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Guo W, Zhao W, Li D, Jia H, Ren C, Li S, Zhao J, Yu B, Dong J, Guo R, Zhu K, Cao Y, Wang Y, Wang Y, Li Z, Wang Z, Wang D, Hou C, Hausenloy DJ, Chu X, Ji X. Chronic Remote Ischemic Conditioning on Mild Hypertension in the Absence of Antihypertensive Medication: A Multicenter, Randomized, Double-Blind, Proof-of-Concept Clinical Trial. Hypertension 2023; 80:1274-1282. [PMID: 37035920 DOI: 10.1161/hypertensionaha.122.20934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/12/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Exploratory studies have shown that remote ischemic conditioning (RIC) has the potential to lower blood pressure (BP). We investigated whether chronic RIC reduces BP for hypertension. METHODS This is a multicenter, randomized, double-blind, parallel-controlled trial. Patients with an office BP of 130/80 to 160/100 mm Hg and a 24-hour average BP ≥125/75 mm Hg not on antihypertensive medications were recruited. After a 1-week compliance screening phase, they were randomly assigned in a 1:1 ratio to receive RIC or sham RIC twice daily for 4 weeks. The primary efficacy outcome was the change in 24-hour average systolic BP from baseline to 4 weeks. Safety events were assessed over the study period. RESULTS Ninety-five participants were randomly allocated to the RIC (n=49) and sham RIC (n=46) groups. In the intention-to-treat analysis, the reduction in 24-hour average systolic BP was greater in the RIC group than the sham RIC group (-4.6±9.5 versus -0.9±6.8 mm Hg; baseline-adjusted between-group mean difference: -3.6 mm Hg [95% CI, -6.9 to -0.3 mm Hg]; adjusted P=0.035). The per-protocol analysis showed that 24-hour average systolic BP reduced -5.9±8.6 mm Hg in the RIC group and -0.7±6.7 mm Hg in the sham RIC group (baseline-adjusted between-group mean difference: -5.2 mm Hg [95% CI, -8.5 to -1.9 mm Hg]; adjusted P=0.002). No major adverse events were reported in both groups. CONCLUSIONS RIC is safe in patients with mild hypertension and may lower BP in the absence of antihypertensive medications. However, the effects of RIC on clinical outcomes in these patients require further investigation. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04915313.
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Affiliation(s)
- Wenting Guo
- Department of Neurology (W.G., W.Z.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenbo Zhao
- Department of Neurology (W.G., W.Z.), Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine (W.Z., C.R., Yan Wang), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dong Li
- Peking University Care Health Management Center, Beijing, China (D.L., Ying Wang, Z.L.)
| | - Haiying Jia
- Health Management Center, The 306 Hospital of People's Liberation Army, Beijing, China (H.J., Z.W., D.W.)
| | - Changhong Ren
- Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine (W.Z., C.R., Yan Wang), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sijie Li
- Department of Emergency (S.L.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jing Zhao
- Health Management Center (J.Z., B.Y., J.D., R.G., K.Z., Y.C., X.C.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Bingxin Yu
- Health Management Center (J.Z., B.Y., J.D., R.G., K.Z., Y.C., X.C.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Dong
- Health Management Center (J.Z., B.Y., J.D., R.G., K.Z., Y.C., X.C.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Rongfen Guo
- Health Management Center (J.Z., B.Y., J.D., R.G., K.Z., Y.C., X.C.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kun Zhu
- Health Management Center (J.Z., B.Y., J.D., R.G., K.Z., Y.C., X.C.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu Cao
- Health Management Center (J.Z., B.Y., J.D., R.G., K.Z., Y.C., X.C.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Wang
- Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine (W.Z., C.R., Yan Wang), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ying Wang
- Peking University Care Health Management Center, Beijing, China (D.L., Ying Wang, Z.L.)
| | - Zunshan Li
- Peking University Care Health Management Center, Beijing, China (D.L., Ying Wang, Z.L.)
| | - Zhen Wang
- Health Management Center, The 306 Hospital of People's Liberation Army, Beijing, China (H.J., Z.W., D.W.)
| | - Dan Wang
- Health Management Center, The 306 Hospital of People's Liberation Army, Beijing, China (H.J., Z.W., D.W.)
| | - Chengbei Hou
- Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Derek J Hausenloy
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School (D.J.H.)
- National Heart Research Institute Singapore, National Heart Centre (D.J.H.)
- Yong Loo Lin School of Medicine, National University Singapore (D.J.H.)
| | - Xi Chu
- Health Management Center (J.Z., B.Y., J.D., R.G., K.Z., Y.C., X.C.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Neurosurgery (X.J.), Xuanwu Hospital, Capital Medical University, Beijing, China
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Tyson CC, Svetkey LP, Lin PH, Granados I, Kennedy D, Dunbar KT, Redd C, Bennett G, Boulware LE, Fish LJ. Self-Perceived Barriers and Facilitators to Dietary Approaches to Stop Hypertension Diet Adherence Among Black Americans With Chronic Kidney Disease: A Qualitative Study. J Ren Nutr 2023; 33:59-68. [PMID: 35597318 PMCID: PMC10344422 DOI: 10.1053/j.jrn.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/25/2022] [Accepted: 05/01/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE The Dietary Approaches to Stop Hypertension (DASH) eating plan improves hypertension in Black individuals and is associated with favorable chronic kidney disease (CKD) outcomes. Yet, adherence to DASH is low among US adults in general, particularly among Black Americans. We assessed perceptions about DASH, its cultural compatibility, and barriers and facilitators to DASH adherence in Black adults with CKD. DESIGN AND METHODS We conducted focus groups and semistructured individual interviews involving 22 Black men and women with CKD Stages 3-4 from outpatient clinics at a US academic medical center. Transcripts of audio-recorded interviews were analyzed using thematic analysis. RESULTS Among participants (2 focus groups [N = 8 and 5] and 9 individual interviews), 13 (59%) had CKD Stage 3, 13 (59%) were female, the median age was 61 years, and 19 (90%) had hypertension. After receiving information about DASH, participants perceived it as culturally compatible based on 3 emergent themes: (1) Black individuals already eat DASH-recommended foods ("Blacks eat pretty much like this"), (2) traditional recipes (e.g., southern or soul food) can be modified into healthy versions ("you can come up with decent substitutes to make it just as good"), and ( 3) diet is not uniform among Black individuals ("I can't say that I eat traditional"). Perceived barriers to DASH adherence included unfamiliarity with serving sizes, poor cooking skills, unsupportive household members, and high cost of healthy food. Eleven (52%) reported after paying monthly bills that they "rarely" or "never" had leftover money to purchase healthy food. Perceived facilitators included having local access to healthy food, living alone or with supportive household members, and having willpower and internal/external motivation for change. CONCLUSIONS Black adults with CKD viewed DASH as a healthy, culturally compatible diet. Recognizing that diet in Black adults is not uniform, interventions should emphasize person-centered, rather than stereotypically culture-centered, approaches to DASH adherence.
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Affiliation(s)
- Crystal C Tyson
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
| | - Laura P Svetkey
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Stedman Nutrition & Metabolism Center, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Pao-Hwa Lin
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Stedman Nutrition & Metabolism Center, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Isa Granados
- Duke Cancer Institute, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Kayla T Dunbar
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Cynthia Redd
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Gary Bennett
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Department of Psychology and Neuroscience, Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
| | - L Ebony Boulware
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Laura J Fish
- Duke Cancer Institute, Duke University, Durham, North Carolina; Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina
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Carson TL, Buro AW, Miller D, Peña A, Ard JD, Lampe JW, Yi N, Lefkowitz E, William VDP, Morrow C, Wilson L, Barnes S, Demark-Wahnefried W. Rationale and study protocol for a randomized controlled feeding study to determine the structural- and functional-level effects of diet-specific interventions on the gut microbiota of non-Hispanic black and white adults. Contemp Clin Trials 2022; 123:106968. [PMID: 36265810 PMCID: PMC10095329 DOI: 10.1016/j.cct.2022.106968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Colorectal cancer (CRC), the third leading cause of cancer-related deaths in the US, has been associated with an overrepresentation or paucity of several microbial taxa in the gut microbiota, but causality has not been established. Black men and women have among the highest CRC incidence and mortality rates of any racial/ethnic group. This study will examine the impact of the Dietary Approaches to Stop Hypertension (DASH) diet on gut microbiota and fecal metabolites associated with CRC risk. METHODS A generally healthy sample of non-Hispanic Black and white adults (n = 112) is being recruited to participate in a parallel-arm randomized controlled feeding study. Participants are randomized to receive the DASH diet or a standard American diet for a 28-day period. Fecal samples are collected weekly throughout the study to analyze changes in the gut microbiota using 16 s rRNA and selected metagenomics. Differences in bacterial alpha and beta diversity and taxa that have been associated with CRC (Bacteroides, Fusobacterium, Clostridium, Lactobacillus, Bifidobacterium, Ruminococcus, Porphyromonas, Succinivibrio) are being evaluated. Covariate measures include body mass index, comorbidities, medication history, physical activity, stress, and demographic characteristics. CONCLUSION Our findings will provide preliminary evidence for the DASH diet as an approach for cultivating a healthier gut microbiota across non-Hispanic Black and non-Hispanic White adults. These results can impact clinical, translational, and population-level approaches for modification of the gut microbiota to reduce risk of chronic diseases including CRC. TRIAL REGISTRATION This study was registered on ClinicalTrials.gov, identifier NCT04538482, on September 4, 2020 (https://clinicaltrials.gov/ct2/show/NCT04538482).
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Affiliation(s)
- Tiffany L Carson
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America.
| | - Acadia W Buro
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Darci Miller
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Alissa Peña
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Jamy D Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Johanna W Lampe
- Public Health Science Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Nengjun Yi
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Elliot Lefkowitz
- Center for Clinical and Translational Sciences, University of Alabama at Birmingham, Birmingham, AL, United States of America; Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Van Der Pol William
- Center for Clinical and Translational Sciences, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Casey Morrow
- Department of Cell, Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Landon Wilson
- Department of Pharmacology and Toxicology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America; Targeted Metabolomics and Proteomics Laboratory, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Stephen Barnes
- Department of Pharmacology and Toxicology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America; Targeted Metabolomics and Proteomics Laboratory, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States of America
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Na M, Wang Y, Zhang X, Sarpong C, Kris-Etherton PM, Gao M, Xing A, Wu S, Gao X. Dietary Approaches to Stop Hypertension (DASH)-Style Dietary Pattern and 24-Hour Ambulatory Blood Pressure in Elderly Chinese with or without Hypertension. J Nutr 2022; 152:1755-1762. [PMID: 35404464 PMCID: PMC9258602 DOI: 10.1093/jn/nxac086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/18/2022] [Accepted: 04/04/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND It is unknown whether the Dietary Approaches to Stop Hypertension (DASH) dietary pattern is associated with other blood pressure (BP) variables, beyond mean systolic blood pressure (SBP) and diastolic blood pressure (DBP). OBJECTIVES The study aimed to study the associations between the DASH dietary pattern and daytime and nighttime mean BPs and BP variance independent of the mean (VIM). METHODS A sample of 324 Chinese adults aged ≥ 60 y who were not on BP-lowering medications were included in the analysis. The DASH score was calculated using data collected by a validated FFQ. The 24-h ambulatory BP was measured and the mean and VIM SBP and DBP were calculated for both the daytime (06:00-21:59) and nighttime periods (22:00-05:59). Multivariable linear models were constructed to assess associations between the DASH dietary pattern and daytime and nighttime BP outcomes, adjusting for sociodemographic factors, lifestyle, BMI, and hypertension (clinic SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg), and sleep parameters (only for nighttime BP outcomes). An interaction term between DASH score and hypertension status was added to explore the potential differential association in normotensive and hypertensive individuals. RESULTS Every 1-unit increase in the DASH score was associated with a 0.18-unit (95% CI: -0.34, -0.01 unit) and a 0.22-unit (95% CI: -0.36, -0.09 unit) decrease in nighttime VIM SBP and nighttime VIM DBP, respectively. DASH score was not associated with any daytime BP outcomes, nighttime mean SBP, or nighttime mean DBP. A significant interaction (DASH score × hypertension status) was detected for VIM SBP (P-interaction = 0.04), indicating a differential association between DASH score and nighttime VIM SBP by hypertension status. CONCLUSIONS Independently of sleep parameters and other factors, the DASH dietary pattern is associated with lower nighttime BP variability in elderly adults.
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Affiliation(s)
- Muzi Na
- Address correspondence to MN (E-mail: )
| | - Yanxiu Wang
- Department of Cardiology, Kailuan General Hospital, Hebei United University, Tangshan, China
| | - Xinyuan Zhang
- Department of Nutritional Sciences, Penn State College of Health and Human Development, University Park, PA, USA
| | - Christopher Sarpong
- Department of Biology, Penn State Eberly College of Science, University Park, PA, USA
| | - Penny M Kris-Etherton
- Department of Nutritional Sciences, Penn State College of Health and Human Development, University Park, PA, USA
| | - Ming Gao
- Department of Cardiology, Kailuan General Hospital, Hebei United University, Tangshan, China
| | - Aijun Xing
- Department of Cardiology, Kailuan General Hospital, Hebei United University, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Hebei United University, Tangshan, China
| | - Xiang Gao
- Department of Nutrition and Food Hygiene, School of Public Health, Fudan University, Shanghai, China
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Dhillon J, Jacobs AG, Ortiz S, Diaz Rios LK. A Systematic Review of Literature on the Representation of Racial and Ethnic Minority Groups in Clinical Nutrition Interventions. Adv Nutr 2022; 13:1505-1528. [PMID: 35108358 PMCID: PMC9526835 DOI: 10.1093/advances/nmac002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/29/2021] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
The racial and ethnic disparities in diet-related chronic diseases are major concerns. This systematic review examines the extent to which diet-induced changes in health outcomes, such as cardiometabolic, inflammation, cancer, bone health, and kidney function outcomes, etc., have been reported and discussed by race or ethnicity in randomized trials with 2 or more diet arms that recruited both minority and non-Hispanic White groups. Databases (i.e., PubMed, Cochrane Library, and Web of Science) were searched up to August 2021. Thirty-four studies that discussed effects of defined dietary interventions on health outcomes by racial or ethnic minority group compared with non-Hispanic Whites were included in the systematic review (PROSPERO registration number: CRD42021229256). Acute trials and those with 1 diet arm that accounted for race or ethnicity in their analyses and studies that focused on a single racial or ethnic group were discussed separately. Most studies were conducted in Black compared with White adults testing effects of energy restriction, macronutrient modification, sodium reduction, or variations of the Dietary Approaches to Stop Hypertension (DASH) diet on cardiometabolic outcomes. There was limited focus on other minority groups. Evidence suggests greater blood pressure reduction for Black adults compared with Whites particularly with DASH (or similar) diets. Overall, there was limited consideration for group-specific eating patterns and diet acceptability. Overall risk of bias was low. With emerging precision nutrition initiatives that aim to optimize metabolic responses in population subgroups through tailored approaches, it is imperative to ensure adequate representation of racial and ethnic subgroups for addressing health disparities. Factors that help explain variability in responses such as socioecological context should be included and adequately powered. Given the racial and ethnic disparities in chronic diseases, studying the adoption, maintenance, and effectiveness of dietary interventions on health outcomes among different groups is critical for developing approaches that can mitigate diet-related health disparities.
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Affiliation(s)
| | | | - Sigry Ortiz
- Department of Molecular & Cell Biology, School of Natural Sciences, University of California Merced, Merced, CA, USA
| | - L Karina Diaz Rios
- Division of Agriculture and Natural Resources, University of California Merced, Merced, CA, USA
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St-Onge MP, Campbell A, Aggarwal B, Taylor JL, Spruill TM, RoyChoudhury A. Mild sleep restriction increases 24-hour ambulatory blood pressure in premenopausal women with no indication of mediation by psychological effects. Am Heart J 2020; 223:12-22. [PMID: 32135337 DOI: 10.1016/j.ahj.2020.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 02/06/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies assessing the impact of sleep restriction (SR) on blood pressure (BP) are limited by short study length, extreme SR (<4 hours a night), and lack of attention to psychological distress as a possible mediator. METHODS A community-based cohort was assembled with 237 women (age 34.1 ± 13.5 years; body mass index 25.4 ± 5.4 kg/m2), and a randomized, crossover, intervention study was conducted in 41 women (24 completed: age 30.2 ± 6.5 years; body mass index 24.3 ± 2.8 kg/m2) to determine the causal effect of SR on BP. Sleep was maintained as usual (HS) or reduced by 1.5 hours a night (SR) for 6 weeks. In the cohort, associations between sleep and psychosocial factors were evaluated using multivariable models adjusted for demographic and clinical confounders. In the intervention study, in-office BP was measured weekly; ambulatory BP was measured at end point. Psychological factors were assessed at baseline and end point. Mixed-model analyses with total sleep time (TST, main predictor), week and fraction of time spent in physical activity (covariates), and subject (random effect) were performed. RESULTS Among the community cohort, higher perceived stress, stressful events and distress, and lower resilience were associated with shorter sleep, worse sleep quality, and greater insomnia symptoms (P < .05). In the intervention, systolic BP increased as TST decreased (TST × week interaction, [coefficient ± standard error] -0.0097 ± 0.0046, P = .036). Wake ambulatory diastolic blood pressure (-0.059 ± 0.022, P = .021) and mean arterial pressure (-0.067 ± 0.023, P = .018) were higher after SR versus HS. Psychological distress variables were not affected by TST and did not mediate the effects of SR on BP. CONCLUSIONS These results suggest that SR influences CVD risk in women via mechanisms independent of psychological stressors.
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Affiliation(s)
- Marie-Pierre St-Onge
- Sleep center of excellence, Department of Medicine, Columbia University Irving Medical Center, New York, NY; Institute of Human Nutrition, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY.
| | - Ayanna Campbell
- Sleep center of excellence, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Brooke Aggarwal
- Sleep center of excellence, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Jasmine L Taylor
- Institute of Human Nutrition, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY; Tulane Medical Center, New Orleans, LA
| | - Tanya M Spruill
- Department of Population Health, NYU School of Medicine, New York, NY
| | - Arindam RoyChoudhury
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, NY
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Tyson CC, Davenport CA, Lin PH, Scialla JJ, Hall R, Diamantidis CJ, Lunyera J, Bhavsar N, Rebholz CM, Pendergast J, Boulware LE, Svetkey LP. DASH Diet and Blood Pressure Among Black Americans With and Without CKD: The Jackson Heart Study. Am J Hypertens 2019; 32:975-982. [PMID: 31187128 DOI: 10.1093/ajh/hpz090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/08/2019] [Accepted: 05/29/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Dietary Approaches to Stop Hypertension (DASH) diet lowers blood pressure (BP) more effectively in blacks compared to other US racial subgroups. Considering chronic kidney disease (CKD) raises BP through complex mechanisms, DASH may affect BP differently among blacks with and without CKD. We compared the association of DASH accordance to BP and prevalent hypertension among blacks with and without CKD. METHODS Our study involved 3,135 black Americans enrolled in the Jackson Heart Study (2000-2004) with diet and office BP data. Using linear models adjusted for demographics, health behaviors, and clinical factors, we determined the association of a modified DASH score (excluding sodium intake, ranging from 0 to 8 with increasing DASH accordance) with BP. We performed tests for interaction between DASH score and CKD status. RESULTS Among participants (mean age: 55 years; hypertension: 60%; CKD: 19%), the median DASH score was similar among participants with and without CKD (1.0 [interquartile range (IQR): 0.5-2] and 1.0 [IQR: 0.5-1.5]). CKD status modified the association of the DASH score with systolic BP (SBP) and diastolic BP (DBP; P interactions were 0.06 and <0.01). Among participants without CKD, SBP and DBP were not associated with the DASH score (-0.4 [95% confidence interval: -1.0, 0.1] mm Hg and -0.1 [-0.4, 0.2] mm Hg per one unit higher DASH score). Among participants with CKD, one unit higher DASH score was associated with lower SBP by 1.6 (0.5, 2.6) mm Hg and lower DBP by 0.9 (0.3, 1.5) mm Hg. CONCLUSIONS Despite low DASH scores overall, better DASH accordance was associated with lower BP among Black Americans with CKD.
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Affiliation(s)
- Crystal C Tyson
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Clemontina A Davenport
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Pao-Hwa Lin
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Julia J Scialla
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Rasheeda Hall
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Joseph Lunyera
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nrupen Bhavsar
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Casey M Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jane Pendergast
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - L Ebony Boulware
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laura P Svetkey
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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