Wong, Martin C. S., Wang, Harry H. X., Kwan, Mandy W. M., Li, Shannon T. S., Liang, Miaoyin, Fung, Franklin D. H., Yeung, Ming Sze, Fong, Brian C. Y., Zhang, De Xing, Chan, David K. L., Yan, Bryan P., Coats, Andrew J. S. and Griffiths, Sian M. (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

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Abstract

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.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Hypertension -- Prevention -- Hong Kong, Cardiovascular system -- Diseases, Diet, Clinical trials
Journal or Publication Title:	International Journal of Cardiology
Publisher:	Elsevier Ireland Ltd.
ISSN:	0167-5273
Official Date:	1 December 2016
Dates:	Date Event 1 December 2016 Published 29 August 2016 Available 23 August 2016 Accepted 26 June 2016 Submitted
Date of first compliant deposit:	4 January 2017
Volume:	224
Page Range:	pp. 79-87
DOI:	10.1016/j.ijcard.2016.08.334
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Funder:	Hong Kong (China). Food and Health Bureau
Related URLs:	Other Repository

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