Real-World Effectiveness of Individualized DASH-Based Nutritional Support on Blood Pressure Trajectories in Elderly Hypertensive Patients: A Retrospective Cohort Study.

BACKGROUND

Hypertension control among Chinese older adults remains suboptimal, and the real-world effectiveness of individualized Dietary Approaches to Stop Hypertension (DASH)-based nutritional support delivered through community nursing is unclear. This study evaluated its association with 6-month blood pressure trajectories.

METHODS

This retrospective cohort study used electronic health records to compare nurse-delivered individualized DASH-based nutritional support with standard care. Propensity score matching (1:1) was performed. The primary outcome was the 6-month systolic blood pressure (SBP) trajectory, analyzed using linear mixed-effects models with a Group × Time interaction. Secondary outcomes included diastolic blood pressure (DBP), blood pressure control (< 140/90 mmHg), body mass index (BMI), and hypotension.

RESULTS

Among 366 eligible patients, 210 were matched (105 per group), with all postmatching standardized mean differences < 0.10. SBP trajectories differed significantly between groups (pinteraction < 0.001). At 6 months, the between-group differences were -4.3 mmHg for SBP (95% CI, -6.6 to -2.0; p < 0.001) and -2.7 mmHg for DBP (p < 0.001). Blood pressure control was higher in the intervention group (61.9% vs. 40.0%; p = 0.003). The SBP difference was larger among patients with severe hypertension (-7.5 vs. -3.1 mmHg; pinteraction = 0.012). In the higher-contact subgroup (≥ 3 documented nutritional contacts), the SBP difference was -5.6 mmHg. BMI decreased by 1.2 kg/m2 (p < 0.001). Hypotension was uncommon and comparable between groups (3.8% vs. 2.9%; p = 1.000).

CONCLUSIONS

Individualized community-based DASH nutritional support was associated with more favorable blood pressure trajectories and higher control rates without an observed increase in hypotension. Larger differences were observed among patients with severe baseline hypertension and those with greater documented intervention contact.