DASH diet: Best nonpharmacological intervention for hypertension

A new network meta-analysis shines a spotlight on the Dietary Approach to Stop Hypertension (DASH) diet as the most effective nondrug intervention to control blood pressure (BP) in adults with prehypertension to established hypertension. Interventions such as aerobic exercise, isometric training, salt restriction, breathing control, and meditation are also helpful.

The Bayesian network meta‐analyses included 120 articles (corresponding to 126 trials) that evaluated 22 nonpharmacological interventions, with a median follow‐up of 12 weeks. Studies were conducted in Europe (49.20 percent), US (24.60 percent), Asia (13.49 percent), and Africa (3.18 percent). Ninety-one trials recruited only patients with hypertension, 27 involved patients with hypertension and prehypertension, and eight included only patients with prehypertension.

The total study population comprised 14,923 participants (mean age, 51.2 years), of which 8,530 were randomly assigned to intervention groups and 6,393 to usual care. The mean systolic (S)BP and diastolic (D)BP levels ranged from 136.74 to 143.80 mm Hg and from 86.27 to 87.51 mm Hg, respectively.

According to the surface under the cumulative ranking probabilities, the DASH diet was superior to usual care and all other nonpharmacological interventions in lowering SBP (weighted mean difference, 6.97 mm Hg, 95 percent credible interval [CrI], 4.50–9.47) and DBP (weighted mean difference, 3.54 mm Hg, 95 percent CrI, 1.80–5.28).

Aerobic exercise, isometric training, low‐sodium and high‐potassium salt, comprehensive lifestyle modification, breathing control, and meditation also proved better than usual care in terms of improving BP control.

As a combined intervention, comprehensive lifestyle modification could improve both SBP and DBP control effectively. For overweight and obese patients, low‐calorie diet or low‐calorie diet plus exercise could produce greater BP reductions than exercise alone.