In 2021, about 38.1 million adults in the United States were living with diagnosed diabetes, and the vast majority—around 90% to 95%—had type 2 diabetes.
Many of these individuals also struggle with high blood pressure, a major risk factor for heart disease and stroke. While blood sugar control is often the main focus for people with diabetes, blood pressure is just as critical to monitor and manage.
A new study from Johns Hopkins Medicine offers a helpful tool: a modified version of the well-known DASH diet (Dietary Approaches to Stop Hypertension), which has been adjusted to meet the needs of people with type 2 diabetes. This new diet, called DASH4D, was shown to lower blood pressure in people with diabetes—even those already taking multiple blood pressure medications.
The original DASH diet promotes eating plenty of fruits, vegetables, and low-fat dairy, while reducing saturated fat, cholesterol, and sodium. For this study, researchers changed the DASH diet in several important ways. They reduced the amount of carbohydrates, increased healthy unsaturated fats, and lowered potassium to make it safe for people with diabetes who may also have kidney disease.
The study, published on June 9 in JAMA Internal Medicine, involved 102 adults with type 2 diabetes. Most participants were older adults, with an average age of 66. About two-thirds were women, and most identified as Black.
A large number were taking two or more medications to manage their blood pressure, which averaged 135/75 mmHg at the start of the study—slightly above the recommended goal of under 130/80 mmHg for people with diabetes.
In this crossover feeding study, each participant tried four different diets in random order:
- The modified DASH4D diet with lower sodium
- The same DASH4D diet but with higher sodium
- A typical American diet with lower sodium
- A typical American diet with higher sodium
Participants followed each diet for five weeks, and during those weeks, they only ate food provided by the study team. Calorie levels were adjusted to keep their weight stable, so weight loss did not affect the results.
Researchers found that the DASH4D diet with lower sodium produced the best blood pressure results. Compared to the typical American diet high in sodium, it lowered systolic blood pressure (the top number) by 4.6 mmHg and diastolic pressure (the bottom number) by 2.3 mmHg. Most of the improvement happened within the first three weeks of each diet phase.
Although a drop of five points in systolic blood pressure may seem small, it has meaningful health benefits for people with diabetes. This reduction can lower the risk of stroke by 14%, heart failure by 8%, and cardiovascular events like heart attacks by 6%.
Dr. Scott Pilla, the lead author, said that even with medication, people with diabetes can benefit from targeted dietary changes. “We found that you can lower blood pressure even further through diet,” he said.
Dr. Lawrence Appel, one of the original developers of the DASH diet and a co-author of this study, agreed: “Blood pressure is one of the most important numbers to control because the higher the number, the higher the risk of stroke and heart disease.”
The next step, according to the researchers, is to share this information with the public in ways that are easy to understand and apply. They hope to make the DASH4D diet more accessible and adaptable to different cultures, lifestyles, and food preferences.
In short, this study shows that the right diet—specifically, one that’s low in sodium and tailored to the needs of people with diabetes—can be a powerful addition to medication in controlling blood pressure. It’s a simple, practical way to lower the risk of serious health problems and improve daily life for millions of people with type 2 diabetes.
If you care about high blood pressure, please read studies about what to eat and to avoid for high blood pressure, and 12 foods that lower blood pressure.
For more health information, please see recent studies about the connection between potato and high blood pressure, and how to eat your way to healthy blood pressure.
The research findings can be found in JAMA Internal Medicine.
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