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To the Editor: The authors of the PREMIER trial¹ found that clinically significant reductions in BP can be achieved through lifestyle modification. However, their claim that "adoption of the DASH [Dietary Approaches to Stop Hypertension] diet further improves BP control" is not supported by their data. Indeed, the addition of the DASH diet to the "established" treatment resulted in a small and nonsignificant difference in BP (<1 mm Hg) compared with the "established" treatment alone. In fact, the BP differences between groups could be fully accounted for by differential weight loss. Unlike the DASH diet studies, which controlled diet and caloric consumption,^2-4 the DASH diet condition in the PREMIER study was confounded with weight loss. The absence of a DASH diet–only condition and greater weight loss in the DASH plus established treatment condition in PREMIER make it impossible to determine the potential incremental benefit of the DASH diet.

The magnitude . . . [Full Text of this Article]

James A. Blumenthal, PhD; Andrew Sherwood, PhD; Simon L. Bacon, PhD
Department of Psychiatry and Behavioral Sciences
Duke University Medical Center
Durham, NC

Alan Hinderliter, MD
Department of Medicine
University of North Carolina at Chapel Hill

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