AJH 2003; 16:337–342

The DASH Diet Enhances the Blood Pressure

Response to Losartan in Hypertensive Patients

Paul R. Conlin, Thomas P. Erlinger, Arline Bohannon, Edgar R. Miller III,

Lawrence J. Appel, Laura P. Svetkey, and Thomas J. Moore

Background: The Dietary Approaches to Stop Hyper- ⫾ 1.5/⫺1.6 ⫾ 1.0 mm Hg), but there was a significant
tension (DASH) diet, which emphasizes fruits, vegetables, reduction in systolic ABP (⫺5.3 ⫾ 1.5 mm Hg, P ⬍ .05)
and no change in DBP (⫺2.5 ⫾ 1.0 mm Hg) on the DASH

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and low fat dairy products, significantly lowers blood
pressure (BP). We conducted a clinical trial to assess the diet (n ⫽ 27). Losartan significantly reduced ABP on the
BP response to the DASH diet with an antihypertensive control diet (⫺6.7 ⫾ 1.5/⫺3.7 ⫾ 1.0 mm Hg, P ⬍ .05)
medication, losartan, in participants with essential hyper- and to a greater extent on the DASH diet (⫺11.7 ⫾
tension. 1.5/⫺6.9 ⫾ 1.0 mm Hg, P ⬍ .05 versus basal and control
diet) particularly in African Americans. On the DASH
Methods: A total of 55 hypertensive participants were
diet, ⌬SBP on losartan was inversely related to basal
randomly assigned to 8 weeks of controlled feeding with
plasma renin activity (n ⫽ ⫺0.53, P ⫽ .004).
either a control diet or the DASH diet. Within each diet
arm, participants received losartan 50 mg daily or placebo Conclusions: The DASH diet enhances the ABP re-
for 4 weeks each, in double blind, randomized, cross-over sponse to losartan in essential hypertension. This effect is
fashion. Twenty-four-hour ambulatory BP (ABP) was particularly marked in African Americans. Am J Hyper-
measured at the end of a 2-week run-in period (baseline) tens 2003;16:337–342 © 2003 American Journal of Hy-
and after each 4-week intervention period. pertension, Ltd.
Results: There was no significant change in ABP dur- Key Words: Hypertension, DASH diet, losartan, blood
ing the placebo period on the control diet (n ⫽ 28) (⫺2.3 pressure.

R
ecommendations for hypertension prevention blood pressure (BP) in individuals with diastolic BP
and treatment consistently include lifestyle (DBP) between 80 and 95 mm Hg and systolic BP (SBP)
modifications as both an initial step and as an ⬍160 mm Hg. The DASH diet was particularly effective
adjunct to pharmacologic therapy. Dietary interventions in participants with stage 1 systolic or diastolic hyperten-
have been the mainstay of nonpharmacologic therapy sion.2,3 The importance of these findings was acknowl-
but have traditionally focused on salt restriction and edged by the Sixth Report of the Joint National Committee
weight loss. The success of these interventions has (JNC-VI), which recommended the DASH diet for pre-
typically been suboptimal, largely related to the diffi- vention and treatment of hypertension.4
culty in achieving and sustaining dietary and lifestyle The DASH study did not enroll patients with higher
changes. levels of BP. Most of these patients, who are currently
We previously reported the results of a multicenter treated with antihypertensive medication, might achieve
study, the Dietary Approaches to Stop Hypertension additional BP lowering with concomitant use of the DASH
(DASH) study.1 We showed that a diet emphasizing fruits, diet. The present study was designed to test the hypothesis
vegetables, and low fat dairy products significantly lowers that the DASH diet enhances the BP response to antihy-

Received September 18, 2002. First decision November 13, 2002. Ac- Company, Inc. The authors also acknowledge grant support from the
cepted December 19, 2002. National Heart, Lung and Blood Institute (DK63214, HL57173,
From the Division of Endocrinology, Diabetes and Hypertension HL57114, HL57139, and HL03857) and the General Clinical Research
(PRC), Brigham and Women’s Hospital, Boston, Massachusetts; Veter- Center Program of the National Center for Research Resources, National
ans Affairs Boston Healthcare System and Harvard Medical School Institutes of Health to Brigham and Women’s Hospital (M01-RR02635)
(PRC), Boston, Massachusetts; Johns Hopkins School of Medicine (TPE, and Johns Hopkins University (M01-RR00722).
ERM, LJA), Baltimore, Maryland; Duke Hypertension Center (AB,
LPS), Duke University Medical Center and the Sarah W. Stedman Center Address correspondence and reprint requests to Dr. Paul R. Conlin,
for Nutritional Studies, Durham, North Carolina; and Boston University Division of Endocrinology, Diabetes and Hypertension, Brigham and
Medical Center (TJM), Boston, Massachusetts. Women’s Hospital, 221 Longwood Avenue, Boston, MA 02115; e-mail:
This project was supported by an unrestricted grant from Merck and pconlin@partners.org

© 2003 by the American Journal of Hypertension, Ltd. 0895-7061/03/$30.00

Published by Elsevier Inc. doi:10.1016/S0895-7061(03)00056-6
338 DASH DIET AND LOSARTAN AJH–May 2003–VOL. 16, NO. 5, PART 1

Table 1. Nutrient composition of diets

2100 kcal/day Control Diet DASH Diet

Fat (%) 37 27
Sat. Fat (%) 16 6
Protein (%) 15 18
CHO (%) 48 55
Fiber (g) 9 31
Potassium (mg) 1700 4700
Magnesium (mg) 165 500
Calcium (mg) 450 1240
Sodium (g) 3 3

DASH ⫽ Dietary Approaches to Stop Hypertension; CHO ⫽ carbo-

hydrate.
FIG. 1. Study design. ABP ⫽ ambulatory blood pressure; DASH ⫽

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Dietary Approaches to Stop Hypertension.

pertensive medication in patients with stages 1 and 2

hypertension.
Based on observations (unpublished) that the DASH protein, and lower amounts of saturated fat, total fat, and
diet was associated with a small but significant increase in cholesterol. Both diets contained the same sodium content
plasma renin activity (PRA) and a significant association (approximately 3 g sodium/2100 kcal intake).
between the BP response to the DASH diet and the pres-
ence of the G-6A angiotensinogen gene polymorphism,5 Study Design
we hypothesized that using an agent that interrupts the
renin angiotensin system would be effective in conjunction Eligible participants began a 2-week run-in period of con-
with the DASH diet. The angiotensin receptor blocker trolled feeding eating the control diet. This study period
losartan was used to explore this question. was used to determine caloric requirements and participant
adherence to the feeding protocol.
After the run-in period, participants were randomized
Methods in block format (accounting for ethnicity) to continue the
Study Population control diet (n ⫽ 28) or begin the DASH diet (n ⫽ 27).
The diet assignment was continued for 8 weeks and was
This multicenter feeding study was conducted in a double
subdivided into two 4-week treatment periods during
blind, randomized, placebo controlled manner. Study par-
which participants were given either losartan 50 mg daily
ticipants were adults with essential hypertension. The pro-
or matching placebo in double blind, randomized, cross-
tocol excluded individuals with significant concomitant
over fashion (Fig. 1).
medical conditions that would interfere with or be affected
For the full 10 weeks of controlled feeding (2 weeks of
by participation in the study. Those taking antihyperten-
run-in and 8 weeks of randomized diet feeding), all meals
sive medication were withdrawn from medication before
were prepared in metabolic kitchens and supplied to study
completing two screening visits at least 1 week apart. To
participants. Compliance with the dietary intervention was
be eligible, participants were required to have measure-
assessed by participants’ daily attendance (Monday
ments of mean DBP 90 to 109 mm Hg and mean SBP
through Friday) for one on-site meal, attendance at study
⬍180 mm Hg (JNC-VI stages 1 and 2 systolic and dia-
visits for BP measurement, and self-report of adherence.
stolic hypertension)4 at each screening visit. Human re-
Caloric intake was adjusted during the study to maintain
search committees approved the study at each of the
entry-level weight. All participants were asked to continue
participating centers and all individuals provided written
with any exercise or physical activities in which they had
informed consent before entering the study.
participated before entry into the study.
Study Diets
Study Measurements
The study diets, outlined in Table 1, have been previously
described.1,6 The control diet is typical of what many The primary outcome measurements were 24-h SBP and
Americans eat in terms of macronutrient and micronutrient DBP measured with ambulatory BP monitors (model
composition. The DASH diet emphasizes fruits, vegeta- 90207, SpaceLabs, Redmond, WA). The devices were
bles, and low–fat dairy products; it includes whole grains, placed on the nondominant arm and programmed to take
poultry, fish, and nuts; and it is reduced in fat, red meat, readings automatically every 30 min over a 24-h period.
sweets, and sugar containing beverages. Compared to the Recordings were considered complete if at least 14 accept-
control diet, the DASH diet was designed to contain higher able readings were recorded between 6:00 AM and
amounts of potassium, magnesium, calcium, fiber, and 12:00 AM. Participants who failed to complete this number
AJH–May 2003–VOL. 16, NO. 5, PART 1 DASH DIET AND LOSARTAN 339

Table 2. Baseline characteristics of study

participants

Control DASH
Characteristic Diet Diet
Number 28 27
Blood pressure (mm Hg)
SBP 150 ⫾ 12 151 ⫾ 12
DBP 95 ⫾ 4 95 ⫾ 6
Age (y) 52 ⫾ 8 52 ⫾ 11
Ethnicity, n (%)
African American 18 (64) 17 (63)
Non–African American 10 (36) 10 (37)
BMI (kg/m2) 30 ⫾ 5 32 ⫾ 18
Female sex (%) 54 56

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SBP ⫽ systolic blood pressure; DBP ⫽ diastolic blood pressure; BMI
⫽ body mass index; other abbreviation as in Table 1.
Data are given as mean ⫾ SD.

of acceptable readings were asked to wear the device for

an additional 24-h period.
Blood pressure was also measured with a standard
mercury sphygmomanometer at baseline and weekly dur-
ing the protocol. Duplicate seated measurements were
FIG. 2. Twenty-four-hour ambulatory systolic (A) and diastolic (B)
obtained in the right arm after 5 min of undisturbed sitting. blood pressures at baseline and during placebo and losartan treat-
The mean of duplicate measurements taken on 2 succes- ment. *P ⬍ .05 v baseline; †P ⬍ .05 v placebo. BP ⫽ blood pressure;
other abbreviation as in Fig. 1.
sive days, at the time of ambulatory BP monitor placement
and removal, were used for baseline and end of treatment
period measurements.
completed the study. Baseline demographic characteristics
Twenty-four-hour urine collections were obtained at
of the 55 randomized participants are shown in Table 2.
the end of each treatment period for measurement of
During the placebo period there was no significant
creatinine, sodium, and potassium excretion. Plasma renin
change from baseline in 24-h ambulatory SBP or DBP on
activity (PRA) was measured at baseline and after each
the control diet (⌬ BP, ⫺2.3 ⫾ 1.5/⫺1.6 ⫾ 1.0 mm Hg)
treatment period, with participants in the sitting position
but there was a significant reduction from baseline in
after at least 90 min of upright posture.
ambulatory SBP (⫺5.3 ⫾ 1.5 mm Hg, P ⬍ .05) and no
change in DBP (⫺2.5 ⫾ 1.0 mm Hg) on the DASH diet
Statistical Analyses
(Fig. 2). Losartan significantly reduced both SBP and DBP
Data were analyzed based on all randomized participants from baseline on the control diet (⌬ BP, ⫺6.7 ⫾ 1.5/⫺3.7
(intent-to-treat) and are expressed as mean ⫾ SE. Changes ⫾ 1.0 mm Hg, P ⬍ .05) and on the DASH diet (⌬ BP,
in ambulatory BP from the end of the run-in period (base- ⫺11.7 ⫾ 1.5/⫺6.9 ⫾ 1.0 mm Hg, P ⬍ .05). The SBP and
line) to the end of each 4-week treatment period were the DBP changes from baseline with losartan were signifi-
primary outcome measures. The study was designed with cantly greater (P ⬍ .05) on the DASH diet than on the
80% power to detect a between group difference of 4 mm control diet. Clinic BP changed in parallel with ambula-
Hg for DBP and 6 mm Hg for SBP as significant. Analyses tory BP (Table 3). Both SBP (P ⬍ .05) and DBP (P ⫽ .07)
used an ANOVA model for repeated measures with ad- were lower in participants on the DASH diet versus the
justment for site, ethnicity, sex, treatment period, and control diet.
carry-over effects. A value of P ⬍ .05 was considered The DASH diet had greater effects in hypertensive
significant. For analyses by diet and ethicity, corrections African Americans than in non–African Americans, con-
for multiple comparisons were applied. The association of sistent with prior observations.1 There was a significant
PRA and change in BP was assessed by multiple linear interaction of losartan treatment with ethnicity (P ⬍ .001)
regression. for both SBP and DBP. Overall, non–African Americans
had a greater response to losartan than African Americans.
However, the DASH diet substantially augmented the BP
Results
response to losartan in African Americans, (Table 4), in
A total of 183 individuals were screened for the study; 66 whom the interventions were more than additive. In non–
were eligible and started the run-in period. Of these, 55 African Americans the BP response to losartan did not
participants were randomized. All randomized participants differ on the DASH or control diets.
340 DASH DIET AND LOSARTAN AJH–May 2003–VOL. 16, NO. 5, PART 1

Table 3. Clinic blood pressures

Control Diet (n ⴝ 28) DASH Diet (n ⴝ 27)

SBP DBP SBP DBP
Baseline 148.7 ⫾ 2.7 94.0 ⫾ 0.9 150.1 ⫾ 3.0 94.2 ⫾ 1.6
Placebo 147.0 ⫾ 3.2 93.2 ⫾ 1.7 142.0 ⫾ 2.6* 89.2 ⫾ 1.3
Losartan 138.6 ⫾ 3.5* 87.5 ⫾ 1.6 132.2 ⫾ 2.5*† 85.6 ⫾ 1.7*

Abbreviations as in Tables 1 and 2.

Data are given as mean ⫾ SD.
* P ⬍ .05 v baseline; † P ⬍ .05 v control diet.

A greater number of losartan treated participants on the that this relationship remained significant (P ⬍ .01). The

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DASH diet had clinic BP ⬍140/90 mm Hg than did those relationship between change in DBP from baseline and
on the control diet. In all, 46% (13/28) of those on the baseline PRA was also inverse (P ⫽ .08). No similar
control diet with losartan had BP ⬍140/90 mm Hg, relationships were present in individuals on the control
whereas 63% (17/27) on the DASH diet with losartan diet.
achieved BP ⬍140/90 mm Hg. African Americans showed
similar trends: 33% (6/18) on the control diet with losartan
and 53% (9/17) on the DASH diet with losartan had BP
Discussion
⬍140/90 mm Hg. In this study, the DASH diet with losartan significantly
Twenty-four-hour urine potassium excretion showed reduced BP in patients with stages 1 and 2 hypertension in
clear separation between diets, with participants on the comparison to losartan treatment on a control diet back-
DASH diet having significantly higher urine potassium, ground. These results have important implications for the
reflecting the increased fruit and vegetable intake (Table treatment of patients with essential hypertension. Dietary
5). There was no difference in urinary potassium excretion modifications are frequently advocated as an adjunct to
within diets during the placebo and losartan treatment antihypertensive therapy, with a focus on sodium restric-
periods. tion.4 Fewer data are available on the effects of dietary
The PRA did not change from baseline after the pla- patterns such as the DASH diet. Two prior studies as-
cebo period on either diet, but it increased significantly (P sessed the impact of low fat/high fiber diets with or with-
⬍ .05) during losartan treatment, similarly on both diets out sodium restriction on BP in treated hypertensive
(Table 5). In participants on the DASH diet, the losartan subjects. Significant antihypertensive effects were
induced change in SBP was significantly but inversely achieved only with the addition of sodium restriction.7,8
related to baseline PRA (r ⫽ ⫺0.53, P ⫽ .004) (Fig. 3). The DASH diet combined with multiple lifestyle chang-
Those with higher PRA at baseline had a greater fall in es— exercise, moderate sodium restriction, and weight
SBP in response to the combined DASH diet–losartan loss—when compared with a control diet without lifestyle
interventions. Multiple linear regression, including terms changes is associated with significantly lower BP in
for baseline BP, ethnicity, and intervention period, showed treated hypertensive patients.9 Our data show that the

Table 4. Changes in 24-h ambulatory blood pressure from baseline in African Americans and
non–African Americans

African Americans Non–African Americans

Control DASH Control DASH
(n ⴝ 18) (n ⴝ 17) (n ⴝ 10) (n ⴝ 10)
Placebo
⌬ SBP ⫺2.3 ⫾ 1.9 ⫺6.4 ⫾ 1.9 ⫺2.2 ⫾ 2.1 ⫺3.3 ⫾ 2.2
Losartan
⌬ SBP ⫺4.3 ⫾ 1.9* ⫺11.0 ⫾ 1.9*† ⫺11.0 ⫾ 2.2* ⫺12.7 ⫾ 2.2*
Placebo
⌬ DBP ⫺1.5 ⫾ 1.4 ⫺2.8 ⫾ 1.4 ⫺1.8 ⫾ 1.5 ⫺2.0 ⫾ 1.5
Losartan
⌬ DBP ⫺2.0 ⫾ 1.4 ⫺6.1 ⫾ 1.4*† ⫺6.7 ⫾ 1.5* ⫺8.3 ⫾ 1.5*

Abbreviations as in Tables 1–3.

Data are given as mean ⫾ SD.
* P ⬍ .01 v placebo; † P ⬍ .05 v control diet.
AJH–May 2003–VOL. 16, NO. 5, PART 1 DASH DIET AND LOSARTAN 341

Table 5. Plasma renin activity and 24-h urine potassium excretion

Control Diet DASH Diet

Baseline Placebo Losartan Baseline Placebo Losartan
Plasma renin activity
(ng/mL/h) 1.1 ⫾ 0.9 1.5 ⫾ 1.9 4.1 ⫾ 7.3* 0.7 ⫾ 0.7 0.8 ⫾ 0.7 3.4 ⫾ 4.3*
Urine potassium
(mmol/24 h) ND 38 ⫾ 19 40 ⫾ 17 ND 53 ⫾ 25† 58 ⫾ 28†

ND ⫽ not determined; other abbreviation as in Tables 1– 4.

Data are given as mean ⫾ SD.
* P ⬍ .05 v placebo and baseline; † P ⬍ .05 v control diet.

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DASH diet alone lowers BP and augments the BP re- Although this study was not designed to elucidate the
sponse to losartan in patients with stages 1 and 2 hyper- mechanism(s) for an amplified effect of the DASH diet
tension. with losartan, an interaction with the renin-angiotensin
This study showed effects of the DASH diet that were system is suggested by the relationship between baseline
qualitatively similar to findings from the hypertensive PRA and the BP response to the DASH diet and losartan.
subgroups (stage 1 systolic or diastolic hypertension) in Those participants with higher baseline PRA, regardless of
the DASH study1–3,10 and the DASH-Sodium study.11 The ethnicity, had greater BP responses to the DASH diet and
changes that we observed in clinic BP were less than those losartan. We recently reported an association between the
observed in hypertensive patients in the DASH study2,3 BP response to the DASH diet and the G-6A angiotensino-
but were greater than those observed in hypertensive sub- gen gene polymorphism,5 which is associated with in-
jects in the DASH-Sodium trial.11 However, the present creased angiotensinogen levels16,17 and enhanced BP
study involved patients with higher levels of BP and also responses to sodium restriction18 and ACE-inhibition.19
enrolled fewer participants than either the DASH study or African Americans have a much higher prevalence of the
DASH-Sodium study, potentially contributing to more G-6A polymorphism than nonminorities,20 and it is also
variability in the BP responses. this ethnic subgroup that had the greatest response to the
The BP response to losartan on the control diet differed DASH diet.1,11
by ethnicity. Non–African Americans experienced a The nutrients responsible for an interaction between the
greater effect than did African Americans. The lesser effect DASH diet and the renin-angiotensin system cannot be
of losartan in African Americans on the control diet is directly ascertained. Still, it is worthwhile to consider this
consistent with prior observations showing lesser BP ef- issue in view of the evidence that certain dietary factors
fects with agents that block the renin-angiotensin system may affect renin-angiotensin system function. Two nutri-
in African Americans than in non–African Americans.12,13 ents that may play a role are potassium and calcium.
These differences by ethnicity may be negated by concom- Studies have evaluated the effects of potassium intake on
itant administration of a diuretic14,15 or sodium restriction. renin-angiotensin system activity and suggest that an in-
In our study, the BP response to losartan with the DASH teraction exists.21,22 Hollenberg et al.21 showed that a low
diet was similar in both ethnic subgroups. Thus, the DASH potassium intake (40 mmol/day) reduced renal blood flow
diet neutralizes ethnic differences in the BP response to and blunted the vascular response to angiotensin II, con-
losartan. sistent with an increase in renin-angiotensin system activ-
ity. Potassium supplementation significantly lowers BP23
and significantly increases PRA.23 Similarly, a relation-
ship between dietary calcium, calcium regulating hor-
mones, and the renin-angiotensin system has been known
for some time.24 Oral calcium administration significantly
increases PRA and suppresses calcium regulating hor-
mones (ie, parathyroid hormone and 1,25 dihydroxyvita-
min D).25 Despite these observations, the available
evidence does not clarify the specific nutrients responsible
for effects of the DASH diet on BP or renin-angiotensin
system activity. As such, an interactive effect among nu-
trients is quite plausible, as has been suggested in other
clinical trials of the effects of diet on BP.26
Our results show that the DASH diet with losartan
FIG. 3. Regression relationship between the change in systolic significantly lowers BP in patients with stages 1 and 2
blood pressure (SBP) and baseline plasma renin activity (PRA). hypertension. This effect is particularly marked in African
342 DASH DIET AND LOSARTAN AJH–May 2003–VOL. 16, NO. 5, PART 1

Americans. For hypertensive individuals, adopting the 13. Materson BJ, Reda DJ, Cushman WC, Massie BM, Freis ED,
DASH diet may further lower BP and lead to better control Kochar MS, Hamburger RJ, Fye C, Lakshman R, Gottdiener J,
Ramirez EA, Henderson WG, for the Department of Veterans Af-
rates. fairs Cooperative Study Group on Antihypertensive Agents: Single-
drug therapy for hypertension in men. A comparison of six
References antihypertensive agents with placebo. N Engl J Med 1993;328:914–
921.
1. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, 14. Middlemost SJ, Tager R, Davis J, Sareli P: Effectiveness of enalapril
Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin in combination with low-dose hydrochlorothiazide versus enalapril
PH, Karanja N: A clinical trial of the effects of dietary patterns on alone for mild to moderate systemic hypertension in black patients.
blood pressure. N Engl J Med 1997;336:1117–1124. Am J Cardiol 1994;73:1092–1097.
2. Conlin PR, Chow D, Miller ER III, Svetkey LP, Lin PH, Harsha 15. Dahlof B, Hansson L, Acosta JH, Bolzano K, Fairhurst G, Ferreira
DW, Moore TJ, Sacks FM, Appel LJ, for the DASH Research C, Kaarsalo E, Silva MC, Simone A: Controlled trial of enalapril
Group: The effect of dietary patterns on blood pressure control in and hydrochlorothiazide in 200 hypertensive patients. Am J Hyper-
hypertensive patients: results from the Dietary Approaches to Stop tens 1988;1:38–41.
Hypertension (DASH) Trial. Am J Hypertens 2000;13:949–955. 16. Jeunemaitre X, Soubrier F, Kotelevtsev YV, Lifton RP, Williams

Downloaded from https://academic.oup.com/ajh/article/16/5/337/160707 by guest on 08 August 2024

3. Moore TM, Conlin PR, Ard J, Svetkey LP: The DASH diet is CS, Charru A, Hunt SC, Hopkins PN, Williams RR, Lalouel JM:
effective treatment for stage 1 isolated systolic hypertension. Hy- Molecular basis of human hypertension: role of angiotensinogen.
pertension 2001;38:155–158. Cell 1992;71:169–180.
4. The Sixth Report of the Joint National Committee on Prevention, 17. Bloem LJ, Foroud TM, Ambrosius WT, Hanna MP, Tewksbury DA,
Detection, Evaluation, and Treatment of high blood pressure. Arch Pratt JH: Association of the angiotensinogen gene to serum angio-
Intern Med 1997;157:2413–2445. tensinogen in blacks and whites. Hypertension 1997;29:1078–1082.
5. Svetkey LP, Moore TJ, Simons-Morton DG, Appel LJ, Bray GA, 18. Hunt SC, Cook NR, Oberman A, Cutler JA, Hennekens CH, Al-
Sacks FM, Ard JD, Mortensen RM, Mitchell SR, Conlin PR, Kesari lender PS, Walker WG, Whelton PK, Williams RR: Angiotensino-
M: Angiotensinogen genotype and BP response in the Dietary gen genotype, sodium reduction, weight loss, and prevention of
Approaches to Stop Hypertension (DASH) study. J Hypertens 2001; hypertension: trials of hypertension prevention, phase II. Hyperten-
19:1949–1956. sion 1998;32:393–401.
6. Sacks F, Obarzanek E, Windhauser M, Svetkey LP, Vollmer WM, 19. Hingorani AD, Jia H, Stevens PA, Hopper R, Dickerson JE, Brown
McCullough M, Karanja N, Lin PH, Steele P, Proschan MA, Evans MJ: Renin-angiotensin system gene polymorphisms influence blood
MA, Appel LJ, Bray GA, Vogt TM, Moore TJ: Rationale and design pressure and the response to angiotensin converting enzyme inhibi-
of the dietary approaches to stop hypertension trial. Ann Epidemiol tion. J Hypertens 1995;13:1602–1609.
1995;5:108–118. 20. Rotimi C, Cooper R, Ogunbiyi O, Morrison L, Ladipo M, Tewks-
7. Sciarrone SE, Beilin LJ, Rouse IL, Rogers PB: A factorial study of bury D, Ward R: Hypertension, serum angiotensinogen, and molec-
salt restriction and a low-fat/high-fibre diet in hypertensive subjects. ular variants of the angiotensinogen gene among Nigerians.
J Hypertens 1992;10:287–298. Circulation 1997;95:2348–2350.
8. Little P, Girling G, Hasler A, Trafford A, Craven A: A controlled 21. Hollenberg NK, Williams GH, Burger B: The influence of potas-
trial of a low sodium, low fat, high fibre diet in treated hypertensive sium on the renal vasculature and the adrenal gland and their
patients: the efficacy of multiple dietary intervention. Postgrad Med responsiveness to angiotensin II in normal man. Clin Sci Mol Med
J 1990;66:616–621. 1975;49:527–534.
9. Miller ER III, Erlinger TP, Young DR, Jehn M, Charleston J, 22. Langford HG, Cushman WC, Hsu H: Chronic effect of KCl on
Rhodes D, Wasan SK, Appel LJ: Results of the Diet, Exercise, and black-white differences in plasma renin activity, aldosterone, and
Weight Loss Intervention Trial (DEW-IT). Hypertension 2002;40: urinary electrolytes. Am J Hypertens 1991;4:399–403.
612–618. 23. Whelton PK, He J, Cutler JA, Brancati FL, Appel LJ, Follmann D,
10. Moore TJ, Vollmer WM, Appel LJ, Sacks FM, Svetkey LP, Vogt Klag MJ: Effects of oral potassium on blood pressure. Meta-analysis
TM, Conlin PR, Simons-Morton D, Carter-Edwards L, Harsha DM: of randomized controlled clinical trials. JAMA 1997;277:1624–
Effect of dietary patterns on ambulatory blood pressure: results from 1632.
the DASH study. Hypertension 1999;34:472–477. 24. Resnick LM, Muller FB, Laragh JH: Calcium-regulating hormones
11. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha in essential hypertension. Relation to plasma renin activity and
D, Obarzanek E, Conlin PR, Miller ER III, Simons-Morton DG, sodium metabolism. Ann Intern Med 1986;105:649–654.
Karanja N, Lin P-H, for the DASH-Sodium collaborative research 25. Petrov V, Lijnen P: Modification of intracellular calcium and
group: a clinical trial of the effects on blood pressure of reduced plasma renin by dietary calcium in men. Am J Hypertens 1999;12:
dietary sodium and the DASH dietary pattern (the DASH-Sodium 1217–1224.
trial). N Eng J Med 2001;344:3–10. 26. Resnick LM, Oparil S, Chait A, Haynes RB, Kris-Etherton P, Stern
12. Weir MR, Gray JM, Paster R, Saunders E: Differing mechanisms of JS, Clark S, Holcomb S, Hatton DC, Metz JA, McMahon M,
action of angiotensin-converting enzyme inhibition in black and Pi-Sunyer FX, McCarron DA: Factors affecting blood pressure
white hypertensive patients. The Trandolapril Multicenter Study responses to diet: the Vanguard study. Am J Hypertens 2000;13:
Group. Hypertension 1995;26:124–130. 956–965.