Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: In his Editorial accompanying
the PREMIER trial,1 Dr Pickering2 pointed out that there was no significant difference
in BP reduction between the groups that received lifestyle counseling vs the
group that received lifestyle counseling plus the DASH diet. We take issue,
however, with Pickering's statement that the DASH diet was the first convincing
evidence that nonpharmacological treatment could reduce BP in patients with
hypertension as much as some drugs can, and with his comment that "no study
has demonstrated any additive effect of combining lifestyle interventions
on blood pressure." In the DASH Sodium study,3 although
effects were not strictly additive, the combination of sodium restriction
and the DASH diet resulted in greater effects on BP than either intervention
alone. Several randomized controlled factorial trials have found additive
effects of different lifestyle changes resulting in decreases in systolic
BP of as much as 14 mm Hg.4- 7 The
lack of additive effects in PREMIER may be partly due to the relatively low
baseline BPs compounded by a familiarization effect as suggested by an "unexpectedly"
large decrease in BP among the controls.
Beilin LJ, Burke V, Puddey IB. 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