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To the Editor: In his Editorial accompanying the PREMIER trial,¹ Dr Pickering² pointed out that there was no significant difference in BP reduction between the groups that received lifestyle counseling vs the group that received lifestyle counseling plus the DASH diet. We take issue, however, with Pickering's statement that the DASH diet was the first convincing evidence that nonpharmacological treatment could reduce BP in patients with hypertension as much as some drugs can, and with his comment that "no study has demonstrated any additive effect of combining lifestyle interventions on blood pressure." In the DASH Sodium study,³ although effects were not strictly additive, the combination of sodium restriction and the DASH diet resulted in greater effects on BP than either intervention alone. Several randomized controlled factorial trials have found additive effects of different lifestyle changes resulting in decreases in systolic BP of as much as 14 mm Hg.^4-7 The lack . . . [Full Text of this Article]

Lawrence J. Beilin, MBBS, MD(Lond), FRCP, FRACP; Valerie Burke, MD, FRACP; Ian B. Puddey, MBBS, FRACP, MD
Royal Perth Hospital Unit
School of Medicine & Pharmacology
University of Western Australia
Perth

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