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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 PressureThe ENCORE Study
James A. Blumenthal, PhD;
Michael A. Babyak, PhD;
Alan Hinderliter, MD;
Lana L. Watkins, PhD;
Linda Craighead, PhD;
Pao-Hwa Lin, PhD;
Carla Caccia, RD;
Julie Johnson, PA-C;
Robert Waugh, MD;
Andrew Sherwood, PhD
Arch Intern Med. 2010;170(2):126-135.
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 Randomized, controlled trial in a tertiary care medical center with assessments at baseline and 4 months. Enrollment began October 29, 2003, and ended July 28, 2008.
Participants Overweight or obese, unmedicated outpatients 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 resulted in even larger BP reductions, greater improvements in vascular and autonomic function, and reduced left ventricular mass.
Clinical Trial Registration clinicaltrials.gov Identifier: NCT00571844
Author Affiliations: Departments of Psychiatry and Behavioral Sciences (Drs Blumenthal, Babyak, Watkins, and Sherwood and Mss Caccia and Johnson) and Medicine (Drs Lin and Waugh), Duke University Medical Center, Durham, North Carolina; the Department of Medicine, University of North Carolina at Chapel Hill (Dr Hinderliter); and the Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead).
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