The effectiveness of Dietary Approaches to Stop Hypertension (DASH) counselling on estimated 10-year cardiovascular risk among patients with newly diagnosed grade 1 hypertension: a randomised clinical trial

Wong, M. C.S. et al. (2016) The effectiveness of Dietary Approaches to Stop Hypertension (DASH) counselling on estimated 10-year cardiovascular risk among patients with newly diagnosed grade 1 hypertension: a randomised clinical trial. International Journal of Cardiology, 224, pp. 79-87. (doi: 10.1016/j.ijcard.2016.08.334) (PMID:27631719)

Abstract

Background: The Dietary Approaches to Stop Hypertension (DASH) has been shown to lower blood pressure in the West. However, the real-life impact of DASH on reducing cardiovascular (CV) risk in routine clinical setting has not been studied. Methods: A parallel-group, open-labelled, physician-blinded, randomised controlled trial was conducted in January–June 2013 and followed up for 6- and 12-months in primary care settings in Hong Kong. Patients newly diagnosed with grade 1 hypertension (aged 40–70 years) who had no concomitant medical conditions requiring dietary modifications were consecutively recruited. Subjects were randomised to standard education (usual care) (n = 275), or usual care plus dietitian-delivered DASH-based dietary counselling in a single one-to-one session (intervention) (n = 281). Primary outcomes were the changes in estimated 10-year CV risk. Results: Outcome data were available for 504 (90.6%) and 485 (87.2%) patients at 6 and 12 months, respectively. There was no difference in the reduction of 10-year CV risk between the two groups at 6 months (− 0.13%, 95% confidence interval [95% CI] − 0.50% to 0.23%, p = 0.477) and 12 months (− 0.08%, 95% CI − 0.33% to 0.18%, p = 0.568). Multivariate regression analyses showed that male subjects, younger patients, current smokers, subjects with lower educational level, and those who dined out for main meals for ≥ 4 times in a typical week were significantly associated with no improvements in CV risk. Conclusions: The findings may not support automatic referral of newly diagnosed grade 1 hypertensive patients for further one-to-one dietitian counselling on top of primary care physician's usual care. Patients with those risk factors identified should receive more clinical attention to reduce their CV risk. Clinical trial registration: ChiCTR-TRC-13003014 (http://www.chictr.org.cn/enindex.aspx).

• Item Type: Articles
• Additional Information: This work was supported by grants from the Health and Medical Research Fund, Food and Health Bureau, Hong Kong Government (09100701) led by M.C.S. Wong at The Chinese University of Hong Kong. H.H.X. Wang was supported by New Faculty Start-Up Research Fund (51000-31121405 and 51000-18821202) at Sun Yat-Sen University.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Wang, Professor Haoxiang
• Authors: Wong, M. C.S., Wang, H. H.X., Kwan, M. W.M., Li, S. T.S., Liang, M., Fung, F. D.H., Yeung, M. S., Fong, B. C.Y., Zhang, D. X., Chan, D. K.L., Yan, B. P., Coats, A. J.S., and Griffiths, S. M.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
• Journal Name: International Journal of Cardiology
• Publisher: Elsevier
• ISSN: 0167-5273
• Published Online: 29 August 2016
• Copyright Holders: Copyright © 2016 Elsevier Inc.
• First Published: First published in International Journal of Cardiology 224: 79-87
• Publisher Policy: Reproduced in accordance with the publisher copyright policy