Skip to main content
Journal cover image

Determinants and consequences of adherence to the dietary approaches to stop hypertension diet in African-American and white adults with high blood pressure: results from the ENCORE trial.

Publication ,  Journal Article
Epstein, DE; Sherwood, A; Smith, PJ; Craighead, L; Caccia, C; Lin, P-H; Babyak, MA; Johnson, JJ; Hinderliter, A; Blumenthal, JA
Published in: J Acad Nutr Diet
November 2012

BACKGROUND: Although the Dietary Approaches to Stop Hypertension (DASH) diet is an accepted nonpharmacologic treatment for hypertension, little is known about what patient characteristics affect dietary adherence and what level of adherence is needed to reduce blood pressure (BP). OBJECTIVE: Our aim was to determine what factors predict dietary adherence and the extent to which dietary adherence is necessary to produce clinically meaningful BP reductions. DESIGN: Ancillary study of the ENCORE (Exercise and Nutrition Interventions for Cardiovascular Health) trial--a 16-week randomized clinical trial of diet and exercise. PARTICIPANTS/SETTING: Participants included 144 sedentary, overweight, or obese adults (body mass index 25 to 39.9) with high BP (systolic 130 to 159 mm Hg and/or diastolic 85 to 99 mm Hg). INTERVENTION: Patients were randomized to one of three groups: DASH diet alone, DASH diet plus weight management, and Usual Diet Controls. MAIN OUTCOMES MEASURES: Our primary outcomes were a composite index of adherence to the DASH diet and clinic BP. STATISTICAL ANALYSES PERFORMED: General linear models were used to compare treatment groups on post-treatment adherence to the DASH diet. Linear regression was used to examine potential predictors of post-treatment DASH adherence. Analysis of covariance was used to examine the relation of adherence to the DASH diet and BP. RESULTS: Participants in the DASH diet plus weight management (16.1 systolic BP [SBP]; 95% CI 13.0 to 19.2 mm Hg and 9.9 diastolic BP [DBP]; 95% CI 8.1 to 11.6 mm Hg) and DASH diet alone (11.2 SBP; 95% CI 8.1 to 14.3 mm Hg and 7.5 DBP; 95% CI 5.8 to 9.3 mm Hg) groups showed significant reductions in BP in comparison with Usual Diet Controls participants (3.4 SBP; 95% CI 0.4 to 6.4 mm Hg and DBP 3.8; 95% CI 2.2 to 5.5 mm Hg). Greater post-treatment consumption of DASH foods was noted in both the DASH diet alone (mean = 6.20; 95% CI 5.83 to 6.57) and DASH diet plus weight management groups (mean = 6.23; 95% CI 5.88 to 6.59) compared with Usual Diet Controls (mean = 3.66; 95% CI 3.30 to 4.01; P<0.0001), and greater adherence to the DASH diet was associated with larger reductions in clinic SBP and DBP (P ≤ 0.01). Only ethnicity predicted dietary adherence, with African Americans less adherent to the DASH diet compared with whites (4.68; 95% CI 4.34 to 5.03 vs 5.83; 95% CI 5.50 to 6.11; P<0.001). CONCLUSIONS: Greater adherence to the DASH diet was associated with larger BP reductions independent of weight loss. African Americans were less likely to be adherent to the DASH dietary eating plan compared with whites, suggesting that culturally sensitive dietary strategies might be needed to improve adherence to the DASH diet.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Acad Nutr Diet

DOI

ISSN

2212-2672

Publication Date

November 2012

Volume

112

Issue

11

Start / End Page

1763 / 1773

Location

United States

Related Subject Headings

  • White People
  • Weight Loss
  • Treatment Outcome
  • Patient Compliance
  • Overweight
  • Middle Aged
  • Male
  • Linear Models
  • Hypertension
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Epstein, D. E., Sherwood, A., Smith, P. J., Craighead, L., Caccia, C., Lin, P.-H., … Blumenthal, J. A. (2012). Determinants and consequences of adherence to the dietary approaches to stop hypertension diet in African-American and white adults with high blood pressure: results from the ENCORE trial. J Acad Nutr Diet, 112(11), 1763–1773. https://doi.org/10.1016/j.jand.2012.07.007
Epstein, Dawn E., Andrew Sherwood, Patrick J. Smith, Linda Craighead, Carla Caccia, Pao-Hwa Lin, Michael A. Babyak, Julie J. Johnson, Alan Hinderliter, and James A. Blumenthal. “Determinants and consequences of adherence to the dietary approaches to stop hypertension diet in African-American and white adults with high blood pressure: results from the ENCORE trial.J Acad Nutr Diet 112, no. 11 (November 2012): 1763–73. https://doi.org/10.1016/j.jand.2012.07.007.
Epstein, Dawn E., et al. “Determinants and consequences of adherence to the dietary approaches to stop hypertension diet in African-American and white adults with high blood pressure: results from the ENCORE trial.J Acad Nutr Diet, vol. 112, no. 11, Nov. 2012, pp. 1763–73. Pubmed, doi:10.1016/j.jand.2012.07.007.
Epstein DE, Sherwood A, Smith PJ, Craighead L, Caccia C, Lin P-H, Babyak MA, Johnson JJ, Hinderliter A, Blumenthal JA. Determinants and consequences of adherence to the dietary approaches to stop hypertension diet in African-American and white adults with high blood pressure: results from the ENCORE trial. J Acad Nutr Diet. 2012 Nov;112(11):1763–1773.
Journal cover image

Published In

J Acad Nutr Diet

DOI

ISSN

2212-2672

Publication Date

November 2012

Volume

112

Issue

11

Start / End Page

1763 / 1773

Location

United States

Related Subject Headings

  • White People
  • Weight Loss
  • Treatment Outcome
  • Patient Compliance
  • Overweight
  • Middle Aged
  • Male
  • Linear Models
  • Hypertension
  • Humans