Background: Hypertension and obesity disproportionately affect veterans and contribute to cardiovascular disease. The sodium-restricted Dietary Approaches to Stop Hypertension eating pattern (DASH-SRD) reduces blood pressure (BP) and is guideline-recommended, but adherence is low in this population. We conducted a randomized trial of a remotely delivered dietary intervention to promote and sustain adoption of DASH-SRD in veterans with hypertension and obesity.
Methods: Veterans with hypertension and obesity received 2 weeks of home-delivered DASH-SRD meals after 2 weeks of ad-lib diet (Phase 1), then 5 telephone-delivered, dietitian-led motivational interviewing counseling sessions over 4 months, with or without a newly developed mobile application (Phase 2). DASH adherence (score 0-9 per 3-day food diary), clinic blood pressure (BP), and urinary sodium:potassium ratio was collected at baseline and at months 1 and 6 of Phase 2. Generalized estimating equations were used to evaluate changes in these parameters during the intervention.
Results: Sixty-one veterans (age 67 ± 8 years, 15% female, 16% non-White) with obesity (BMI 34.4 ± 5.2) and hypertension completed the trial. Dietary counseling session attendance was 96%. Between baseline and 6 months, DASH adherence score improved (1.8 ± 1.6-2.3 ± 1.4 points, P = .02), BP decreased (systolic 133 ± 17-128 ± 15 mmHg, P = .048; diastolic 73 ± 11-69 ± 12 mmHg, P = .03), and urinary sodium:potassium ratio declined (2.6 ± 1.1-1.5 ± 0.8, P < .001). There were no significant differences between the mobile application plus counseling and counseling-alone groups.
Conclusion: In Veterans with hypertension and obesity, a brief interval of home-delivered meals followed by telephone dietitian counseling sustainably improved DASH-SRD adherence and reduced BP.
Trial registration: https://clinicaltrials.gov/study/NCT03170375.
Published by Elsevier Inc.