Explore the vast range of titles available.

To determine the impact of dietary patterns on the control of hypertension we studied the subgroup of 133 participants with systolic blood pressure (BP) of 140 to 159 mm Hg and/or diastolic BP of 90 to 95 mm Hg enrolled in the Dietary Approaches to Stop Hypertension (DASH) study. Participants were fed a control diet for a 3-week period and were then randomized to receive for 8 weeks either the control diet; a diet rich in fruits and vegetables, but otherwise similar to control; or a combination diet rich in fruits, vegetables, and low-fat dairy products, including whole grains, fish, poultry, and nuts, and reduced in fats, red meats, sweets, and sugar-containing beverages. Sodium intake and body weight were held constant throughout the study. The combination diet significantly reduced systolic BP (11.4 mm Hg, P < .001) and diastolic BP (−5.5 mm Hg, P < .001). The fruits-and-vegetables diet also significantly reduced systolic BP (−7.2 mm Hg, P < .001) and diastolic BP (−2.8 mm Hg, P = .013). The combination diet produced significantly greater BP effects (P < .05) than the fruits-and-vegetables diet. Blood pressure changes were evident within 2 weeks of starting the intervention feeding. After the 8-week intervention period, 70% of participants eating the combination diet had a normal BP (systolic BP < 140 and diastolic BP < 90 mm Hg) compared with 45% on the fruits-and-vegetables diet and 23% on the control diet. In patients with hypertension, the DASH combination diet effectively lowers BP and may be useful in achieving control of Stage 1 hypertension.

The Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, and low fat dairy products, significantly lowers blood pressure (BP). We conducted a clinical trial to assess the BP response to the DASH diet with an antihypertensive medication, losartan, in participants with essential hypertension. A total of 55 hypertensive participants were randomly assigned to 8 weeks of controlled feeding with either a control diet or the DASH diet. Within each diet arm, participants received losartan 50 mg daily or placebo for 4 weeks each, in double blind, randomized, cross-over fashion. Twenty-four-hour ambulatory BP (ABP) was measured at the end of a 2-week run-in period (baseline) and after each 4-week intervention period. There was no significant change in ABP during the placebo period on the control diet ( n = 28) (−2.3 ± 1.5/−1.6 ± 1.0 mm Hg), but there was a significant 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 diet ( n = 27). Losartan significantly reduced ABP on the control diet (−6.7 ± 1.5/−3.7 ± 1.0 mm Hg, P < .05) and to a greater extent on the DASH diet (−11.7 ± 1.5/−6.9 ± 1.0 mm Hg, P < .05 versus basal and control diet) particularly in African Americans. On the DASH diet, ΔSBP on losartan was inversely related to basal plasma renin activity ( n = −0.53, P = .004). The DASH diet enhances the ABP response to losartan in essential hypertension. This effect is particularly marked in African Americans.

Objective Using participant responses from 525 different‐sex married and cohabiting African American couples, we examined the dyadic association between relational sanctification and relational forgiveness. Background Religion has a central role in the lives of many African Americans because it traditionally has been a place of refuge against stressors that disproportionally impact African Americans. However, little is known about how African American couples utilize relational sanctification as a strength. Method Data were collected from African American couples between October 2019 and January 2020 as part of a larger study called the Strong African American Couples Project. Utilizing dyadic panels from Qualtrics, this project specifically targeted African American couples who were cohabiting (n = 233) or married (n = 292) thus, enabling us to analyze a multigroup actor–partner interdependence model. Results Significant actor effects were found between sanctification and individual as well as perceived partner forgiveness in married and cohabiting couple relationships. No significant partner effects were found. Conclusion These findings highlight the importance of recognizing various aspects of religiosity and spirituality within relationships, especially for African American couples with historically high rates of dissolution and self‐rated religiosity. Implications As interventionalists work with religious and spiritual African American couples, they need to understand the role that sanctity may have within these partner relationships and the positive impact it can have on relational outcomes.

Hypertension is associated with impaired fibrinolysis. Both angiotensin receptor blockers (ARB) and the DASH (Dietary Approaches to Stop Hypertension) diet effectively lower blood pressure in hypertensive patients. Some evidence suggests that treatment with ARBs could increase fibrinolysis, however, data is conflicting. The impact of the DASH diet on fibrinolytic parameters is not known. Fifty-five hypertensive participants (35 African-American, 20 white) were randomly assigned to receive 8 weeks of either a control diet or the DASH diet. The diets did not differ in sodium content (approximately 3 g/day). Within each diet, individuals were randomly assigned to receive losartan or placebo for 4 weeks in double-blind, cross-over fashion. Tissue plasminogen activator (t-PA) antigen, t-PA activity, plasminogen activator inhibitor-1 (PAI-1) activity and plasma renin activity (PRA) were measured at the end of a 2-week run-in period on the control diet and after each treatment period. The DASH diet did not affect markers of fibrinolysis. Losartan significantly lowered t-PA antigen levels (-1.8 ng/mL, P = 0.045), but had no effect on t-PA or PAI-1 activities. This effect was more pronounced in whites (-4.1 ng/mL (P = 0.003)) compared with African-Americans (-0.3 ng/mL (P = 0.7), P-interaction = 0.03). Results were not materially affected by adjustment for basline values or changes in blood pressure. This study demonstrates that losartan reduces t-PA antigen levels in white, but not African-American hypertensive individuals. In contrast, the DASH diet had no significant effect on markers of fibrinolysis in whites or African-Americans.

Background Essential hypertension results from the interaction of several genetic and environmental factors. Identification of genetic factors that smodulate blood pressure (BP) response to interventions can lead to improved strategies for prevention and control. The purpose of this study was to identify genes that modulate BP response to dietary interventions. Methods We used data and samples collected in two randomized feeding studies to determine the extent to which genetic architecture is associated with the effect on BP of sodium intake and the Dietary Approaches to Stop Hypertension (DASH) dietary pattern. Participants in both trials were adults with above-optimal BP or unmedicated stage 1 hypertension. Genomic DNA was typed forseveral candidate genes. Results The effect of sodium intake on BP differed by genotype at the angiotensinogen, β2-adrenergic receptor, and kallikrein loci. The effect of DASH dietary pattern on BP differed by genotype at the β2-adrenergic receptor locus. Conclusions These findings have implications for understanding the mechanism(s) through which diet affects BP, the heterogeneity of these effects, and the extent to which dietary interventions can modulate genetic predisposition. American Journal of Hypertension, advance online publication 18 November 2010;. doi:10.1038/ajh.2010.223

Background: Selective cyclo-oxygenase 2 inhibitors (‘coxibs’) have been demonstrated to increase cardiovascular risk, but the cumulative burden of adverse effects in the US population is uncertain. Objective: To quantify cardiovascular and gastrointestinal (GI) haemorrhage disease burden from coxibs and traditional ‘non-selective’ non-steroidal anti-inflammatory drugs (t-NSAIDs) in the US population. Design, setting and participants: Adult respondents from the 1999–2003 Medical Expenditure Panel Survey, a representative sample of the US population which first became available in December 2006, were included. Respondents were followed for 2 years. Exposure was defined by two or more prescriptions of rofecoxib, celecoxib or a t-NSAID in the first year. Main outcome measures: Acute myocardial infarction (AMI), stroke and/or GI haemorrhage in the year following exposure. Results: Exposure to rofecoxib was associated with an adjusted odds ratio (OR) of 3.30 for AMI (95% CI 1.41, 7.68; p = 0.01) and 4.28 for GI haemorrhage (95% CI 1.33, 13.71; p = 0.02). Celecoxib was not associated with a statistically significant effect on AMI (OR 1.44; 95% CI 0.57, 3.69; p = 0.44), but there was an OR of 2.43 for stroke (95% CI 1.05, 5.58; p = 0.04) and 4.98 for GI haemorrhage (95% CI 2.22, 11.17; p<0.001). The group of t-NSAIDs was not associated with a significant adverse effect on AMI (OR 1.47; 95% CI 0.76, 2.84; p = 0.25) or stroke (OR 1.26; 95% CI 0.42, 3.81; p = 0.68), and was associated with an OR of 2.38 for GI haemorrhage (CI 1.04, 5.46; p = 0.04). In the 1999–2004 period rofecoxib was associated with 46 783 AMIs and 31 188 GI haemorrhages; celecoxib with 21 832 strokes and 69 654 GI haemorrhages; resulting in an estimated 26 603 deaths from both coxibs. The t-NSAID group was associated with an excess of 87 327 GI haemorrhages and 9606 deaths in the same period. Conclusions: Iatrogenic effects of coxibs in the US population were substantial, posing an important public health risk. Drugs that were rapidly accepted for assumed safety advantages proved instead to have caused substantial injury and death.

Ambulatory blood pressure monitoring (ABPM) is commonly used in clinical trials. Yet, its ability to detect blood pressure (BP) change in comparison to multiple office-based measurements has received limited attention. We recorded ambulatory and five daily pairs of random zero (RZ) BPs pre- and post-intervention on 321 adult participants in the multicentre Dietary Approaches to Stop Hypertension trial. Treatment effect estimates measured by ambulatory monitoring were similar to those measured by RZ and did not differ significantly for waking vs 24-h ambulatory measurements. For systolic BP, the standard deviations of change in mean 24-h ambulatory BP (8.0 mmHg among hypertensives and 6.0 mmHg among nonhypertensives) were comparable to or lower than the corresponding standard deviations of change in RZ-BP based on five daily readings (8.9 and 5.9 mmHg). The standard deviations of change for mean waking ambulatory BP (8.7 and 6.7 mmHg) were comparable to those obtained using three to four daily RZ readings. Results for diastolic BP were qualitatively similar. Ambulatory monitoring was more efficient (ie, a smaller sample size could detect a given BP change) than three to four sets of daily RZ readings and required fewer clinic visits. The average of 33 ambulatory BP readings during the waking hours had an efficiency comparable to that from the mean of four daily pairs of RZ-BPs. Participants readily accepted the ABPM devices, and their use requires less staff training. ABPM provides a useful alternative to RZ-BP measurements in clinical trials.

ConclusionThe DASH diet, which does not include sodium reduction or weight loss, had significant blood-pressure-lowering effects in virtually all subgroups. These effects were particularly striking in African Americans and in those with stage 1 hypertension. This intervention adds to our current nonpharmacologic approaches to control high blood pressure. The DASH diet may be an effective strategy for preventing and treating hypertension in a broad cross-section of the population, including those at high risk for hypertension and its complications.