Dietary Approaches to Stop Hypertension (DASH) in clinical practice: A primary care experience

Background: The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure placed increas ed emphasis on lifestyle modification for the prevention and management of hypertension. The Dietary Approaches to Stop Hypertension (DASH) diet, rich in fruits, vegetables, nuts, and low-fat dairy foods, with reduced saturat ed and total fats, was found in clinical trials to lower blood pressure sub stantially and significantly. The DASH diet appears appropriate for use in the primary care setting, although it is unknown whether results will mirro r those found in clinical trial. Methods: A review of the literature of successful physician-based dietary i nterventions and of the Stages of Change model as it applies to dietary beh avior was completed. Some changes needed to adapt the DASH diet to the outp atient family practice setting were identified and implemented among a pred ominantly non-Caucasian (56%), female (61%) population. The most common con cerns and diagnoses among this population are essential hypertension, diabe tes, and general medical examination. Results: Under study conditions, DASH reported that patients experienced an average reduction of 6 mmHg systolic and 3 mmHg diastolic blood pressure. Results were better in those with high blood pressure-systolic dropped by 1 1 mmHg and diastolic dropped by 6 mmHg. This reduction occurred within 2 we eks of starting the plan. Our clinical experience matches these published r esults. Conclusions: The DASH diet can be used successfully by patients in the prim ary care setting to lower blood pressure. The challenge of incorporating th is intervention into primary care by more practitioners remains. The challe nges for the patient and provider to sustain lifestyle modifications are fo rmidable and also continuing.