ; P = 0.02 ) and diastolic blood pressure ( −9.5 ± 2.6 vs. −0.7 ± 3.3 mmHg ; P = 0.04 ) . CONCLUSIONS Among diabetic patients , the DASH diet had beneficial effects on cardiometabolic risks Abstract — Evidence suggests that obesity may raise blood pressure ( BP ) through oxidative stress – sensitive mechanisms and that the Dietary Approaches to Stop Hypertension combination diet ( DASH-CD ) may decrease BP by enhancing antioxidant capacity . To address this question , 12 obese patients with high-normal – to – stage 1 hypertension ( hypertensives ) and 12 lean normotensives were studied on their usual diets and after following the DASH-CD and a low-antioxidant diet in r and om sequence for 4 weeks each . Acute oxidative stress was induced by a 4-hour infusion of intralipid and heparin  . Ferric-reducing activity of plasma ( FRAP ) and plasma F2-isoprostanes were measured as biomarkers of antioxidant capacity and oxidative stress , respectively . BP was lower in obese hypertensives on the DASH-CD than on the usual and low-antioxidant diets ( −8.1±1.5/−7.4±1.6 mm Hg , P < 0.05 ) . BP did not change significantly in lean normotensives after 4 weeks on the DASH-CD but tended to rise on the low-antioxidant diet  . FRAP on usual diets was higher in lean subjects than in obese subjects . FRAP increased in obese but not lean volunteers on the DASH-CD compared with usual diet , and the group difference disappeared . F2-isoprostanes increased from baseline during intralipid and heparin in both groups on the low-antioxidant diet but not in obese hypertensives on the DASH-CD . Among free-living obese hypertensives , the DASH-CD  raises antioxidant capacity , lowers BP , and reduces oxidative stress induced by acute hyperlipidemia . The findings are consistent with evidence that elevated BP in obese subjects may reflect an imbalance between antioxidant capacity and oxidative stress that is improved by the DASH-CD The mechanism underlying blood pressure ( BP ) reduction in the high fruits and vegetables arm of the Dietary Approaches to Stop Hypertension ( DASH ) study is unknown but may include potassium , magnesium and fibre . This study was design ed to separate minerals and fibre from other components of DASH on BP in abdominally obese individuals with metabolic syndrome with pre-hypertension to stage 1 hypertension ( obese hypertensives ) . A total of 15 obese hypertensives and 15 lean normotensives were studied on a st and ardized usual diet , r and omized to DASH or usual diet supplemented with potassium , magnesium and fibre to match DASH , then crossed over to the complementary diet . All diets were 3 weeks long , isocaloric and matched for sodium and calcium . In obese hypertensives , BP was lower after 3 weeks on DASH than usual diet ( −7.6±1.4/−5.3±1.4 mm Hg , P<0.001/0.02 ) and usual diet supplemented ( −6.2±1.4/−3.7±1.4 P<0.005/0.06 ) , whereas BP was not significantly different on usual and supplemented diets . BP values were not different among the three diets in lean normotensives . Small artery elasticity was lower in obese hypertensives than in lean normotensives on the usual and supplemented diets ( P<0.02 ) . This index of endothelial function improved in obese hypertensives ( P<0.02 ) but not lean normotensives on DASH , and was no longer different from values in lean normotensives ( P>0.50 ) . DASH is more effective than potassium , magnesium and fibre supplements for lowering BP in obese hypertensives , which suggest that high fruits and vegetables DASH  lowers BP and improves endothelial function in this group by nutritional factors in addition to potassium , magnesium and fibre This pilot study aims to provide effect size confidence intervals , clinical trial and intervention feasibility data , and procedural material s for a full-scale r and omized controlled trial that will determine the efficacy of Dietary Approaches to Stop Hypertension ( DASH ) as adjunct therapy to st and ard care for adults with uncontrolled asthma . The DASH diet encompasses foods ( e.g. , fresh fruit , vegetables , and nuts ) and antioxidant nutrients ( e.g. , vitamins A , C , E , and zinc ) with potential benefits for persons with asthma , but it is unknown whether the whole diet is beneficial . Participants ( n = 90 ) will be r and omized to receive usual care alone or combined with a DASH intervention  consisting of 8 group and 3 individual sessions during the first 3 months , followed by at least monthly phone consultations for another 3 months . Follow-up assessment s will occur at 3 and 6 months . The primary outcome measure is the 7-item Juniper Asthma Control Question naire , a vali date d composite measure of daytime and nocturnal symptoms , activity limitations , rescue medication use , and percentage predicted forced expiratory volume in 1 second . We will explore changes in inflammatory markers important to asthma pathophysiology ( e.g. , fractional exhaled nitric oxide ) and their potential to mediate the intervention effect on disease control . We will also conduct pre-specified subgroup analyses by genotype ( e.g. , polymorphisms on the glutathione S transferase gene ) and phenotype ( e.g. , atopy , obesity ) . By evaluating a dietary pattern approach to improving asthma control , this study could advance the evidence base for refining clinical guidelines and public health recommendations regarding the role of dietary modifications in asthma management Background Dietary Approaches to Stop Hypertension ( DASH ) has been shown to successfully reduce systolic ( SBP ) and diastolic blood pressure ( DBP ) when evaluated in clinical ly controlled environments but there is a lack of information regarding the efficacy of the original DASH diet when it is applied in a free-living environment . Purpose To provide descriptive data as to the changes in blood pressure individuals could expect to achieve when following the DASH diet in a free-living environment for 4-weeks with no additional behavioral modifications . Methods Twenty , pre- and stage 1 hypertensive participants were r and omly split into 2 groups ; DASH ( males N = 5 , females N = 5 , age = 38.5 ± 10.8 ) and control ( males N = 7 , females N = 3 , age = 38.1 ± 11.1 ) . The DASH group was instructed on how to follow the DASH diet on their own for 4-weeks while the control group continued their normal diet  . SBP , DBP , body weight , 3-day food diaries and physical activity recall question naire data were collected pre and post intervention using a traditional person-to-person instructional technique . Results Two-way ANOVA demonstrated that there was a significant group ( DASH , control ) by time ( pre , post ) interaction for SBP ( P = 0.003 ) and no significant effects for DBP . The interaction was due to a significant reduction ( P < 0.001 ) in SBP in the DASH group ( pre : 141.3 ± 11.3 mmHg vs. post : 130.7 ± 9.1 mmHg ) over the course of the intervention with no change in SBP in the control group ( pre : 133.5 ± 6.6 mmHg vs. post : 131.9 ± 8.9 mmHg ) . Pearson 's correlation analyses revealed that changes in potential moderators of blood pressure including body weight , BMI , sodium intake and total kilocalories were each not associated with changes in SBP ( r ≤ 0.14 , P ≥ 0.5 ) or DBP ( r < 0.10 , P ≥ 0.6 ) pre- to post-treatment . Chi-square demonstrated no significant differences in the number of participants per group ( n = 4 DASH , n = 1 control ) who indicated increasing physical activity during the intervention . Conclusion DASH diet followed in a free-living environment significantly reduced SBP but not DBP . However , the changes in SBP and DBP were very similar to those noted in controlled clinical feeding evaluations of the DASH diet . Presently , none of the potential moderators of blood pressure that were assessed were independently associated with the observed changes in blood pressure which may be due to our small sample size or the possibility that it is the combined change in multiple factors that lead to reductions in blood pressure when following the DASH diet OBJECTIVE To our knowledge , no reports are available indicating the effects of the dietary approaches to stop hypertension ( DASH ) eating plan on insulin resistance , inflammation , and oxidative stress among pregnant women with gestational diabetes mellitus ( GDM ) . This study was design ed to investigate the effects of the DASH diet on insulin resistance , serum high-sensitivity C-reactive protein ( hs-CRP ) and biomarkers of oxidative stress among pregnant women with GDM . METHODS This r and omized controlled clinical trial was performed with 32 pregnant women diagnosed with GDM at 24 to 28 wk gestation . Participants were r and omly assigned to consume either the control ( n = 16 ) or DASH diet ( n = 16 ) for 4 wk . The DASH diet was rich in fruits , vegetables , whole grains , and low-fat dairy products and was low in saturated fats , total fats , cholesterol , refined grains , and sweets , with a total of 2400 mg/d of sodium . The control diet contained 40 % to 55 % of its energy as carbohydrates , 10 % to 20 % as proteins , and 25 % to 30 % as total fats . Fasting blood sample s were taken at baseline and after 4 wk of intervention to measure fasting plasma glucose ( FPG ) , serum insulin , and hs-CRP , homeostasis model of assessment -insulin resistance ( HOMA-IR ) , plasma total antioxidant capacity ( TAC ) , and total glutathione levels ( GSH ) . RESULTS Consumption of the DASH diet compared with the control diet result ed in decreased FPG ( -7.62 versus 3.68 mg/dL ; P = 0.02 ) , serum insulin levels ( -2.62 versus 4.32 μIU/mL , P = 0.03 ) , and HOMA-IR score ( -0.8 versus 1.1 ; P = 0.03 ) . Increased concentrations of plasma TAC ( 45.2 versus -159.2 mmol/L ; P < 0.0001 ) and GSH ( 108.1 versus -150.9 μmol/L ; P < 0.0001 ) also were seen in the DASH group compared with control group . We failed to find a significant difference in mean changes of serum hs-CRP levels between the two diets . Within-group comparisons revealed significant reductions in plasma TAC and GSH levels in the control diet , while a significant increase in these biomarkers in the DASH diet . CONCLUSION Consumption of the DASH diet in pregnant women with GDM had beneficial effects on FPG , serum insulin levels , HOMA-IR score , plasma TAC , and total GSH levels . The effects of this dietary pattern on pregnancy outcomes need to be investigated in future studies Abstract —Blood pressure-lowering mechanisms of the Dietary Approaches to Stop Hypertension ( DASH ) diet , rich in fruits , vegetables , and low-fat dairy foods , were analyzed based on the pressure-natriuresis relationship . Participants ( n=375 ) were r and omly assigned to control or DASH diet groups by using a parallel-group design . They then ate their assigned diet for 3 consecutive 30-day intervention feeding periods , during which sodium intake varied among 3 levels by a r and omly assigned sequence . Urinary sodium excretion rate and mean arterial pressure were measured at the end of each sodium intake level . Mean arterial pressure and urinary sodium excretion were plotted on x and y axes , respectively , for participants eating control and DASH diets and were modeled as linear relationships for simplicity to allow the estimation of the extrapolated x-intercept and slope of the relationships . The DASH diet steepened the slope of the relationship ( 29.5±3.4 vs 64.9±13.1 [mmol/d]/mm Hg , P = 0.0002 ) without significantly shifting the x-intercept ( 94.1±0.5 vs 93.2±0.6 mm Hg , NS ) of the relationship . These data suggest a natriuretic action of the DASH diet BACKGROUND It is known that obesity , sodium intake , and alcohol consumption factors influence blood pressure . In this clinical trial , Dietary Approaches to Stop Hypertension , we assessed the effects of dietary patterns on blood pressure . METHODS We enrolled 459 adults with systolic blood pressures of less than 160 mm Hg and diastolic blood pressures of 80 to 95 mm Hg . For three weeks , the subjects were fed a control diet that was low in fruits , vegetables , and dairy products , with a fat content typical of the average diet in the United States . They were then r and omly assigned to receive for eight weeks the control diet , a diet rich in fruits and vegetables , or a " combination " diet rich in fruits , vegetables , and low-fat dairy products and with reduced saturated and total fat . Sodium intake and body weight were maintained at constant levels . RESULTS At base line , the mean ( + /-SD ) systolic and diastolic blood pressures were 131.3+/-10.8 mm Hg and 84.7+/-4.7 mm Hg , respectively . The combination diet reduced systolic and diastolic blood pressure by 5.5 and 3.0 mm Hg more , respectively , than the control diet ( P<0.001 for each ) ; the fruits- and -vegetables diet reduced systolic blood pressure by 2.8 mm Hg more ( P<0.001 ) and diastolic blood pressure by 1.1 mm Hg more than the control diet ( P=0.07 ) . Among the 133 subjects with hypertension ( systolic pressure , > or = 140 mm Hg ; diastolic pressure , > or = 90 mm Hg ; or both ) , the combination diet reduced systolic and diastolic blood pressure by 11.4 and 5.5 mm Hg more , respectively , than the control diet ( P<0.001 for each ) ; among the 326 subjects without hypertension , the corresponding reductions were 3.5 mm Hg ( P<0.001 ) and 2.1 mm Hg ( P=0.003 ) . CONCLUSIONS A diet rich in fruits , vegetables , and low-fat dairy foods and with reduced saturated and total fat can substantially lower blood pressure . This diet offers an additional nutritional approach to preventing and treating hypertension Potential blood pressure- ( BP- ) lowering mechanisms of the DASH dietary pattern were measured in 20 unmedicated hypertensive adults in a controlled feeding study . At screening , participants averaged 44.3 ± 7.8 years , BMI 33.9 ± 6.6 Kg/m2 , and BP 144.2 ± 9.38/88.5 ± 6.03 mmHg . All consumed a control diet for one week , then were r and omized to control or DASH for another two weeks ( week one and two ) . With DASH , but not  controls , SBP fell by 10.65 ± 12.89 ( P = 0.023 ) and 9.60 ± 11.23 ( P = 0.039 ) mmHg and DBP by 5.95 ± 8.01 ( P = 0.069 ) and 8.60 ± 9.13 mmHg ( P = 0.011 ) at the end of week one and two , respectively . Univariate regressions showed that changes in urinary sodium/potassium ratio ( β = 1.99 ) and plasma renin activity ( β = −15.78 ) and percent change in plasma nitrite after hyperemia were associated with SBP changes at week one ( all P < 0.05 ) . Plasma nitrite following hyperemia showed a treatment effect ( P = 0.014 ) and increased at week two ( P = 0.001 ) . Pulse wave velocity decreased over time with DASH ( trend P = 0.019 ) , and reached significance at week two ( P = 0.026 ) . This response may be mediated by an improvement in upregulation of nitric oxide bioavailability . Early natriuresis and reductions in oxidative stress can not be ruled out . Future studies are needed to verify these findings , assess the possibility of earlier effects , and examine other potential mediators Salt induces oxidative stress in salt-sensitive ( SS ) animals and man . It is not known whether in SS subjects the low-sodium dietary approaches to stop hypertension ( LS-DASH ) reduces oxidative stress more than DASH , which is high in antioxidants . To assess the effects of DASH and LS-DASH on oxidative stress , 19 volunteers were studied after 3 weeks of a st and ardized usual low fruits and vegetables diet ( ULFV ) , followed by 3 weeks on DASH ( both diets ∼120 mmol Na+ per day ) , then 3 weeks on LS-DASH ( 60 mmol Na+ per day ) . SS was defined as systolic blood pressure ⩾5 mm Hg lower on LS-DASH than DASH . In SS subjects ( N=9 ) , systolic blood pressure was lower on LS-DASH ( 111.0±2.0 mm Hg ) than DASH ( 118.0±2.2 , P<0.01 ) and ULFV ( 122.3±2.7 , P=0.002 ) . In salt-resistant ( SR ) volunteers ( N=10 ) , systolic blood pressure was lower on DASH ( 113.0±1.6 ) than ULFV ( 119.0±1.8 , P<0.05 ) but not LS-DASH ( 115.7±1.8 ) . Urine F2-isoprostanes , a marker of oxidative stress , were lower in SS subjects on LS-DASH ( 1.69±0.24 ) than ULFV ( 3.09±0.50 , P<0.05 ) and marginally lower than DASH ( 2.46±0.44 , P<0.20 ) . F2-isoprostanes were not different among the three diets in SR volunteers ( 2.18±0.29 , 2.06±0.29 , 2.27±0.53 , respectively ) . Aortic augmentation index , a measure of vascular stiffness , was lower in SS subjects on LS-DASH than either DASH or ULFV , and lower on DASH than ULFV in SR volunteers . In SS but not SR subjects , LS-DASH is associated with lower values for F2-isoprostanes and the aortic augmentation index . The results suggest that LS-DASH  decreases oxidative stress , improves vascular function and lowers blood pressure in SS but not SR volunteers Low-sodium Dietary Approaches to Stop Hypertension ( DASH ) diets are base producing but restrict red meat without clear justification . We hypothesized that a vitality diet ( VD ) , a low-sodium DASH-type diet with a low dietary acid load containing 6 servings of 100 g cooked lean red meat per week , would be more effective in reducing blood pressure ( BP ) compared with a higher acid load reference healthy diet ( RHD ) based on general dietary guidelines to reduce fat intake and increase intake of breads and cereals . A r and omized , parallel dietary intervention study was conducted to compare the BP-lowering effect of these 2 diets in postmenopausal women with high/normal BP . Women were r and omly assigned to follow either VD or RHD for 14 weeks . Home BP was measured daily with an automated BP monitor under st and ard conditions . Of 111 women commencing the study , 95 completed ( 46 VD , 49 RHD ) . Systolic BP ( SBP ) throughout the intervention was lower in the VD group compared to the RHD group ( repeated- measures analysis of variance time by diet , P = .04 ) , such that at the end of the study , the VD had a fall of SBP by 5.6 + /- 1.3 mm Hg ( mean + /- SEM ) compared with a fall of 2.7 + /- 1.0 mm Hg in the RHD ( group difference , P = .08 ) . When only those taking antihypertensive medications were assessed , the VD ( n = 17 ) had a significant fall of 6.5 + /- 2.5 mm Hg SBP ( P = .02 ) and 4.6 + /- 1.4 mm Hg diastolic BP ( P = .005 ) after 14 weeks , and their BP was lower than that of the RHD group ( n = 18 ) throughout the study ( P < .05 ) . We concluded that a low-sodium DASH diet with a low dietary acid load , which also included lean red meat on most days of the week , was effective in reducing  BP in older women , particularly in those taking antihypertensive medications We tested whether lowering of blood pressure ( BP ) on the dietary approaches to stop hypertension ( DASH ) diet was associated with changes in peripheral vascular function : endothelial function , assessed by flow-mediated vasodilatation ( FMD ) of the brachial artery , and subcutaneous adipose tissue blood flow ( ATBF ) . We also assessed effects on heart rate variability ( HRV ) as a measure of autonomic control of the heart . We allocated 27 men and women to DASH diet and control groups .  We measured FMD , ATBF and HRV on fasting and after ingestion of 75 g glucose , before and after 30 days on dietary intervention , aim ing for weight maintenance . The control group did not change their diet . The DASH-diet group complied with the diet as shown by significant reductions in systolic ( P<0.001 ) and diastolic ( P=0.005 ) BP , and in plasma C-reactive protein ( P<0.01 ) , LDL-cholesterol ( P<0.01 ) and apolipoprotein B ( P=0.001 ) , a novel finding . Body weight changed by < 1 kg . There were no changes in the control group . We found no changes in FMD , or in ATBF , in the DASH-diet group , although heart rate fell ( P<0.05 ) . Glucose and insulin concentrations did not change . In this small-scale study , the DASH diet lowered BP independently of peripheral mechanisms BACKGROUND Although the DASH ( Dietary Approaches to Stop Hypertension ) diet has been shown to lower blood pressure ( BP ) in short-term feeding studies , it has not been shown to lower BP among free-living individuals , nor has it been shown to alter cardiovascular biomarkers of risk . OBJECTIVE To compare the DASH diet alone or combined with a weight management program with usual diet controls among participants with prehypertension or stage 1 hypertension ( systolic BP , 130 - 159 mm Hg ; or diastolic BP , 85 - 99 mm Hg ) . DESIGN AND SETTING R and omized , controlled trial in a tertiary care medical center with assessment s at baseline and 4 months . Enrollment began October 29 , 2003 , and ended July 28 , 2008 . PARTICIPANTS Overweight or obese , unmedicated out patients with high BP ( N = 144 ) . INTERVENTIONS Usual diet controls , DASH diet alone , and DASH diet plus weight management . OUTCOME MEASURES The main outcome measure is BP measured in the clinic and by ambulatory BP monitoring . Secondary outcomes included pulse wave velocity , flow-mediated dilation of the brachial artery , baroreflex sensitivity , and left ventricular mass . RESULTS Clinic-measured BP was reduced by 16.1/9.9 mm Hg ( DASH plus weight management ) ; 11.2/7.5 mm ( DASH alone ) ; and 3.4/3.8 mm ( usual diet controls ) ( P < .001 ) . A similar pattern was observed for ambulatory BP ( P < .05 ) . Greater improvement was noted for DASH plus weight management compared with DASH alone for pulse wave velocity , baroreflex sensitivity , and left ventricular mass ( all P < .05 ) . CONCLUSION For overweight or obese persons with above-normal BP , the addition of exercise and weight loss to the DASH diet result ed in even larger BP reductions , greater improvements in vascular and autonomic function , and reduced left ventricular mass . CLINICAL TRIAL REGISTRATION clinical trials.gov Identifier : NCT00571844 Although gestational diabetes mellitus ( GDM ) is associated with an increased risk of maternal and neonatal morbidity , there is no consensus as to the optimal approach of nutritional management in these patients . The present study was design ed to assess the effect of the Dietary Approaches to Stop Hypertension ( DASH ) eating plan on glucose tolerance and lipid profiles of pregnant women with GDM . The present r and omised controlled clinical trial was performed among thirty-four women diagnosed with GDM at 24 - 28 weeks of gestation . Subjects were r and omly assigned to consume either the control diet ( n 17 ) or the DASH eating pattern ( n 17 ) for 4 weeks . The control diet was design ed to contain 45 - 55 % carbohydrates , 15 - 20 % protein and 25 - 30 % total fat . The macronutrient composition of the DASH diet was similar to the control diet ; however , the DASH diet was rich in fruits , vegetables , whole grains and low-fat dairy products , and contained lower amounts of saturated fats , cholesterol and refined grains with a total of 2400 mg Na/d . Fasting blood sample s were taken at baseline and after 4 weeks of intervention to measure fasting plasma glucose , glycated Hb ( HbA1c ) and lipid profiles . Participants underwent a 3 h oral glucose tolerance tests and blood sample s were collected at 60 , 120 and 180 min to measure plasma glucose levels . Adherence to the DASH eating pattern , compared with the control diet , result ed in improved glucose tolerance such that plasma glucose levels reduced at 60 ( 21·86 v. 20·45 mmol/l , Pgroup = 0·02 ) , 120 ( 22·3 v. 0·2 mmol/l , Pgroup = 0·001 ) and 180 min ( 21·7 v. 0·22 mmol/l , Pgroup = 0·002 ) after the glucose load . Decreased HbA1c levels ( 20·2 v. 0·05 % , Pgroup = 0·001 ) was also seen in the DASH group compared with the control group . Mean changes for serum total ( 20·42 v. 0·31 mmol/l , Pgroup = 0·01 ) and LDL-cholesterol ( 20·47 v. 0·22 mmol/l , Pgroup = 0·005 ) , TAG ( 20·17 v. 0·34 mmol/l , Pgroup = 0·01 ) and total : HDL-cholesterol ratio ( 20·6 ( SD 0·9 ) v. 0·3 ( SD 0·8 ) , Pgroup = 0·008 ) were significantly different between the two diets . Additionally , consumption of the DASH diet favourably influenced systolic blood pressure ( 22·6 v. 1·7 mmHg , Pgroup = 0·001 ) . Mean changes of fasting plasma glucose ( 20·29 v. 0·15 mmol/l , Pgroup = 0·09 ) were nonsignificant comparing the DASH diet with the control diet . In conclusion , consumption of the DASH eating pattern for 4 weeks among pregnant women with GDM result ed in beneficial effects on glucose tolerance and lipid profiles compared with the control diet BACKGROUND The Dietary Approaches to Stop Hypertension ( DASH ) diet is widely promoted in the USA for the prevention and treatment of high blood pressure . It is high in fruit and vegetables , low-fat dairy and wholegrain foods and low in saturated fat and refined sugar . To our knowledge , the use of this dietary pattern has not been assessed in a free-living UK population . METHODS The DASH diet was adapted to fit UK food preferences and portion sizes . Fourteen healthy subjects followed the adapted DASH diet for 30 days in which they self-selected all food and beverages .  Dietary intake was assessed by 5-day food diaries completed before and towards the end of the study . Blood pressure was measured at the beginning and end of the study to assess compliance to the DASH style diet . RESULTS The DASH diet was easily adapted to fit with UK food preferences . Furthermore , it was well tolerated and accepted by subjects . When on the DASH style diet , subjects reported consuming significantly ( P < 0.01 ) more carbohydrate and protein and less total fat ( 5 % , 6 % and 9 % total energy , respectively ) . Sodium intakes decreased by 860 mg day(-1 ) ( P < 0.001 ) . Systolic and diastolic blood pressure decreased significantly ( P < 0.05 ) by 4.6 and 3.9 mmHg , respectively when on the DASH style diet . CONCLUSIONS The DASH style diet was well accepted and was associated with a decrease in blood pressure in normotensive individuals and should be considered when giving dietary advice to people with elevated blood pressure in the UK Abstract —We evaluated the effect on serum lipids of sodium intake in 2 diets . Participants were r and omly assigned to a typical American control diet or the Dietary Approaches to Stop Hypertension ( DASH ) diet , each prepared with 3 levels of sodium ( targeted at 50 , 100 , and 150 mmol/d per 2100 kcal ) . The DASH diet is increased in fruits , vegetables , and low-fat dairy products and is reduced in saturated and total fat . Within assigned diet , participants ate each sodium level for 30 days . The order of sodium intake was r and om . Participants were 390 adults , age 22 years or older , with blood pressure of 120 to 159 mm Hg systolic and 80 to 95 mm Hg diastolic .  Serum lipids were measured at baseline and at the end of each sodium period . Within each diet , sodium intake did not significantly affect serum total cholesterol , LDL cholesterol , HDL cholesterol , or triglycerides . On the control diet , the ratio of total cholesterol-to-HDL cholesterol increased by 2 % from 4.53 on higher sodium to 4.63 on lower sodium intake ( P = 0.04 ) . On the DASH diet , sodium intake did not affect this ratio . There was no dose-response of sodium intake on serum lipids or the cholesterol ratio in either diet . At each sodium level , total cholesterol , LDL cholesterol , and HDL cholesterol were lower on the DASH diet versus the typical American diet . There were no significant interactions between the effects of sodium and the DASH diet on serum lipids . In conclusion , changes in dietary sodium intake over the range of 50 to 150 mmol/d did not affect blood lipid concentrations CONTEXT Weight loss , sodium reduction , increased physical activity , and limited alcohol intake are established recommendations that reduce blood pressure ( BP ) . The Dietary Approaches to Stop Hypertension ( DASH ) diet also lowers BP . To date , no trial has evaluated the effects of simultaneously implementing these lifestyle recommendations . OBJECTIVE To determine the effect on BP of 2 multicomponent , behavioral interventions . DESIGN , SETTING , AND PARTICIPANTS R and omized trial with enrollment at 4 clinical centers ( January 2000-June 2001 ) among 810 adults ( mean [ SD ] age , 50 [ 8.9 ] years ; 62 % women ; 34 % African American ) with above-optimal BP , including stage 1 hypertension ( 120 - 159 mm Hg systolic and 80 - 95 mm Hg diastolic ) , and who were not taking antihypertensive medications . INTERVENTION Participants were r and omized to one of 3 intervention groups : ( 1 ) " established , " a behavioral intervention that implemented established recommendations ( n = 268 ) ; ( 2 ) " established plus DASH,"which also implemented the DASH diet ( n = 269 ) ; and ( 3 ) an " advice only " comparison group ( n = 273 ) . MAIN OUTCOME MEASURES Blood pressure measurement and hypertension status at 6 months . RESULTS Both behavioral interventions significantly reduced weight , improved fitness , and lowered sodium intake . The established plus DASH intervention also increased fruit , vegetable , and dairy intake . Across the groups , gradients in BP and hypertensive status were evident . After subtracting change in advice only , the mean net reduction in systolic BP was 3.7 mm Hg ( P<.001 ) in the established group and 4.3 mm Hg ( P<.001 ) in the established plus DASH group ; the systolic BP difference between the established and established plus DASH groups was 0.6 mm Hg ( P = .43 ) . Compared with the baseline hypertension prevalence of 38 % , the prevalence at 6 months was 26 % in the advice only group , 17 % in the established group ( P = .01 compared with the advice only group ) , and 12 % in the established plus DASH group ( P<.001 compared with the advice only group ; P = .12 compared with the established group ) . The prevalence of optimal BP ( < 120 mm Hg systolic and < 80 mm Hg diastolic ) was 19 % in the advice only group , 30 % in the established group ( P = .005 compared with the advice only group ) , and 35 % in the established plus DASH group ( P<.001 compared with the advice only group ; P = .24 compared with the established group ) . CONCLUSION Individuals with above-optimal BP , including stage 1 hypertension , can make multiple lifestyle changes that lower BP and reduce their cardiovascular disease risk Few studies exist regarding the effects of the Dietary Approaches to Stop Hypertension ( DASH ) diet on novel cardiovascular risk factors among type 2 diabetic patients . We evaluated the effects of the DASH eating pattern on C-reactive protein ( CRP ) level , coagulation abnormalities , and hepatic function tests in type 2 diabetic patients . In this r and omized , crossover clinical trial , 31 type 2 diabetic patients consumed a control diet or the DASH diet  for 8 wk . The DASH diet was rich in fruits , vegetables , whole grains , and low-fat dairy products and low in saturated fat , total fat , cholesterol , refined grains , and sweets , with a total of 2400 mg/d sodium . The control diet was a st and ard diet for diabetic patients .  There was a 4-wk washout between the 2 trial phases . The main outcome measures were CRP level , coagulation indices , and hepatic function tests . The mean percent change for plasma CRP level was -26.9 ± 3.5 % after the DASH diet period and -5.1 ± 3.8 % after the control diet period ( P = 0.02 ) . Decreases in both alanine aminotransferase and aspartate aminotransferase levels were greater after consuming the DASH diet compared with the control diet ( -14.8 ± 3.0 % vs -6.6 ± 3.4 % ; P = 0.001 ; -29.4 ± 3.7 % vs -5.9 ± 1.4 % ; P = 0.001 , respectively ) . The decrease in the plasma fibrinogen level during the DASH diet period ( -11.4 ± 3.6 % ) was greater than that during the control diet ( 0.5 ± 3.4 % ) ( P = 0.03 ) . Among diabetic patients , the DASH diet can play an important role in reducing inflammation , plasma levels of fibrinogen , and liver aminotransferases . Future longer term studies are recommended
target: Changes in both systolic and diastolic BP were greater in participants with higher baseline BP or BMI .
  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
background: 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 r and omised controlled trials ( RCT ) was conducted to determine the effects of the DASH diet on cardiovascular risk factors .