Food Insight Series on Blood Pressure Management Part 1: Dietary Approaches to Stop Hypertension-A Little DASH Will Do

The rate of hypertension in the US population has increased in recent decades. Data from the Centers for Disease Control and Prevention (CDC) indicate that 3 in 10 people over the age of 20 currently suffer from hypertension. This is up from 1988-1994 when 1 in 4 were believed to have hypertension. Projections from the American Heart Association are that by 2030, an additional 27 million Americans will have hypertension.

The good news is that the percentage of people with hypertension who have their blood pressure under control (systolic pressure

This series of three articles will explore proven strategies that health professionals should emphasize (in addition to medication if needed) for the management of high blood pressure. This first article will focus on the landmark study, “Dietary Approaches to Stop Hypertension,” better known as the DASH diet.

The DASH Diet: Foods versus Nutrient Approach to Reducing Blood Pressure

The DASH diet debuted in 1997 when “A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure” appeared in the New England Journal of Medicine (NEJM). The DASH diet emphasizes consumption of fruits, vegetables, fat-free or low-fat milk and milk products, whole grains, fish, lean meats (such as beef and skinless poultry), and nuts—making it rich in potassium, magnesium, calcium, fiber, and protein. Rather than focusing on the effects of individual nutrients, the DASH diet illustrates the combined positive effect that dietary patterns have on blood pressure and overall health.

In the clinical trial published in NEJM, the effects of different eating patterns were examined for a total of 11 weeks in 459 participants. During the first 3 weeks, all subjects were fed a control diet (low in fruits, vegetables, and dairy products, with fat content similar to the average American diet). During the final 8 weeks of the trial, subjects were randomly assigned one of three diets—the control diet, a diet rich in fruits and vegetables, or a “combination diet” (aka DASH diet) which was rich in fruits, vegetables, and low-fat dairy products; reduced in saturated fat, total fat, and cholesterol; and high in fiber and protein. Regardless of diet assignment, sodium intake (~3000 mg/day) and body weight remained constant.

Results of the study found that the DASH diet reduced blood pressure more than either of the two other diets. In comparison to the control diet or diet rich in fruits and vegetables, the DASH diet reduced systolic blood pressure by 5.5 and 2.7 mmHg and diastolic blood pressure by 3 and 1.9 mmHg respectively. These results indicate that adopting the DASH diet can successfully lower blood pressure, particularly for individuals with high blood pressure. The DASH diet may also help to prevent hypertension in individuals with normal blood pressure.

Since the time of publication, the DASH diet has received praise for its potentially significant role in improving health. The DASH diet has been identified as one of the five most effective lifestyle modifications to manage hypertension by the National Heart, Lung, and Blood Institute (NHLBI) in its Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) published in 2003. Other documented strategies to manage hypertension outlined in the JNC 7 Report include reducing body weight if overweight, keeping sodium intake to less than 2,400 mg per day, engaging in regular physical activity, and limiting alcohol intake to one drink per day for females and two drinks per day for males. Additionally, the DASH diet has also been proven to lower cholesterol, improve insulin sensitivity, and help people increase their overall fruit and vegetable consumption—a key recommendation from the U.S. Dietary Guidelines for Americans.

Beyond Sodium Reduction

Through the years, public health officials have primarily focused blood pressure-lowering initiatives on limiting sodium intake by consumers and urging manufacturers to reduce the sodium content of foods. These efforts continue as both consumer taste preferences and the gradual reduction of sodium in the food supply must occur simultaneously and need time to succeed. With the evolution of consumer palates and the availability of more reduced-sodium products, there are many actions consumers can take today that may impact blood pressure even more than by solely reducing sodium—one of which is following the DASH diet. In fact, evidence from the clinical trial shows that following the DASH diet for as little as two weeks can result in lower blood pressure even without lowering sodium intake. Additionally, other studies have demonstrated the blood pressure-lowering effects of increasing the consumption of micronutrients such as potassium, magnesium, and calcium.

Recommended levels of potassium, magnesium, and calcium are all part of the DASH diet. Unfortunately, the majority of Americans do not consume adequate amounts of these key nutrients.

With all the talk of the health benefits associated with following the DASH diet and key nutrients provided, you may be wondering what specific foods comprise the eating plan. See below for a 1-day sample menu of the wide variety of delicious foods that can be enjoyed.


While adherence to the DASH diet can independently reduce blood pressure, the most successful plans to manage high blood pressure include a multi-faceted diet and lifestyle approach. This nutrient-rich diet, along with consistent physical activity, monitored sodium intake, and moderate alcohol consumption, is a generally healthful lifestyle to adopt for all individuals with and without hypertension, and can have a great impact on reducing the risk for developing chronic health conditions that many in our nation face today.


While many strategies to reduce high blood pressure exist, recommendations from health professionals often overlook the power of potassium. To highlight this vital nutrient, the next article in the series will focus on the beneficial effects of increasing potassium intake. Look for the potassium article in the October issue of Food Insight.