Background Findings from both observational and experimental studies (including the DASH Trial -Dietary Approaches to Stop Hypertension) are consistent with a significant, causal role for dietary salt intake in the distribution of blood pressure (BP) in populations. The DASH diet quality score, based on the intervention arm in the DASH-trial, has emerged as a potentially useful measure of diet quality in adult populations. We have studied associations between DASH score and blood pressure, both clinic and 24 hour ambulatory measurements (ABPM) in middle-aged men and women.
Methods We used cross-sectional data from two studies of men and women aged 50 to 69 years, recruited in 1998 (n=1018) and 2010 (n=2047). Participants completed a physical examination including three standardised clinical BP recordings and a general health and lifestyle questionnaire. A sub-sample (n=1189) in 2010 had 24hr ambulatory BP measurements (ABPM). Diet quality was assessed using a DASH score constructed from a standardised Willett FFQ. DASH scores were categorised into quintiles, with lower quintiles indicating less healthy diets. Hypertension was defined as clinic BP>140/90mmHg (mean of readings 2 and 3) and 24-hour ABPM >130/70mmHg.
Results Clear inverse trends were seen between DASH scores and systolic (SBP) and diastolic (DBP) BP in clinic and ABPM recordings. The associations between DASH score and clinic BP were similar in the 1998 and 2010 datasets. In the 2010 data, clinic SBP increased by 7.5 mmHg in men and 5.1 mmHg in women between the highest and lowest DASH quintiles and 24-hour ABPM systolic BP increased by 6.3mmHg and 5.4mmHg in men and women respectively between the highest and lowest DASH quintiles. In fully adjusted analyses, the odds ratios (OR) for clinic hypertension and ABPM hypertension in participants with DASH score in the first relative to the fifth DASH score quintile were as follows: clinic hypertension: OR 1.60 (95% CI 0.9–2.8), ABPM hypertension: OR 4.2; 95 % CI [1.1–15.9]). Stratifying by gender, these trends persisted for men however they were attenuated for women.
Conclusion This study provides evidence of criterion validity for the use of DASH score as a measure of diet quality, especially in the diet-hypertension relationship in men. Our findings are consistent with the hypothesis that dietary patterns exert effects beyond the sum of the component parts. Public policy promoting a DASH-style healthy diet could have a significant impact on population health by reducing average blood pressure in the population.
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