Physicians' Academy for Cardiovascular Education

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 Pressure

Literature - Juraschek SP, Miller III ER, Weaver CM, et al. - J Am Coll Cardiol 2017;70:2841–8

Main results


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.

Editorial comment

In their editorial article [4], 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.’


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