First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
Department of Cardiology, Helena Venizelou Hospital, Athens, Greece.
Adv Nutr. 2020 Sep 1;11(5):1150-1160. doi: 10.1093/advances/nmaa041.
The Dietary Approaches to Stop Hypertension (DASH) diet is recognized as an effective dietary intervention to reduce blood pressure (BP). However, among randomized controlled trials (RCTs) investigating the DASH diet-mediated BP reduction, there are significant methodological and clinical differences. The purpose of this study was to comprehensively assess the DASH diet effect on BP in adults with and without hypertension, accounting for underlying methodological and clinical confounders. We systematically searched Medline and the Cochrane Collaboration Library databases and identified 30 RCTs (n = 5545 participants) that investigated the BP effects of the DASH diet compared with a control diet in hypertensive and nonhypertensive adults. Both random-effects and fixed-effect models were used to calculate the mean attained systolic BP (SBP) and diastolic BP (DBP) differences during follow-up. Subgroup and meta-regression analyses were also conducted. Compared with a control diet, the DASH diet reduced both SBP and DBP (difference in means: -3.2 mm Hg; 95% CI: -4.2, -2.3 mm Hg; P < 0.001, and -2.5 mm Hg; 95% CI: -3.5, -1.5 mm Hg; P < 0.001, respectively). Hypertension status did not modify the effect on BP reduction. The DASH diet compared with a control diet reduced SBP levels to a higher extent in trials with sodium intake >2400 mg/d than in trials with sodium intake ≤2400 mg/d, whereas both SBP and DBP were reduced more in trials with mean age <50 y than in trials of older participants. The quality of evidence was rated as moderate for both outcomes according to the Grading of Recommendations, Assessment, Development, and Evaluation approach. The adoption of the DASH diet was accompanied by significant BP reduction in adults with and without hypertension, although higher daily sodium intake and younger age enhanced the BP-lowering effect of the intervention. This meta-analysis was registered at www.crd.york.ac.uk/prospero as CRD42019128120.
DASH 饮食被认为是一种有效的饮食干预措施，可以降低血压（BP）。然而，在研究 DASH 饮食介导的 BP 降低的随机对照试验（RCT）中，存在显著的方法学和临床差异。本研究的目的是全面评估 DASH 饮食对高血压和非高血压成年人血压的影响，同时考虑潜在的方法学和临床混杂因素。我们系统地检索了 Medline 和 Cochrane 协作图书馆数据库，确定了 30 项 RCT（n=5545 名参与者），这些 RCT 研究了 DASH 饮食与高血压和非高血压成年人的对照饮食相比对血压的影响。我们使用随机效应和固定效应模型计算了随访期间平均收缩压（SBP）和舒张压（DBP）的差异。还进行了亚组和荟萃回归分析。与对照饮食相比，DASH 饮食降低了 SBP 和 DBP（平均差值：-3.2mmHg；95%置信区间：-4.2，-2.3mmHg；P<0.001 和 -2.5mmHg；95%置信区间：-3.5，-1.5mmHg；P<0.001）。高血压状态并没有改变对血压降低的影响。与对照饮食相比，DASH 饮食在钠摄入量>2400mg/d 的试验中降低 SBP 水平的幅度更大，而在钠摄入量≤2400mg/d 的试验中，SBP 和 DBP 的降低幅度更大；与年龄较大的参与者相比，平均年龄<50 岁的试验中 SBP 和 DBP 的降低幅度更大。根据推荐评估、制定和评估方法，这两种结果的证据质量均被评为中等。DASH 饮食的采用伴随着成年人高血压和非高血压患者血压的显著降低，尽管较高的每日钠摄入量和较年轻的年龄增强了干预的降压效果。本荟萃分析已在 www.crd.york.ac.uk/prospero 上根据 CRD42019128120 进行了注册。
