title: Determinants and consequences of adherence to the dietary approaches to stop hypertension diet in African-American and white adults with high blood pressure: results from the ENCORE trial.
abstract: BACKGROUND
  Although the Dietary Approaches to Stop Hypertension (DASH) diet is an accepted nonpharmacologic treatment for hypertension, little is known about what patient characteristics affect dietary adherence and what level of adherence is needed to reduce blood pressure (BP).
  
  
  OBJECTIVE
  Our aim was to determine what factors predict dietary adherence and the extent to which dietary adherence is necessary to produce clinically meaningful BP reductions.
  
  
  METHODS
  Ancillary study of the ENCORE (Exercise and Nutrition Interventions for Cardiovascular Health) trial--a 16-week randomized clinical trial of diet and exercise.
  
  
  METHODS
  Participants included 144 sedentary, overweight, or obese adults (body mass index 25 to 39.9) with high BP (systolic 130 to 159 mm Hg and/or diastolic 85 to 99 mm Hg).
  
  
  METHODS
  Patients were randomized to one of three groups: DASH diet alone, DASH diet plus weight management, and Usual Diet Controls.
  
  
  METHODS
  Our primary outcomes were a composite index of adherence to the DASH diet and clinic BP.
  
  
  METHODS
  General linear models were used to compare treatment groups on post-treatment adherence to the DASH diet. Linear regression was used to examine potential predictors of post-treatment DASH adherence. Analysis of covariance was used to examine the relation of adherence to the DASH diet and BP.
  
  
  RESULTS
  Participants in the DASH diet plus weight management (16.1 systolic BP [SBP]; 95% CI 13.0 to 19.2 mm Hg and 9.9 diastolic BP [DBP]; 95% CI 8.1 to 11.6 mm Hg) and DASH diet alone (11.2 SBP; 95% CI 8.1 to 14.3 mm Hg and 7.5 DBP; 95% CI 5.8 to 9.3 mm Hg) groups showed significant reductions in BP in comparison with Usual Diet Controls participants (3.4 SBP; 95% CI 0.4 to 6.4 mm Hg and DBP 3.8; 95% CI 2.2 to 5.5 mm Hg). Greater post-treatment consumption of DASH foods was noted in both the DASH diet alone (mean = 6.20; 95% CI 5.83 to 6.57) and DASH diet plus weight management groups (mean = 6.23; 95% CI 5.88 to 6.59) compared with Usual Diet Controls (mean = 3.66; 95% CI 3.30 to 4.01; P<0.0001), and greater adherence to the DASH diet was associated with larger reductions in clinic SBP and DBP (P ≤ 0.01). Only ethnicity predicted dietary adherence, with African Americans less adherent to the DASH diet compared with whites (4.68; 95% CI 4.34 to 5.03 vs 5.83; 95% CI 5.50 to 6.11; P<0.001).
  
  
  CONCLUSIONS
  Greater adherence to the DASH diet was associated with larger BP reductions independent of weight loss. African Americans were less likely to be adherent to the DASH dietary eating plan compared with whites, suggesting that culturally sensitive dietary strategies might be needed to improve adherence to the DASH diet.
authors.affiliation: Department of Psychology and Neuroscience, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Dawn E
authors.initials: DE
authors.lastname: Epstein
authors.forename: Andrew
authors.initials: A
authors.lastname: Sherwood
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Smith
authors.forename: Linda
authors.initials: L
authors.lastname: Craighead
authors.forename: Carla
authors.initials: C
authors.lastname: Caccia
authors.forename: Pao-Hwa
authors.initials: PH
authors.lastname: Lin
authors.forename: Michael A
authors.initials: MA
authors.lastname: Babyak
authors.forename: Julie J
authors.initials: JJ
authors.lastname: Johnson
authors.forename: Alan
authors.initials: A
authors.lastname: Hinderliter
authors.forename: James A
authors.initials: JA
authors.lastname: Blumenthal
mesh_terms: D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D004038:Diet, Reducing / Q000208:ethnology / Q000523:psychology; D004039:Diet, Sodium-Restricted / Q000208:ethnology / Q000523:psychology; D015444:Exercise / Q000502:physiology; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000178:diet therapy*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000150:complications / Q000178:diet therapy; D010349:Patient Compliance; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data