ORIGINAL ARTICLE Comparison of three DASH scoring paradigms and prevalent hypertension among older Hispanics C Tangney 1 , D Sarkar 1,3 and BA Staffileno 2 Older Hispanics are less likely to be aware of their hypertension or adopt lifestyle modifications for hypertension control than non-Hispanic whites. Few reports exist concerning Dietary Approaches to Stop Hypertension (DASH) accordance among Hispanics. This study was designed to: (1) assess accordance to a DASH pattern using three widely used DASH scoring paradigms; and (2) determine which DASH paradigm was most strongly associated with hypertension in 169 older Hispanics (mean age, 66 years and 73% female). Food frequency questionnaires were used to calculate DASH scores. Logistic regression modeling was performed for prevalent hypertension with the DASH scores, age, gender and acculturation. Using the Folsom et al. DASH scoring paradigm, 55% of adults were deemed DASH accordant compared with 17% using Fung et al. scores and 13% using the Toledo et al. Folsom et al. scores were predictive of prevalent hypertension (odds ratio = 1.35, 95% confidence interval (1.04, 1.77) in this older Hispanic sample; the remaining two scoring systems were not associated with hypertension in this sample. Journal of Human Hypertension advance online publication, 28 May 2015; doi:10.1038/jhh.2015.50 INTRODUCTION Hypertension is a major public health concern in the United States population. Approximately one out of every three adults or 77.9 million people have high blood pressure (BP). 1 Although the prevalence of hypertension is lower among Hispanics compared with Caucasians (22 vs 28%), Hispanics are less likely to be aware of their hypertension or adopt healthy lifestyle modifications for controlling their hypertension. 2 The Dietary Approaches to Stop Hypertension (DASH) eating pattern has been widely promoted and was developed as a treatment recommended for hyperten- sion (http://www.nhlbi.nih.gov/health/health-topics/topics/dash). Lifestyle changes, such as the DASH eating plan along with weight loss and increased physical activity have been shown to reduce BP. 3–6 More recently, there is renewed attention to this pattern with the release of the American Heart Association/ American College of Cardiology guidelines for lifestyle manage- ment of cardiovascular risk. 7 The DASH eating pattern is high in fruits and vegetables, moderate in low-fat dairy products, low in animal protein such as red or processed meats and moderate in legumes, nuts and seeds. There are more than 10 different DASH scoring paradigms to assess accordance or adherence. (Accordance is used 8–10 to assess the level of conformity to a dietary recommendation/pattern. Adherence is used compliance to a plan is assessed once the individual has been counseled on this plan. 5,6 ) These paradigms differ in many ways including, the tools used to collect food intake, the number of food items that constitute a key food group to be scored, which food items comprise the food group to be scored or finally whether intakes of nutrients or food items/groups (or a combination of both) are the basis for scoring. Although food frequency questionnaires (FFQ), food records or 24-hour recalls may all be used to measure usual dietary intakes, the FFQ is easiest to use with large population samples. Then, the scoring is standardized for food items on the FFQ. However, if there are no specific food items on the FFQ to score (such as a whole grain food item), assumptions are made that could contribute to misclassification. Scoring paradigms selected include those of Toledo et al., 11 Fung et al. 12 and Folsom et al. 13 because: (1) these investigators predominately used food groups to assess DASH accordance; (2) FFQs were used to measure usual intake; and (3) there is evidence for lower risk of hypertension 8,10,11,14 and cardiovascular disease 12,13 among those deemed accordant to one of these DASH scoring systems. The emphasis on food items or groups as a feature of the scoring tool was particularly key because we wanted to identify a scoring approach which could be applied directly on the completed FFQ, so the clinician might provide immediate feedback to clients. Scoring intake of foods or food groups would also be useful for behavioral targets with clients. In our previous work 15 we tested a scoring paradigm by Mellen et al. 10 that is exclusively nutrient-driven. Because many nutrients are found in the key foods advocated for the DASH food pattern, it was important to ascertain whether DASH accordance with more food-based scoring paradigms would also be associated with hypertension in this sample of adults. Because we had observed that acculturation scores were predictive of hypertension status, 15 these were also examined in relation to DASH scores. Thus, the overall purpose of this study was to apply three commonly available DASH scoring paradigms 11–13 to FFQs completed by a sample of Hispanic individuals currently living in the Chicago area. The primary objective was to determine whether DASH scores computed from the three tools were associated with the presence or absence of hypertension, and measured systolic BP (SBP) and diastolic BP or (DBP). In addition, 1 Department of Clinical Nutrition, Rush University Medical Center, Chicago, IL, USA and 2 Department of Adult Health and Gerontological Nursing, College of Nursing, Rush University Medical Center, Chicago, IL, USA. Correspondence: Dr C Tangney, Department of Clinical Nutrition, Rush University Medical Center, 1700 West Van Buren Street, Suite 425, Chicago, IL 60612, USA. E-mail: ctangney@rush.edu 3 This work is in partial fulfillment of a Master’s of Science degree in Clinical Nutrition. Received 9 February 2015; revised 4 April 2015; accepted 9 April 2015 Journal of Human Hypertension (2015), 1 – 6 © 2015 Macmillan Publishers Limited All rights reserved 0950-9240/15 www.nature.com/jhh