title: The effectiveness of Dietary Approaches to Stop Hypertension (DASH) counselling on estimated 10-year cardiovascular risk among patients with newly diagnosed grade 1 hypertension: A randomised clinical trial.
abstract: The Dietary Approaches to Stop Hypertension (DASH) has been shown to lower blood pressure in the West. However, the real-life impact of DASH on reducing cardiovascular (CV) risk in routine clinical setting has not been studied.
  
  
  
  A parallel-group, open-labelled, physician-blinded, randomised controlled trial was conducted in January-June 2013 and followed up for 6- and 12-months in primary care settings in Hong Kong. Patients newly diagnosed with grade 1 hypertension (aged 40-70years) who had no concomitant medical conditions requiring dietary modifications were consecutively recruited. Subjects were randomised to standard education (usual care) (n=275), or usual care plus dietitian-delivered DASH-based dietary counselling in a single one-to-one session (intervention) (n=281). Primary outcomes were the changes in estimated 10-year CV risk.
  
  
  
  Outcome data were available for 504 (90.6%) and 485 (87.2%) patients at 6 and 12months, respectively. There was no difference in the reduction of 10-year CV risk between the two groups at 6months (-0.13%, 95% confidence interval [95% CI] -0.50% to 0.23%, p=0.477) and 12months (-0.08%, 95% CI -0.33% to 0.18%, p=0.568). Multivariate regression analyses showed that male subjects, younger patients, current smokers, subjects with lower educational level, and those who dined out for main meals for ≥4 times in a typical week were significantly associated with no improvements in CV risk.
  
  
  
  The findings may not support automatic referral of newly diagnosed grade 1 hypertensive patients for further one-to-one dietitian counselling on top of primary care physician's usual care. Patients with those risk factors identified should receive more clinical attention to reduce their CV risk.
  
  
  
  ChiCTR-TRC-13003014 (http://www.chictr.org.cn/enindex.aspx).
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Martin C S
authors.initials: MCS
authors.lastname: Wong
authors.affiliation: School of Public Health, Sun Yat-Sen University, Guangzhou 510080, PR China; General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 9LX, UK. Electronic address: haoxiangwang@163.com.
authors.forename: Harry H X
authors.initials: HHX
authors.lastname: Wang
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; Department of Family Medicine, Hospital Authority, Hong Kong.
authors.forename: Mandy W M
authors.initials: MWM
authors.lastname: Kwan
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Shannon T S
authors.initials: STS
authors.lastname: Li
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Miaoyin
authors.initials: M
authors.lastname: Liang
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Franklin D H
authors.initials: FDH
authors.lastname: Fung
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Ming Sze
authors.initials: MS
authors.lastname: Yeung
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong.
authors.forename: Brian C Y
authors.initials: BCY
authors.lastname: Fong
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
authors.forename: De Xing
authors.initials: DX
authors.lastname: Zhang
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
authors.forename: David K L
authors.initials: DKL
authors.lastname: Chan
authors.affiliation: Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Bryan P
authors.initials: BP
authors.lastname: Yan
authors.affiliation: Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; Monash University, Australia; The University of Warwick, UK.
authors.forename: Andrew J S
authors.initials: AJS
authors.lastname: Coats
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Sian M
authors.initials: SM
authors.lastname: Griffiths
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000178:diet therapy* / Q000453:epidemiology; D003376:Counseling / Q000379:methods* / Q000639:trends; D004032:Diet / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000178:diet therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods* / Q000639:trends; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016037:Single-Blind Method; D016896:Treatment Outcome
keywords: Associated factors; Cardiovascular risk; Dietary Approaches to Stop Hypertension (DASH); Dietary counselling; Primary care