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Subgroup Analysis of the Dietary Approaches to Stop Hypertension (DASH) Randomized Clinical Trial

Laura P. Svetkey, MD, MHS; Denise Simons-Morton, MD, PhD; William M. Vollmer, PhD; Lawrence J. Appel, MD, MPH; Paul R. Conlin, MD; Donna H. Ryan, MD; Jamy Ard, MD; Betty M. Kennedy; for the DASH Research Group

Arch Intern Med. 1999;159:285-293.

Objective  To determine the effects of dietary patterns on blood pressure in subgroups.

Methods  Dietary Approaches to Stop Hypertension (DASH) was a randomized controlled feeding study conducted at 4 academic medical centers. Participants were 459 adults with untreated systolic blood pressure less than 160 mm Hg and diastolic blood pressure 80 to 95 mm Hg. For 3 weeks, participants were fed a "control" diet. They were then randomized to 8 weeks of (1) control diet; (2) a diet rich in fruits and vegetables; or (3) a combination diet rich in fruits, vegetables, and low-fat dairy foods, and reduced in saturated fat, total fat, and cholesterol (the DASH combination diet). Weight and salt intake were held constant. Change in diastolic blood pressure was the primary outcome variable, and systolic blood pressure a secondary outcome. Subgroups analyzed included race, sex, age, body mass index, years of education, income, physical activity, alcohol intake, and hypertension status.

Results  The combination diet significantly lowered systolic blood pressure in all subgroups (P<.008), and significantly lowered diastolic blood pressure (P<.01) in all but 2 subgroups. The fruits-and-vegetables diet also reduced blood pressure in the same subgroups, but to a lesser extent. The combination diet lowered systolic blood pressure significantly more in African Americans (6.8 mm Hg) than in whites (3.0 mm Hg), and in hypertensive subjects (11.4 mm Hg) than in nonhypertensive subjects (3.4 mm Hg) (P<.05 for both interactions).

Conclusions  The DASH combination diet, without sodium reduction or weight loss, significantly lowered blood pressure in virtually all subgroups examined, and was particularly effective in African Americans and those with hypertension. The DASH combination diet may be an effective strategy for preventing and treating hypertension in a broad cross section of the population, including segments of the population at highest risk for blood pressure–related cardiovascular disease.

From Duke University Medical Center, Department of Medicine, Durham, NC (Drs Svetkey and Ard); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (Dr Simons-Morton); Center for Health Research, Portland, Ore (Dr Vollmer); Johns Hopkins University, Baltimore, Md (Dr Appel); Brigham and Women's Hospital, Boston, Mass (Dr Conlin); and Pennington Biomedical Research Center, Baton Rouge, La (Dr Ryan and Ms Kennedy). A list of the members of the DASH Collaborative Research Group, in addition to the authors, appears in a box on page 292.

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