DASH Diet May Prevent Nearly 27 000 US CVD Events in Patients with Stage 1 Hypertension, According to Simulation Study

Adoption of the Dietary Approaches to Stop Hypertension (DASH) diet may have the greatest impact for US patients with stage 1 hypertension (HTN) compared to other nonpharmacologic interventions, according to new research presented at the American Heart Association’s (AHA) Hypertension Scientific Sessions 2022, held September 7-10 in San Diego.

Findings from the simulation study showed adopting the DASH diet would prevent an estimated 16 000 cardiovascular disease (CVD) events among men and 11 000 among women with untreated stage 1 HTN. The DASH dietary plan was one of several nonpharmacologic lifestyle interventions analyzed in the study for its impact on elevated blood pressure (BP).

“Nearly nine million young and middle-aged adults with untreated stage 1 hypertension represent a significant, impending burden for health care systems,” said presenting author Kendra D. Sims, PhD, MPH, postdoctoral fellow, University of California, San Francisco, in an AHA press release. “Our results provide strong evidence that large-scale, healthy behavior modifications may prevent future heart disease, related complications and excess health care costs.”

The landmark 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of HTN in US adults changed the definition of stage 1 HTN from a systolic BP (SBP) of 140 mm Hg or a diastolic BP of 90 mm Hg to a SBP of 130–139 mm Hg or a DBP of 80–89 mm Hg. By lowering the diagnostic BP threshold, millions of younger, lower-risk adults were newly diagnosed with stage 1 HTN.

Sims and colleagues used the Cardiovascular Disease Policy Model, a population-level state-transition computer simulation of CVD, to simulate US CVD events, mortality, and health care costs between 2018 and 2027. The CVD Policy Model has been used for over 3 decades to reflect trends in CVD risk factors, outcomes, and health care costs in US adults.

The simulations targeted adults aged 35-64 years with untreated SBP between 130-139 mm Hg. Individuals were considered “lower-risk” if they had no previous history of diabetes, chronic kidney disease, or CVD and a predicted <10% 10-year CVD risk. Inputs for effects of dietary modification (including the DASH diet), sustained weight loss, physical activity, smoking cessation, and alcohol moderation on SBP were from published meta-analyses and trial data, according to the abstract.

Researchers estimated that 8.7 million US adults aged 35-64 years (50.6% women) have lower-risk untreated stage 1 HTN, of whom 5.5 million (61%) have regular health care access. Results showed that controlling BP to <130 mm Hg in the full target population using the nonpharmacologic lifestyle changes above could prevent 27 000 CVD events, avoid 2800 deaths, and save an associated $16 million in health care costs in the US over 10 years.

The largest benefit was observed for the DASH diet, leading to an estimated 16 000 CVD events prevented among men and 11 000 among women who adopted the nonpharmacologic intervention.

“Members of many disadvantaged communities face barriers to healthy food and regular health care access,” said Sims in the release. “This means they will not be able to benefit from a counseling from a doctor. Future research should investigate the big picture: social conditions granting people the time and resources to make healthy lifestyle choices. Only with this information can we develop policies for the prevention of heart disease, especially for vulnerable adults.”

Reference: Sims KD, Wei P, Bellows BK, et al. Abstract 137: Projected impact of non-pharmacologic management of stage 1 hypertension among lower-risk U.S. adults.Hypertension. Published online September 7, 2022. doi:10.1161/hyp.79.suppl_1.137