TABLE 1.
Characteristics of the randomized controlled trials on dietary patterns and blood pressure1
| Reference | Country, duration | Subjects | Intervention2 | Control/comparator2 | Office or 24-h ABP | Change in SBP, mm Hg | Change in DBP, mm Hg |
| Moore et al., 1999 (31) | United States, 8 wk | 354 adults >22 y; BP <160/80–95 mm Hg; not taking BP medication | Fruit and vegetable diet: fruit ∼5 servings/d, vegetables ∼3 servings/d, whole grains ∼7 servings/d, low-fat dairy ∼0, nuts/seeds/legumes ∼1 serving/d, snacks/sweets ∼1 serving/d, fats/oils ∼5 servings/dDASH diet: fruit ∼5 servings/d, vegetables ∼4 servings/d, whole grains ∼8 servings/d, low-fat dairy ∼2 servings/d, nuts/seeds/legumes ∼1 serving/d, snacks/sweets ∼1 serving/d, fat/oils ∼3 servings/d, sodium ∼3000 mg/d | Typical American diet: fruit ∼2 servings/d, vegetables ∼2 servings/d, refined grains ∼8 servings/d, low-fat dairy ∼0, meat ∼1.5 servings/d, nuts/seeds/legumes ∼0, snacks and sweets ∼4 servings/d, fats/oils ∼6 servings/d, sodium ∼3000 mg/d | ABP | DASH diet: −4.5 (−6.2,−2.8)*3Fruit and vegetable diet: −3.1 (−4.8, −1.4)* | DASH diet: −2.7 (−4.0, −1.4)*Fruit and vegetable diet: −2.0 (−3.3, −0.8)* |
| Sacks et al., 2001 (32) | United States, 90 d | 412 adults >22 y; BP 120–159/80–95 mm Hg; not taking BP medication | DASH diet with 3 sodium amounts for both intervention and control: High: 150 mmol/d (3500 mg Na), intermediate: 100 mmol/d (2300 mg Na), low: 50 mmol/d (1150 mg Na) | Typical American diet | Office BP | High sodium: −5.9 (−8.0, −3.7)*Intermediate sodium: −5.0 (−7.6, −2.5)*Low sodium: −2.2 (−4.4, −0.1)* | High sodium: −2.9 (4.3, −1.5)*Intermediate sodium: −2.5 (−4.1, −0.8)*Low sodium: −1.0 (−2.5, 0.4)* |
| Appel et al., 2003 (33) | United States, 6 mo | 810 adults >25 y; BP 120–159/80–95 mm Hg; not taking BP medication | Established behavioral intervention: weight loss; sodium intake ~2300 mg/d; increased exercise; limited alcohol intake; no goal for fruit, vegetable, or dairyEstablished plus DASH diet: above goals plus fruit and vegetables ∼9–12 servings/d, low-fat dairy ∼2–3 servings/d | Advised on factors affecting BP such as weight, sodium reduction, physical activity and DASH diet; no behavior change counseling | Office BP | Established: −3.7 (−5.3, −2.1)*Established plus DASH: −4.3 (−5.9, −2.8)* | Established: 1.7 (−2.8, −0.6)*Established plus DASH: −2.6 (−3.7, −1.5)* |
| Blumenthal et al., 2010 (34) | United States, 4 mo | 144 adults >35 y; BP 130–159/85–99 mm Hg; not taking BP medication | Two interventions: DASH diet alone and DASH diet plus weight management, reduced caloric intake, increased exercise | Usual care (typical American diet) | Office BP and ABP | DASH plus weight management: −12.7 ± 4.5*4DASH diet alone: −7.8 ± 4.5* | DASH plus weight management: −6.1 ± 2.2*DASH diet alone: −3.7 ± 2.4* |
| Svetkey et al., 2009 (35) | United States, 6 mo | 574 adults ≥25 y; hypertensive and taking BP medications | MDI: training on management of BPPI: DASH diet, weight loss, exercise, reduced sodium intake, moderate alcohol intake | MDC: usual carePC: usual care (written), materials on lifestyle modification according to guidelines | Office BP | MDI/PI: −9.7 ± 12.7* | MDI/PI: −5.4 ± 4.6* |
| Lima et al., 2013 (40) | Brazil, 6 mo | 206 adults >20 y; BP >140/90 mm Hg; taking BP medication | Intervention: Low glycemic indexBrazilian diet incorporating DASH-Na principles: reduced salt, low-fat dairy ∼3 servings/d, fruit ∼3–5 servings/d, vegetables ∼4–5 servings/d, legumes ∼1 serving/d, grains/roots/tubers ∼5–9 servings/d, meat (mainly fish) ∼1–2 servings/d | Usual care: salt reduction, BP control | Office BP | −9.2 (SD not provided)* | −6.2 (SD not provided)* |
| Brader et al., 2014 (26) | Iceland, Sweden, Denmark, Finland; 12 wk | 37 adults 30–65 y; BP <160/100 mm Hg with or without BP medications, metabolic syndrome | Nordic diet: whole grains (rye, barley, oats), nuts, rapeseed oil, fruit/berries ≥150g/d, vegetables ≥500 g/d, fish ≥300 g/wk, low-fat dairy ∼2 servings/d, salt intake <7 g/d men, <6 g/d women | Control (mean nutrient intake in Nordic countries): wheat products, dairy-based spreads, fruit, vegetables ≤250 g/d, fish ≤100 g/wk, salt intake <10 g/d | ABP | No significant change | −4.4 (−6.9, −2.0)* |
| Nowson et al., 2005 (43) | Australia, 12 wk | 63 men >25 y; BP ≥120/80 mm Hg | DASH diet: fruit ≥4 servings/d, vegetables ≥4 servings/d, low-fat dairy ≥3 servings/d, fish ≥3 servings/wk, legumes ∼1 cup/wk, unsalted nuts ∼30 g 4 times/wk, red meat ≤2 servings/wk, fat ∼4 servings/d | Low-fat diet: advised to reduce high-energy food and drinks, choose plant-based foods, choose low-fat dairy, limit cheese and ice cream, use lean meat, avoid frying foods | Home BP | −5.2 ± 1.8* | −4.8 ± 1.3* |
| Burke et al., 2005 (44) | Australia, 4 and 12 mo | 241 adults 40–70 y; BP <160/90 mm Hg; taking BP medication | Lifestyle program (4 mo): DASH diet high in fruit and vegetables, 4 fish meals/wk, alcohol <2 standard drinks/d, low salt and sugar 12 mo follow-up: telephone contact, group workshops | Usual care: provided with information from the National Heart Foundation and Health Department; no behavior change information | ABP | −3.0 (−6.3, 0.1)* | −1.8 (−3.4, −0.2)* |
| Nowson et al., 2009 (45) | Australia, 14 wk | 111 women 45–75 y; office BP: 120–160/80–95 mm Hg; home BP: ≥116/78 mm Hg | Vitality diet (low acid load, low sodium DASH diet): red meat 6 servings/wk, low-fat dairy ≥3 servings/d, fruit ≥4 servings/d, vegetables ≥4 servings/d, fats/oils ≥4 tsp/d, whole grains ≤4 servings/d, caffeine drinks ≤4 servings/d, alcoholic drinks ≤2 servings/d; sodium 1590 mg/d | Reference healthy diet (high acid load, high carbohydrate, low fat): red meat ≤2 servings/wk, low-fat dairy ≥3 servings/d, fruit ∼2 servings/d, vegetable ∼2–3 servings/d, fats/oils ≥8 tsp/d, whole grains ≥4 servings/d, caffeine drinks ≤4 servings/d, alcoholic drinks ≤2 servings/d | Home BP | Significant change only in those taking antihypertensives: −5.5 (−11.0, 0.1)* | Significant change only in those taking antihypertensives: −3.6 (−6.9, −0.3)*, −5.3 (−8.5, −2.1)* |
| Miller et al., 2002 (36) | United States, 9 wk | 45 adults 22–70 y; BP 130–170/80–100 mm Hg; taking BP medication | Comprehensive lifestyle intervention: DASH diet alcohol ∼2 drinks/d, caffeinated beverages 3/d, sodium 2300 mg/d, increased exercise | Control: no intervention | ABP | −9.5 (−14.5, −4.5)* | −5.3 (−8.5, −2.1)* |
| Toobert et al., 2003 (37) | United States, 6 mo | 279 women <75 y; postmenopausal with type 2 diabetes | Mediterranean lifestyle Program: increased amounts of bread, vegetables, fruit, legumes, fish, less red meat, avoid cream and butter, use of olive/canola oil or margarines | Usual care | Office BP | No significant change | No significant change |
| Esposito et al., 2004 (38) | Italy, 24 mo | 180 adults with metabolic syndrome | Mediterranean diet: whole grains ∼400 g/d, fruit ∼250–300 g/d, vegetables ∼120–150 g/d, walnuts ∼25–30 g/d, olive oil ∼8 g/d | Prudent diet: general information on healthy food choices | Office BP | −3.0 (−5.0, −1.0)* | −2.0 (−3.5, −0.5)* |
| Esposito et al., 2003 (39) | Italy, 24 mo | 120 women 20–46 y | Mediterranean diet: information on calorie restriction for weight loss, behavioral and psychological counseling | Control: information about healthy food choices and exercise | Office BP | −2.0 (−3.5, −0.5)* | −1.7 (−3.0, −0.4)* |
| Vincent-Baudry et al., 2005 (46) | France, 3 mo | 212 adults 18–70 y; BP 140–190/90–105 mm Hg | Mediterranean diet recommended foods: nuts, whole-meal bread and cereals, fresh or dried fruit, vegetables, legumes, olive oil, fish ∼4 times/wk, red meat ∼1/wk, red wine ∼2 glasses/d (men), 1 glass/d (women) | Low-fat diet recommended foods: more poultry, avoid offal and saturated fat–rich animal products, fish ∼2–3 times/wk, fruit and vegetables, low-fat dairy products, use of vegetable oils | Office BP | No significant change | No significant change |
| Domenech et al., 2014 (47) | Spain, 1 y | 284 adults; men 55–80 years, women 60–80 years; type 2 diabetes or with ≥3 CVD risk factors | Interventions: Mediterranean diet and extra virgin olive oil; Mediterranean diet and mixed nuts (30 g/d) Mediterranean diet (amounts used to assess adherence): olive oil ≥4 tbs/d, vegetables ≥2 servings/d, fruit ≥3 servings/d, red meat or meat products <1 serving/d, butter/margarine/cream <12 g/d, sweet and carbonated drinks <1/d, wine ≥7 glasses/wk, legumes ≥3 servings/wk, fish ≥3 servings/wk, sweets/pastries < 3 times/wk, nuts ≥30 g/wk | Control: low-fat diet | ABP | Mediterranean diet and extra virgin olive oil: −4.0 (−6.4, −1.6)*Mediterranean diet and nuts: −4.3 (−6.7, −1.9)* | Mediterranean diet and extra virgin olive oil: −1.9 (−3.4, −0.4)*Mediterranean diet and nuts: −1.9 (−3.4, −0.4)* |
| Adamsson et al., 2011 (41) | Sweden, 6 wk | 88 adults 25–65 y; BP <145/85 mm Hg | Nordic diet: foods supplied to participants except beverages: fruits, berries, legumes, vegetables, low-fat dairy, fatty fish, oats, barley, soy protein, almonds, psyllium seeds | Control (usual Western diet); no foods provided | Office BP | −7.2 (−12.3, −1.9)* | No significant change |
| Poulsen et al., 2014 (42) | Denmark, 26 wk | 181 adults 18–65 y; BP >130/85 mm Hg | New Nordic diet: vegetables ∼400 g/d, fruit ∼300 g/d (berries ∼75 g/d), wild plants and mushrooms ∼5 g/d, nuts ∼30 g/d, milk ∼500 g/d, cheese ∼25 g/d, eggs ∼25 g/d, fresh herbs—no limit, foods organically grown | Average Danish diet: vegetables ∼180 g/d, fruit 200 g/d (berries ∼4 g/d), potatoes ∼100 g/d, no wild plants and mushrooms, fresh herbs ≤1 serving/d, nuts ≤1 serving/d, refined grains, imported fruit | Office BP | −5.2 (−8.0, −2.4)* | No significant change |
| Von Haehling et al., 2013 (49) | Germany, 12 mo | 524 adults >18 y; metabolic syndrome; coronary artery disease | Traditional Tibetan diet: cereals: barley, wheat, rye, corn, rice, oat, buckwheat; meat: beef, mutton, hare, chicken, venison; vegetables: onion, garlic, radish, fennel, leek, carrot, soy beans, dark beans; fruit: pomegranate, banana, pineapple, mango, bramble, apricot, nectarine | Usual care (Western diet): Guidelines by American Heart Association and German Academy and Society of Nutritional MedicineCereals: whole-grain rice, noodles, grains; meat: chicken, turkey, veal, rabbit; all vegetables; all fruits | Office BP | No significant change | No significant change |
| Azadbakht et al., 2011 (48) | Iran, 8 wk | 44 adults, 44–70 y; type 2 diabetes | DASH diet: fruit ∼5 servings/d, vegetables ∼7 servings/d, dairy ∼3 servings/d, whole grains ∼5 servings/d, sodium ∼2300 mg/d | Usual diabetic diet: fruit ∼3 servings/d, vegetables ∼4 servings/d, dairy ∼2 servings/d, whole grains ∼3 servings/d, sodium ∼3000 mg/d | Office BP | −10.5 (−19.2, 1.8)* | −8.8 (−17.1, −0.6)* |
1
Significant change, *P < 0.05. ABP, ambulatory blood pressure; BP, blood pressure; CVD, cardiovascular disease; DASH, Dietary Approaches to Stop Hypertension; DBP, diastolic blood pressure; MDC, physician intervention; MDI, physician control; Na, sodium; PC, patient control; PI, patient intervention.
2
Servings per day unless otherwise stated, glass in terms of mL.
3
Mean; 95% CI in parentheses (all such values).
4
Mean ± SD (all such values).