Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: The authors of the PREMIER trial1 found that clinically significant reductions in
BP can be achieved through lifestyle modification. However, their claim that
"adoption of the DASH [Dietary Approaches to Stop Hypertension] diet further
improves BP control" is not supported by their data. Indeed, the addition
of the DASH diet to the "established" treatment resulted in a small and nonsignificant
difference in BP (<1 mm Hg) compared with the "established" treatment alone.
In fact, the BP differences between groups could be fully accounted for by
differential weight loss. Unlike the DASH diet studies, which controlled diet
and caloric consumption,2- 4 the
DASH diet condition in the PREMIER study was confounded with weight loss.
The absence of a DASH diet–only condition and greater weight loss in
the DASH plus established treatment condition in PREMIER make it impossible
to determine the potential incremental benefit of the DASH diet.
Blumenthal JA, Sherwood A, Bacon SL, Hinderliter A. Effects of Exercise and Weight Loss on HypertensionEffects of Exercise and Weight Loss on Hypertension. JAMA. 2003;290(7):885. doi:10.1001/jama.290.7.885-a