DEAR MAYO CLINIC:

Is the DASH diet effective for extremely high blood pressure? I really want to avoid taking medication.

ANSWER:

Research has found the DASH diet to be an effective way to lower blood pressure in people who have slightly elevated high blood pressure (prehypertension) and in those with stage I (mild to moderate) hypertension. For people in your situation with severe hypertension, this diet alone may not be enough to lower your blood pressure to goal level. But combined with other lifestyle changes, the DASH diet may significantly decrease your need for blood pressure-lowering medication.

DASH stands for Dietary Approaches to Stop Hypertension. The DASH diet is low in saturated fat, cholesterol and total fat, and is a lifelong approach to healthy eating that's designed to help treat or prevent high blood pressure. This diet encourages you to reduce sodium and eat a variety of foods rich in nutrients that help lower blood pressure, such as potassium, calcium and magnesium. In particular, the DASH diet emphasizes eating fruits, vegetables, whole grains and low-fat dairy foods, and includes some fish, poultry and legumes. You can eat red meat, sweets and fats in small amounts.

By following the DASH diet, you may be able to reduce your blood pressure by several mm Hg in just a few weeks. Over time, this diet may help drop your systolic blood pressure (top number) by about 11 mm Hg and your diastolic blood pressure (bottom number) by 6 mm Hg, which can make a significant difference in the health risks posed by high blood pressure.

In studies of people with stage I hypertension (140-159/90-99 mm Hg), research has found that the effect of following the DASH diet is similar to the blood pressure-lowering effect of taking one high blood pressure medication. When those same people followed the DASH diet and made additional healthy lifestyle changes, such as exercising regularly, losing weight and further reducing dietary sodium, the effect was equal to taking two drugs used together to lower blood pressure.

Although the DASH diet and other healthy lifestyle changes may not be enough to control severe hypertension, these steps often lead to less need for blood pressure-lowering medications and lower doses of those medications. In addition, because the diet is a healthy way of eating, it offers health benefits beyond just lowering blood pressure. Following the DASH diet may help protect you against osteoporosis, cancer, heart disease, stroke and diabetes. While this diet is not a weight-loss program, you may lose unwanted pounds by following the diet, because it can help guide you toward healthier meals and snacks.

Talk to your doctor about the DASH diet. Your doctor can work with you to create a comprehensive program focused on reducing blood pressure that includes the DASH diet and other positive lifestyle choices. Although you may still need to take some medication to control blood pressure, it's likely you will need much less medication than you would require without making these healthy changes. -- Gary Schwartz, M.D., Nephrology and Hypertension, Mayo Clinic, Rochester, Minn.

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