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Cardiology

Cite as: Archiv EuroMedica. 2025. 15; 6. DOI 10.35630/2025/15/Iss.6.602

Received 1 August 2025;
Accepted 15 December 2025;
Published 17 December 2025

COMPARISON OF THE EFFECTIVENESS OF THE DASH DIET AND THE MEDITERRANEAN DIET IN THE MANAGEMENT OF ARTERIAL HYPERTENSION: NARRATIVE REVIEW

Jan Drugacz¹ , Olaf Helbig² ,
Bartłomiej Bobrowski³ , Honorata Derlatka⁴ ,
Klaudia Kontek⁵ , Anna Kukhtiak⁶ ,
Julia Marcinkowska⁷ , Łukasz Skowron⁴

¹Individual medical practice Jan Drugacz, Bielsko-Biała, Poland
²Poznan University of Medical Sciences, Poznan, Poland
³Medical practice Bartosz Bobrowski, Cieszyn, Poland
⁴ Collegium Medicum, Jan Kochanowski University, Kielce, Poland
⁵John Paul II District Hospital, Kolbuszowa, Poland
⁶Faculty of Medicine, Medical University of Lodz, Lodz, Poland
⁷Pomeranian Medical University in Szczecin, Szczecin, Poland

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  lek.jandrugacz@gmail.com

ABSTRACT

Background: Arterial hypertension remains the most prevalent modifiable cardiovascular risk factor worldwide and a leading contributor to morbidity and mortality. Lifestyle modification, particularly dietary intervention, is universally recommended as first-line therapy in the prevention and management of hypertension.

Aims: The aim of this narrative review was to compare the effectiveness of the Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean diet in reducing systolic and diastolic blood pressure.

Methods: A narrative review of the literature was conducted using PubMed, Google Scholar, and the World Health Organization databases. Publications in English and Polish concerning adult populations were included, encompassing randomized controlled trials, meta-analyses, and systematic reviews evaluating the effects of DASH and Mediterranean dietary patterns on blood pressure.

Results: Both dietary patterns were consistently associated with significant reductions in systolic and diastolic blood pressure and improvement of cardiometabolic parameters. Meta-analyses of randomized trials indicate that the DASH diet reduces systolic blood pressure by approximately 3.2–5.2 mmHg and diastolic blood pressure by 2.0–2.6 mmHg. The Mediterranean diet demonstrates more modest but clinically relevant blood pressure reductions, with pooled systolic decreases of approximately 1.4–5.5 mmHg and diastolic decreases of 1.5–2.0 mmHg. Comparative analyses indicate a greater antihypertensive effect of the DASH diet, particularly in sodium-sensitive individuals. The Mediterranean diet provides broader metabolic and anti-inflammatory benefits. However, long-term durability, effects in resistant hypertension, and impact on hard clinical outcomes remain insufficiently studied.

Conclusions: Both the DASH and Mediterranean diets represent effective non-pharmacological strategies for systolic and diastolic values reduction and cardiovascular risk modification. However, available evidence indicates that the DASH diet produces a greater magnitude of blood pressure reduction, likely due to its stricter sodium limitation and higher potassium content.

Keywords: arterial hypertension, DASH diet, Mediterranean diet, blood pressure, lifestyle modification.

INTRODUCTION

Cardiovascular diseases remain the leading cause of death in Poland and Europe and are responsible for the highest proportion of disability-adjusted life years (DALYs). At the same time, high arterial pressure remains the most important modifiable cardiovascular risk factor. Research published in 2024 showed that the number of people with a registered arterial hypertension in Poland is 11 million. It was found that the most often hypertension occurs in men aged 55-59 and women aged 50-54. In the population under 55 years of age high BP occurs more often in men, while in older age groups dominate women [1]. In turn, according to estimates from 2010, all over the world, 31,10% of the population suffers from the condition [2,3]. The prevalence of arterial hypertension is increasing, mainly due to the aging society and growing incidence of obesity [2].

According to published by World Health Organization in 2023. global report on hypertension, only 54% of patients were diagnosed, 42% are taking antihypertensive drugs and only 21% of patients have controlled hypertension [4].

Hypertensive heart disease, which is the consequence of the heart muscle damage through arterial hypertension, imposes a serious health and economic burden, positioning it as critical challenge for the public health [5].

In patients with stage 1 hypertension, where lifestyle modifications are recommended as first-line therapy, nutritional strategy interventions have been shown to improve both BP and lipid profiles, potentially delaying or preventing the need for pharmacological treatment[6]

We define lifestyle as individual behaviour patterns that influence the disease state. Modifiable risk factors include excessive consumption of sodium, insufficient consumption of potassium, overweight and obesity, lack of physical activity, smoking, excessive consumption of alcohol, psychosocial stressors, diabetes. The modification of a lifestyle includes healthy diet, regular physical activity, weight management (optimally BMI 18,5-25), avoid of alcohol and smoking, reduction of stress, limiting consumption of caffeine and sleep hygiene [7]. It is the first line action in prevention and treatment of high blood pressure, apart from the direct benefits, also strengthen pharmacological effects of treatment [8].

It has been shown that modification of a lifestyle is effective in treatment both controlled and resistant hypertension. 4-month, organised programme of diet and physical activity, as supportive therapy results in significant reduction clinical and outpatient blood pressure and also improvement of biomarkers of cardiovascular risk factors. This finding is clinically relevant because resistant hypertension is associated with a higher incidence of organ damage and 50% greater risk of adverse cardiovascular events, including heart attack, stroke and death compared with controlled hypertension [9]. Population-based evidence from a 2023 meta-analysis of cohort studies showed that higher adherence to the DASH dietary model was associated with approximately 19% lower hazard of developing hypertension (HR ≈ 0.81), demonstrating its preventive potential at the population level [10] Observational pooled data published in Nutrients indicate that individuals with higher DASH adherence have a significantly lower incidence of hypertension compared with those with low adherence (HR 0.81, 95% CI reported), supporting its role in primary prevention [10]. In the traditional Mediterranean diet, alcohol consumption is common but moderate and occurs mainly in the form of wine consumed with meals. Total fat intake is relatively high in Greece (approximately 40% of total energy intake) and moderate in Italy (around 30% of total energy intake). In both settings, the ratio of monounsaturated to polyunsaturated fatty acids is high due to the predominant use of olive oil as the main culinary fat [11] In the mid-1990s, Antonia Trichopoulou and colleagues developed the Mediterranean Diet Score (MDS) based on median food consumption in an elderly Greek population [12]. A more recent and refined version, the Chrono-Mediterranean Diet Score (CMDS), proposed in 2023 by De Matteis et al., provides a more precise measure of adherence to the Mediterranean diet, particularly in the context of metabolic disease risk and abdominal obesity [13].

Relevance

Current evidence confirms that both the DASH and the Mediterranean dietary model lower BP and improve cardiometabolic parameters, yet several clinically relevant questions remain unresolved. First, there are no direct and comparable data on how these diets affect vascular structure and function, including central blood pressure, arterial stiffness, and microvascular remodelling. Second, the long-term sustainability of their antihypertensive effect is insufficiently studied. Most randomized trials last only a few months, which prevents firm conclusions about adherence over time, weight regain, and potential attenuation of the blood pressure lowering effect.

Another unresolved issue concerns the role of the DASH and Mediterranean diets in resistant hypertension. Available data mainly relate to patients with mild or moderate hypertension, both treated and untreated, while evidence in individuals with uncontrolled blood pressure despite multidrug therapy is extremely limited. It is unclear whether one of the diets provides superior benefit in this high-risk group or whether a combined approach is required.

The mechanistic basis of clinical effects is only partially elucidated. Both models influence sodium and potassium intake, body weight, insulin resistance, lipid profile, oxidative stress, and low-grade inflammation, yet the relative contribution of these pathways, as well as their potential interactions with antihypertensive therapy, is not fully defined. Finally, most comparative studies focus on intermediate endpoints such as office blood pressure or surrogate biomarkers. Evidence regarding hard clinical outcomes including myocardial infarction, stroke, heart failure, and cardiovascular mortality remains limited and does not clearly distinguish between the two dietary patterns.

These uncertainties justify a focused literature analysis comparing DASH and the Mediterranean diet with emphasis on differences in antihypertensive efficacy, durability of effects, potential advantages in resistant hypertension, metabolic mechanisms, and long-term clinical impact.

Novelty

The novelty of this work lies in the systematic comparison of two established dietary models in the context of high blood pressure with emphasis on their differing mechanistic basis and unequal magnitude of blood pressure lowering effects. The article does not simply repeat known epidemiological facts but synthesizes meta-analytic data on blood pressure reduction highlighting the contribution of sodium restriction as a key component of the DASH diet and the metabolic and anti-inflammatory effects of the Mediterranean diet. Additional value is reflected in the indication of potential benefits of a combined approach and the need to investigate the Mediterranean diet under conditions of intensified sodium reduction.

AIM

The aim of this review is to critically compare the DASH diet and the Mediterranean dietary model in terms of their blood pressure lowering properties, metabolic influence, and potential for reducing cardiovascular risk.

Research tasks

To achieve this aim, the following research tasks are formulated.

1. The first task is to analyse data from randomized trials and meta analyses to compare the magnitude and durability of blood pressure reduction with each diet.
2. The second task is to assess available evidence on vascular function, including central pressure and arterial stiffness.
3. The third task is to identify possible advantages of one dietary model in resistant hypertension, where current data are scarce and fragmented.
4. The fourth task is to examine described metabolic and anti-inflammatory mechanisms with determination of the relative contribution of individual factors.
5. The fifth task is to evaluate their impact on clinical outcomes, since evidence on myocardial infarction, stroke, heart failure, and mortality is insufficient and requires systematisation.

Completion of these tasks will allow for the assessment of the comparative value of the DASH and Mediterranean dietary models for hypertension management and will help identify areas where further research is necessary.

METHODOLOGY

This narrative review was conducted between January and February 2025. The literature search covered publications from January 2010 to December 2024. The following electronic databases were searched: PubMed, Google Scholar, and the World Health Organization database.

The search strategy included the following combinations of keywords:

• “DASH diet AND arterial Hypertension”,
• “Mediterranean diet AND arterial Hypertension”,
• “Dietary patterns AND blood pressure”,

Only articles published in English or Polish and conducted in adult populations (≥18 years) were considered.

The inclusion criteria were:

• randomized controlled trials,
• systematic reviews and meta-analyses,
• observational studies (prospective and retrospective),
• studies evaluating the effects of the DASH diet or the Mediterranean diet on systolic and/or diastolic blood pressure.

The exclusion criteria were:

• studies conducted exclusively in paediatric populations,
• animal or in vitro studies,
• publications without full-text availability,
• studies not reporting blood pressure outcomes.

The identified studies were classified according to study design as randomized controlled trials, observational studies, or secondary analyses (systematic reviews and meta-analyses). The selected publications were analysed with regard to methodological quality, relevance to the study aim, and clinical applicability. Due to the narrative nature of the review, no formal quantitative synthesis was performed.

RESULTS

Effects of the DASH Diet on Blood Pressure

A network meta-analysis comparing multiple dietary interventions positioned both the DASH and Mediterranean diets among the top-ranked approaches for cardiovascular risk factor reduction, with a high probability of superiority over conventional dietary advice [14].

Meta-analyses and randomized controlled trials consistently demonstrate significant blood pressure reductions associated with the DASH diet. In hypertensive individuals, the DASH dietary approach was shown to reduce systolic and diastolic blood pressure by approximately 11.6/5.3 mmHg, while in normotensive individuals’ reductions of approximately 3.5/2.1 mmHg were observed [15]

A meta-analysis including 1,917 participants reported a mean reduction in systolic blood pressure of 5.2 mmHg and diastolic blood pressure of 2.6 mmHg following DASH dietary intervention. Additionally, total cholesterol decreased by 0.20 mmol/L and low-density lipoprotein cholesterol by 0.10 mmol/L. Changes in glucose concentration were not statistically significant [16]

Another meta-analysis encompassing 30 studies and 5,545 participants demonstrated an average reduction of −3.2 mmHg in systolic blood pressure and −2.5 mmHg in diastolic blood pressure. The effect was more pronounced in populations with sodium intake exceeding 2,400 mg/day. Blood pressure reduction was also shown to be independent of baseline blood pressure values, although the magnitude of reduction decreased with increasing age [17]

A systematic review and meta-analysis of randomized controlled trials demonstrated that the modified DASH diet reduced mean systolic blood pressure by 3.26 mmHg and diastolic blood pressure by 2.07 mmHg compared with control diets. Greater baseline blood pressure values were associated with higher absolute reductions [18].

A 2023 meta-analysis of randomized controlled trials in hypertensive patients confirmed that the DASH diet significantly reduced systolic blood pressure by −3.89 mmHg and diastolic blood pressure by −2.19 mmHg compared with control diets [19].

Effects of the Mediterranean Diet on Blood Pressure

A meta-analysis including 50 studies and 534,906 participants demonstrated that adherence to the Mediterranean diet was associated with significant improvements in cardiometabolic parameters, including reductions in systolic blood pressure (−2.35 mmHg) and diastolic blood pressure (−1.58 mmHg) [20].

A randomized interventional trial involving 137 participants showed reductions in systolic blood pressure of −1.3 mmHg and −1.0 mmHg after 3 and 6 months of Mediterranean dietary intervention, respectively [21]

In the large randomized controlled NU-AGE trial, including 1,142 elderly participants, a one-year Mediterranean dietary intervention resulted in a significant reduction in systolic blood pressure of −5.5 mmHg. The reduction was more pronounced in men (−9.2 mmHg) than in women (−3.1 mmHg). Changes in diastolic blood pressure were not clinically significant [22]

A 2021 meta-analysis of randomized controlled trials and observational studies (n ≈ 4,137) demonstrated modest but significant blood pressure reductions with the Mediterranean diet, with pooled reductions of −1.4 mmHg for systolic and −1.5 mmHg for diastolic blood pressure. Observational data further indicated approximately 13% lower odds of incident hypertension among individuals with higher adherence [23]

Direct Comparison of DASH and Mediterranean Diets

A recent 2025 comparative review evaluating both dietary approaches demonstrated that the DASH diet produced greater reductions in blood pressure in randomized clinical trials, whereas the Mediterranean diet was associated with smaller average pooled reductions in systolic and diastolic blood pressure (SBP ≈ −1.5 mmHg; DBP ≈ −0.9 mmHg). Nevertheless, both dietary patterns were associated with significant cardiovascular benefits [24]

DISCUSSION

Current international clinical practice guidelines unanimously emphasize lifestyle modification as a fundamental component of hypertension prevention and treatment, with dietary interventions representing a cornerstone of non-pharmacological blood pressure control. According to the 2024 European Society of Cardiology (ESC) Guidelines for the management of elevated blood pressure and hypertension, structured lifestyle interventions including dietary modification, weight reduction, sodium restriction, and increased potassium intake are recommended for all patients with elevated blood pressure and established hypertension, regardless of pharmacological treatment status [25].

Similarly, the 2025 American Heart Association/American College of Cardiology (AHA/ACC) guideline strongly recommends adherence to heart-healthy nutritional strategy, explicitly including the Dietary Approaches to Stop Hypertension (DASH) eating plan, as a first-line strategy for both the prevention and management of hypertension. Lifestyle interventions, including dietary modification, are recommended for all adults with elevated blood pressure and hypertension and are considered mandatory even when pharmacological therapy is initiated [26].

In patients with chronic kidney disease (CKD), who represent a high-risk population for cardiovascular complications, the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in CKD similarly emphasizes non-pharmacological strategies, including dietary sodium restriction, weight management, and overall dietary modification, as integral components of blood pressure control alongside pharmacotherapy [27].

Taken together, current European, American, and nephrology-specific clinical practice guidelines consistently identify dietary modification as a foundational element of hypertension management. This strong guideline-based endorsement provides a robust clinical rationale for the comparative evaluation of dietary models, such as the DASH and Mediterranean diets, in blood pressure control.

Both the DASH and Mediterranean diets are characterized by high intake of vegetables and fruits and reduced consumption of saturated fats. However, despite these similarities, the two dietary models differ in several key components that may explain their different magnitudes of antihypertensive effects. The DASH diet emphasizes strict sodium restriction, low-fat dairy products, and complete exclusion of alcohol, while the Mediterranean diet is based on olive oil as the primary fat source, includes moderate intake of fish, poultry, dairy products, and allows moderate alcohol consumption, particularly wine.

The key nutritional components and recommended intake frequencies of the DASH and Mediterranean diets are summarized in Table 1