DASH-ing Towards Lower Blood Pressure

I spoke to a young man in his 40s in the outpatient Hypertension Clinic, he had been seen in the clinic several months prior for resistant hypertension. With many life changes and new stressors, he was having trouble finding the time to eat healthily and exercise, and his blood pressure was rising as a result. At this prior clinic visit, the physician at the time again made a renewed pitch for life-style modifications in addition the the patient's current blood pressure medications. We were now seeing this gentleman following 4 months of these life-style modifications including the DASH diet and exercise.

What is the DASH Diet? 

The DASH diet stands for ‘Dietary Approaches to Stopping Hypertension’. The DASH diet is high in fruits, vegetables and low-fat dairy, and low in snacks, sweets, meats and saturated and total fat. This is not a diet aimed at weight loss, but a diet that focuses on reducing blood pressure.

 

What’s the impact?

Irrespective of sodium intake, the DASH diet has been found to lower blood pressure in both those with high BP and those with normal BP. A further BP reduction is seen when you add on sodium restriction. With the low-sodium DASH diet, the mean fall in systolic BP in one study was 11.5mmHg!

 

Other Lifestyle/Dietary Modifications that can help lower BP:

• Physical Activity: 30-60min most days of the week
• DASH Diet
• Weight loss: losing 10 lbs can lower BP
• Consuming less salt: limit use in cooking and at table, avoid highly processed foods/canned/prepared foods
• Alcohol: limiting alcohol intake to a maximum of 2/day, weekly max:10 for women, and 3/day, weekly max:15 for men
• Smoking: quitting smoking

Some Potential Downsides of DASH Diet Adherence

• Planning that goes into the diet/meal plan
• Those with dietary restrictions may need to make modifications to the diet
• Food list for DASH diet is not comprehensive, can be difficult to determine where some foods fit into the DASH diet
• High fibre foods like fresh fruits and vegetables can lead to increased gas and bloating, reducing the tolerability of the diet for patients, one way to make it more tolerable is slowly introducing high fibre foods (2/3 per week) so the body can adjust

 

Back to our patient: 

Our patient informed us that with dietary modifications and exercise he had lost 38 lbs over 4 months. He found that he was getting light-headed at times, and noted his BP was consistently in the range of 105-110mmHg systolic. We therefore discussed removing one of his blood pressure medications, with the strong likelihood that we would be able to reduce another medication at our next visit.

 

This was a reminder to me that although we talk to patients about their medications at each visit, to make time to discuss non-pharmacologic and lifestyle modifications during appointments, they work!

-KD-

 

References: 

1. The Nutrition Source. Diet Review: DASH. Harvard School of Public Health. https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/dash-diet/

2. The DASH Diet to lower high blood pressure. The Heart and Stroke Foundation Canada.https://www.heartandstroke.ca/healthy-living/healthy-eating/dash-diet?gclid=CjwKCAjwmv-DBhAMEiwA7xYrd91WuCqqfiEMnsd2u3pV4kXj9bKph6FTs62xKrDNSbq-fo6Kaia_HhoCVewQAvD_BwE&gclsrc=aw.ds

3. Diet in the Treatment of Hypertension. UpToDate. https://www.uptodate.com/contents/diet-in-the-treatment-and-prevention-of-hypertension?search=DASH%20Diet&source=search_result&selectedTitle=1~28&usage_type=default&display_rank=1#H4