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Contempo 1999
January 13, 1999

Advances in the Treatment of Hypertension

Author Affiliations

Author Affiliation: Hypertension Center, New York Presbyterian Hospital, New York, NY.


Edited by Thomas C. Jefferson, MD, JAMA Fishbein Fellow.

JAMA. 1999;281(2):114-116. doi:10.1001/jama.281.2.114

The past year has seen a flurry of publications of large-scale clinical trials that may have major impact on the treatment of hypertensive patients. Most of these appeared after the November 1997 publication of the latest report of the Joint National Committee (JNC VI)1 and generally support its recommendations.

The JNC VI paid much more attention than have previous JNC reports to nonpharmacological treatment of hypertension, particularly the Dietary Approaches to Stop Hypertension (DASH) diet.2 The traditional recommendations for controlling blood pressure by dietary means are to restrict salt and to lose weight. However, vegetarians generally have low blood pressure, and there is some evidence, albeit inconsistent, that dietary supplementation with potassium, calcium, and magnesium may also have beneficial effects on blood pressure. The DASH study showed that a combination diet rich in fruits and vegetables and in which saturated fat was replaced by low-fat dairy products produced a greater reduction of blood pressure than did the intervention in most other dietary studies. The DASH diet has high potassium, calcium, and magnesium content but is not low in sodium. One reason for this may have been that it was a "feeding" study rather than a "counseling" study—the subjects were provided with all their meals. Apart from its inclusion of low-fat dairy products, the DASH diet resembled the Mediterranean diet, which has gained support as the ideal diet for general health. What is particularly exciting about the DASH diet is that it may have benefits beyond lowering blood pressure. The health benefits of the Mediterranean diet have been tested in only 1 experimental human study, the Lyon Diet Heart Study, which found that deaths from both cardiovascular disease and cancer are reduced in subjects consuming the Mediterranean diet.3,4 Further indirect evidence for benefits from the DASH diet beyond blood pressure reduction comes from a prospective study of the relationships between the dietary intake of minerals and stroke performed in 43,738 men who were participants in the Health Professionals Follow-up Study.5 The intake of potassium, magnesium, and fiber (but not of sodium or calcium) was inversely associated with the risk of stroke during an 8-year follow-up period. The DASH diet had the same amount of potassium, magnesium, and fiber as the highest quintiles of intake reported in the Health Professionals Study.