SUNDAY, May 20, 2007 (HealthDay News) -- A strange thing happened after government recommendations on a healthy diet designed to control high blood pressure were issued in 1999: The percentage of Americans with high blood pressure following those recommendations went down, according to a new study.
The fact that so few people with hypertension -- just 22 percent in the group studied -- are following some simple dietary measures indicates a breakdown somewhere in the American health-care system, said lead researcher Dr. Philip Mellen, an assistant professor of internal medicine at Wake Forest University School of Medicine in Winston-Salem, N.C.
"We don't know where it broke down," Mellen said. "We don't know whether their physicians have been telling them to do it or whether physicians don't feel they know enough to counsel them. We have evidence from other sources that there are problems all along the chain."
The problem is a serious one: Left unchecked, hypertension -- the formal name for high blood pressure -- is a major cause of heart attack and stroke.
Mellen's study, which was to be presented Sunday at the annual meeting of the American Society of Hypertension, focused on people who had been told they had high blood pressure.
"Presumably, the guidelines should have prescribed their lifestyle changes," Mellen said. "They did not. Presumably, this would mean that changes in the population have overwhelmed the DASH diet recommendations."
The DASH -- Dietary Approaches to Stop Hypertension -- focuses on nine nutrient types: total fat, saturated fat, protein, cholesterol, fiber, calcium, magnesium, potassium and sodium. Essentially, it calls for eating lots of fruits, vegetables, grains and low-fat dairy. The people with high blood pressure whose records Mellen examined in two National Health and Nutrition Examination Surveys examined were considered to be following the DASH diet if they met half the nutrient targets.
But the overall "DASH-accordance" was about 8 percent lower in the 1999-2004 group than it had been in the 1988-1994 group, Mellen found.
Certain trends emerged. "Being younger meant less DASH accordance," he said. "African-Americans were less likely to be in accord. Accordance was higher in individuals with more than a high school education, and for older individuals and those with diabetes."
Other social differences appear to play a role. "There are significant differences in the availability of healthy foods depending on where you live," Mellen said.
Mellen also kept coming back to the doctor-patient relationship and how it is affected by methods of payment for medical care.
"Dietary counseling is not reimbursed," Mellen said. "Medicare does not reimburse for dietary counseling." It thus is easier for a physician to write a prescription for a blood pressure medication than to spend time talking to someone about good dietary habits, he said.
Dr. George Bakris, director of the hypertensive disorders unit at the University of Chicago, noted that the diet has some practical drawbacks, starting with expense.
"While the diet is certainly nutritious and gives you a balance of all the fruits and vegetables you need, if you go to the store and shop for it, it is more expensive than people appreciate," Bakris said.
The DASH diet also takes more preparation than most meals, he said. "Much of it has to be prepared, and people in this day and age are used to things that are quick," Bakris said. "In the original studies, the food was prepared for the participants. That is not for everybody."
The bottom line: Getting more people with high blood pressure to follow the DASH diet will not be easy, Bakris said. "If you can't afford it, you can't eat it," he said.
Find out more about the DASH diet at the U.S National Heart, Lung and Blood Institute.
SOURCES: Philip Mellen, M.D., assistant professor, internal medicine, Wake Forest University, Winston-Salem, N.C.; George Bakris, M.D., director, hypertensive disorders unit, University of Chicago; May 20, 2007, scientific meeting, American Society of Hypertension, Chicago
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