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Results From the Dietary Approaches to Stop Hypertension (DASH) Trial

Megan L. Jehn, PhD, MHS; Daniel J. Brotman, MD; Lawrence J. Appel, MD, MPH

Arch Intern Med. 2008;168(9):996-1002.

Background  Several studies have suggested that blacks, on average, have a blunted decline in nocturnal blood pressure (BP) as compared with nonblacks. It is unknown whether differences in traditional determinants of BP, specifically diet and obesity, account for observed differences in diurnal patterns.

Methods  We conducted an analysis of the Dietary Approaches to Stop Hypertension (DASH) trial that enrolled adults with prehypertension or stage 1 hypertension. At the end of a 3-week run-in period, ambulatory BP monitoring data were obtained on 333 participants, all of whom ate the same diet. Mean ambulatory daytime (6 AM–11 PM) and nighttime (11 PM–6 AM) systolic BP, diastolic BP, and heart rate (HR) were measured. Dipping was defined as a nighttime drop of less than 10% from mean daytime values.

Results  Office BP was similar in blacks and nonblacks, as were 24-hour and daytime BP and HR. However, blacks demonstrated a statistically significant, blunted nocturnal decline in BP and HR. Blacks were significantly more likely than nonblacks to have systolic nondipping (44.9% vs 26.7%, P = .001), diastolic nondipping (20.9% vs 11.6%, P = .03), and HR nondipping (40.9% vs 19.9%, P < .001). These differences persisted after adjustment for site, sex, age, body mass index, alcohol intake, physical activity, office BP (or HR), education, and income.

Conclusion  Blacks with similar office BP, and who consumed the same diet as nonblacks, had a blunted nocturnal decline in systolic BP, diastolic BP, and HR, even after factors that influence BP were controlled for.

Author Affiliations: School of Health Management and Policy, Arizona State University, Tempe (Dr Jehn); and Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Medical Institutions (Dr Jehn and Appel), and Department of Medicine, The Johns Hopkins Hospital (Drs Brotman and Appel), Baltimore, Maryland.

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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2008;168(9):908.
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