DASH diet combined with low sodium intake leads to greater BP-lowering in patients with higher baseline level
Effects of Sodium Reduction and the DASH Diet in Relation to Baseline Blood PressureLiterature - Juraschek SP, Miller III ER, Weaver CM, et al. - J Am Coll Cardiol 2017;70:2841–8
- The reduction of sodium intake from high to low levels in the control arm was associated with reductions in SBP of -3.20 mmHg (95%CI: -4.96 to -1.44), -8.56 mmHg (95%CI: -10.70 to -6.42), -8.99 mmHg (95%CI: -11.21 to -6.77), -7.04 mmHg (95%CI: -12.92 to -1.15) in the respective strata of baseline SBP . The trend across strata was statistically significant (P=0.004).
- The reduction of sodium intake from high to low levels in the DASH diet group, was associated with reductions in SBP of -0.88 mmHg (95%CI: -2.07 to 0.30), -3.29 mmHg (95%CI: -4.71 to -1.88), -4.90 mmHg (95%CI: -7.25 to -2.55), -10.41 mmHg (95%CI: -15.54 to -5.28) in the SBP strata. This trend was also statistically significant (P<0.001).
- During the high sodium intake period, the DASH diet compared with the control diet significantly changed SBP by -4.47 mmHg (95%CI: -6.64 to -2.29), -4.26 mmHg (95%CI: -6.72 to -1.80), -4.72 mmHg (95%CI: -8.25 to -1.19), -10.63 mmHg (95%CI: -18.86 to -2.41) in the baseline SBP strata. There was no significant trend across strata in this case (P=0.66).
- During the low sodium intake period, the DASH diet compared with the control diet changed SBP by: -2.36 mmHg (95%CI: -4.61 to -0.11), 0.92 mmHg (95%CI: -1.47 to 3.31), -0.55 mmHg (95%CI: -4.03 to 2.93), -14.13 mmHg (95%CI: -25.61 to -2.64) in strata of baseline. There was no significant trend across strata in this case either (P=0.29).
- Compared with the high sodium-control diet, the low sodium-DASH diet lowered SBP by -5.30 mmHg (95%CI: -7.66 to -2.94), -7.48 mmHg (95%CI: -10.11 to -4.84), -9.70 mmHg (95%CI: -13.34 to -6.06), -20.79 mmHg (95%CI: -30.88 to -10.69) in baseline SBP strata. There was evidence of a trend for greater reduction in SBP across strata of higher baseline SBP (P for trend <0.001).The pattern of DBP change by baseline DBP was almost identical to that of SBP.
The combination of low sodium intake and the DASH diet was associated with substantially greater reductions in SBP among participants with a higher SBP at baseline, compared with the combination of high sodium intake and the control diet. In adults with pre-hypertension, stage I hypertension, and baseline SBP ≥150 mmHg, the combination of the DASH diet with low sodium intake can achieve substantial (>20 mmHg) BP reductions. These findings confirm the importance of lifestyle interventions among adults with uncontrolled SBP.
In their editorial article , Wang and Gupta characterize the DASH-Sodium trial results as intriguing, since Juraschek et al. showed that the combined DASH-low sodium diet has favorable effects comparable to or exceeding pharmacological BP-lowering monotherapy in prior trials. Moreover, they discuss important open questions related to the association between sodium intake and BP-levels, including the ideal amount of sodium intake for the general population, the underlying pathophysiologic mechanisms that lead to lower BP with lower sodium intake, as well as the issue of salt-sensitivity differences between individuals. The authors conclude as follows: ‘The DASH-Sodium trial was a landmark study that continues to be highly informative. Nonetheless, questions remain regarding how diet and sodium influence blood pressure and how to sustain dietary modifications at a reasonable cost on a broad scale. The DASH-low sodium diet is an important foundation to offer patients, but it is not enough to solve the global hypertension problem. Public policy to regulate mineral and nutrient content in processed foods, programs to promote healthy diet and physical activity, and deeper mechanistic understanding of how salt modulates blood pressure are just a few of the steps needed to reduce the global burden of hypertension.’