Translating the DASH Diet into Practice

Project Aim: The purpose of the project was to apply high-intensity counseling to improve compliance with dietary and physical activity recommendations and decrease in blood pressure (BP) levels among hypertensive adults. 

Background: Hypertension is a major risk factor for the two leading causes of death in the United States, heart attack and stroke. Although guidelines to prevent and treat hypertension recommend adoption of the Dietary Approaches to Stop Hypertension (DASH) diet, there is lack of compliance with these recommendations in practice. National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2004 indicated only 19% of hypertensive adults were DASH accordant. Seven out of seven hypertensive patients seen in a local primary care setting were found to be non-compliant with the DASH diet.  The medical director of the practice reported the majority of the hypertensive adults seen were non-DASH diet accordant.  Poor compliance leads to progression of pre-hypertension to hypertension and poorly controlled blood pressure (BP) among hypertensive patients. Evidence consistently shows time-intensive counseling generally produces larger changes in dietary behavior than less time-intensive interventions. Despite the evidence in support of time-intensive counseling, current lifestyle modification counseling in the local primary care setting was only limited to office visits.

Project Approach: Hypertensive adults seen in a primary care setting participated in three 1-hour group classes and two 20-minute individual telephone follow-ups. Participants completed a 24-hour dietary intake recall pre- and post-intervention. Pre-intervention systolic BP (SBP) was obtained through chart review, and post-intervention SBP was obtained through BP measurements during the final class session. The percentages of participants engaged in DASH-related behavioral changes and who had decreased BP were used to evaluate data.

Outcomes: Data collection currently in progress, however it is expected there will be an increase in percentages of participants engaged in DASH-related behavioral changes and those with lower BP.

Conclusions: To be determined following review and analysis of results. It is expected high-intensity diet counseling in primary care will show early success in decreasing cardiovascular risk in hypertensive patients seen in primary care. If successful, investment in high-intensity diet and lifestyle counseling should be considered among high-risk patients in the primary care setting.