**1. Introduction**

The prevalence of hypertension doubled in adults older than 30 from 1990 to 2019 [1]. According to the World Health Organization (WHO) [2], it is estimated that almost 50% of adults with hypertension are undiagnosed. Prediction models project that in 2030 approximately 40% of adults in the U.S.A. will develop some form of cardiovascular disease (CVD), including hypertension [3]. To tackle this public health issue, the WHO set a global target to ameliorate the prevalence of hypertension by <sup>1</sup> <sup>4</sup> by 2025 [4].

High blood pressure is the leading cause of disability-adjusted life years (DALY) [5] and accounts for most of the CVD events worldwide [6] and premature deaths [7]. Even though prevention policies are of fundamental importance to mitigate the tremendous increase in hypertension rates and reduce the development of related comorbidities, most clinical practice guidelines focused primarily on the treatment of this condition [8,9]. The recommendations for preventing hypertension include the amendment of dietary deviations from guidelines and physical inactivity [10]. Decreasing the amount of sodium intake and the achievement of weight loss for adults with overweight or obesity are strategies that will prevent hypertension-attributed deaths and reduce the risk of hypertension, respectively [6].

**Citation:** Theodoridis, X.; Chourdakis, M.; Chrysoula, L.; Chroni, V.; Tirodimos, I.; Dipla, K.; Gkaliagkousi, E.; Triantafyllou, A. Adherence to the DASH Diet and Risk of Hypertension: A Systematic Review and Meta-Analysis. *Nutrients* **2023**, *15*, 3261. https://doi.org/ 10.3390/nu15143261

Academic Editor: Giuseppe Della Pepa

Received: 29 June 2023 Revised: 17 July 2023 Accepted: 18 July 2023 Published: 24 July 2023

**Copyright:** © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

The most studied dietary pattern for high blood pressure is the Dietary Approaches to Stop Hypertension (DASH) eating plan. The DASH diet has been proposed for the management of high blood pressure due to the inclusion of food groups with antihypertensive properties [11]. More specifically, the DASH diet emphasizes the consumption of fruits, vegetables, whole grains, legumes, nuts, lean protein, and low-fat dairy products. Furthermore, it focuses on limited intakes of salt, added sugar, and saturated fat. Many studies have assessed whether the level of adherence to the DASH diet can reduce hypertension risk among the adult population, with inconclusive results [12–15].

To the best of our knowledge, there is not a published systematic review and metaanalysis assessing the effect of the level of adherence to the DASH diet on the development of hypertension. Hence, the objective of this work was to synthesize all the data from the available primary studies to shed light on the inconclusive results.
