*Systematic Review* **Adherence to the DASH Diet and Risk of Hypertension: A Systematic Review and Meta-Analysis**

**Xenophon Theodoridis 1,2, Michail Chourdakis 1,\*, Lydia Chrysoula 1, Violeta Chroni 1, Ilias Tirodimos 1, Konstantina Dipla 3, Eugenia Gkaliagkousi <sup>2</sup> and Areti Triantafyllou <sup>2</sup>**


**Abstract:** The aim of this study was to assess the effect of the level of adherence to the DASH diet on hypertension risk by conducting a systematic review and meta-analysis. A systematic literature search was performed. Two independent investigators performed the study selection, data abstraction, and assessment of the included studies. The meta-analysis was performed separately with the adjusted hazard (HR) or incident rate ratios (IRR) and the odds ratios (OR) of the highest compared to the lowest DASH diet adherence scores using a random effects model. A total of 12 studies were included in the qualitative and quantitative synthesis. When cohort studies reporting HR were pooled together, high adherence to the DASH diet was associated with a lower risk of hypertension (HR: 0.81, 95% CI 0.73–0.90, *I* <sup>2</sup> = 69%, PI 0.61–1.08) compared to the low adherence. When cross-sectional studies reporting OR were combined, high adherence to the DASH diet was also related to a lower risk of hypertension (OR: 0.80, 95% CI 0.70–0.91, *I* <sup>2</sup> = 81%, PI 0.46–1.39). The findings suggest that high adherence to the DASH diet has a positive effect on reducing hypertension risk compared to low adherence. These data strengthen and are in line with all hypertension guidelines, indicating that lifestyle changes should start early even in populations with normal blood pressure.

**Keywords:** blood pressure; compliance; DASH diet; systematic review; meta-analysis; hypertension
