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.
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).


METHODS
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.


METHODS
Overweight or obese, unmedicated outpatients with high BP (N = 144).


METHODS
Usual diet controls, DASH diet alone, and DASH diet plus weight management.


METHODS
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).


CONCLUSIONS
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.


BACKGROUND
clinicaltrials.gov Identifier: NCT00571844.
Blumenthal
James A
JA
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Campus Box 3119, Durham, NC 27710, USA. Blume003@mc.duke.edu
Babyak
Michael A
MA
Hinderliter
Alan
A
Watkins
Lana L
LL
Craighead
Linda
L
Lin
Pao-Hwa
PH
Caccia
Carla
C
Johnson
Julie
J
Waugh
Robert
R
Sherwood
Andrew
A
D001794:Blood Pressure; D003376:Counseling; D004038:Diet, Reducing; D015444:Exercise; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000178:diet therapy* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000178:diet therapy / Q000503:physiopathology / Q000628:therapy; D050177:Overweight / Q000178:diet therapy / Q000503:physiopathology / Q000628:therapy; D011188:Potassium / Q000652:urine; D012964:Sodium / Q000652:urine; D015431:Weight Loss
D012964:Sodium; D011188:Potassium