JamesLHollyMD.com

	James L. Holly, M.D.

About SETMA Joint Commission Contact Information History Mission Statement Medical Home Scope of Services I-CARE Initiative Infusion Center The SETMA Way - What is it? SETMA's Model of Care Patient-Centered Medical Home The SETMA Approach to Patient Care	In The News Letters Vital Signs - Examiner Publication SETMA's Providers as of January, 2015 SETMA Knows - Abraham Lincoln and Healthcare Analytics SETMA – 1999 – Four Seminal Events PC-PCC Award January, 2015 Vital Signs Spring 2015 Vital Signs Q&A for PC-PCC Award Links to SETMA 2012 eHealth Innovator Award for LESS initiative Handout for Attendees eHealth Conference January 12, 2012 eHealth Initiative 2012 Award Program Application The eHealth Initiative's 2012 Award Letter 2012 National Quality Forum National Healthcare Improvement Award Effective prioritization of performance improvement goals Dashboard to Measure and Manage Whole System Performance Commitment to transparency Date-driven improvement of NQS priorities Demonstration of readiness to assume responsibilities of an ACO Demonstrated results on publicly reported performance measures Public Reporting Quality Metrics for 2009, 2010, 2011 Internally Tracked Reporting Quality Metrics for 2009, 2010, 2011 Complete Application in PDF Format SETMA's Medical Home Pilgrimage 2009 Medical Home Series I 2010 Medical Home Series II 2011 Medical Home Series Two 2009, 2010, 2011 Medical Home Miscellaneous Articles The Dr. and Mrs. James L. Holly Distinguished Professorship Universal American Letter of Transmittal for Support Dr. Holly's Acceptance Address for the 2012 Distinguished Alumnus Award CMS Medical Home Feedback Report Qualify & Cost SETMA questions Influenza Data SETMA I - October 2011 SETMA II - October 2011 Mark A. Wilson Clinic SETMA West - October 2011 SETMA and Fox 4 News - Healthy Living Videos SETMA Advertisements - Display and Video SETMA Announcements Featured Content Archive	Syllabus PC-MH Externship SETMA's MS4 Patient-Center Medical Home Selective Syllabus Introduction to SETMA's Senior Externship and Syllabus An Introduction to the Origins and Beginnings of Southeast Texas Medical Associates, LLP Patient-Centered Communication PC-MH Health Affairs August 15, 2013 Policy Brief -- Health Gap SETMA 8.20.13 Provider Training -- Health Affairs 2.14.13 -- Patient Engagement SETMA Provider Training 8.20.13 during First Senior Medical Student PC-MH Externship Medical Home Coordination Review Tutorial 2011 Medical Home Series Two Teaching Tool for PC-MH Course - Patient Care Activation, Engagement, Shared-Decision Making	Patient Information What Does Patient-Centered Medical Home Mean to You? What Does Patient-Centered Medical Home Mean to You? Health information exchange Patient Rights and Responsibilities Patient Directions Contact SETMA – Secure Texting What is HIPAA? Authorization To Release or Obtain Medical Records Complete Privacy Policy Website Privacy Policy	Presentations Invited Presentations SETMA Provider Training
Governance Board Governance Board Responsibilities Governance Board Leadership Training The SETMA Team and The SETMA Culture SETMA's Mission, Vision and Goals: Patient Safety and Quality Care Harassment, Neglect, Abuse, Exploitation - Role of HCAHPS & CAHPS Healthcare Provider Standards Providers Responsibility Medication Refills, Reconciliation and Maintenance Provider and Leadership Use of Data and Analytics Commitment To All Patients -- Ethnic Disparities Kaizen - Board Creates Culture of Safety and Quality SETMA's Policy and Practice for Advanced Directives SETMA's Policy on Completion of Medical Records Care Guidelines : Improve processes to evaluate and treat Integrated patient safety program (Sentinel Events) Effectively Manages all programs, services or sites Provides Patients with information about Primary-care Medical Home Organization-wide Planning to Maintain Focus on safety and quality Organization-wide Planning to Maintain Focus on safety and quality SETMA's Performance Quality & Safety Judged by CMS SETMA's Performance Quality & Safety Judged by CMS SETMA Awarded by HIMSS for Quality and Safety 2011 John M. Eisenberg Patient Safety and Quality Awards Application Healthcare Quality Award 2012 Principles of Quality and Metrics Principles Contacting SETMA & Secure Texting PC-MH Mission, Vision, Goal, Access, End-of-Life Communications and Public Reporting Change Existing Processes to Improve Performance Team Members Focused on Safety and Quality	Your Life Your Health View Articles by Subject Aging Well Behavioral Health Cardiovascular Disease Risk Care Coordination Care Transitions Children's Health COGNOS Project Diabetes Exercise Healthcare Reform:Public Policy HIPAA & Security Labor Day Less Initiative Medical Home Medical Records Men's Health Mental Health Nutraceuticals Nutrition Smoking Cessation Thanksgiving Weight Management Women's Health All Articles	Public Reporting Public Reports by Year (2009-2017) Public Reports by Type Fall Risk, Pain, Functional, Wellness, Stress Assessment Fall Risk, Pain, Functional, Wellness, Stress Assessment for 2011 AND 2012 Core Measures: SETMA & Baptist Hospital Core Measures for January to December 2011 PQRS Diabetes Measures - Blood Pressure Diabetes Measures - Glyco and LDL Diabetes Measures - Nephropathy Screening, Foot Exam, and Eye Exam Preventive Measures - Screening (BMI, Colorectal Cancer, Mammography, Osteoporosis) Preventive Measures - Influenza, Pneumococcal, Urinary Incontinence Preventive Measures - Tobacco Use NQF Care for Older Adults Comprehensive CHF Care Diabetes Measures Diabetes Measures - Blood Pressure Control Diabetes Measures - Glyco and LDL Diabetes Measures - Smoking Cessation Female Measures General Health Measures Medication Measures Persistent Medications Medication Measures Pediatric Measures HEDIS (NCQA) Effectiveness of Acute Care Effectiveness of Chronic Care - Clinic/Hospital Effectiveness of Chronic Care - Clinic Only Effectiveness of Chronic Care - Diabetes (Smoking Cessation) Effectiveness of Chronic Care - Diabetes (Glyco and LDL) Effectiveness of Chronic Care - Diabetes (Blood Pressure Control) Effectiveness of Preventive Care Effectiveness of Preventive Care - Older Adults Effectiveness of Chronic Care - Diabetes Measures Effectiveness of Chronic Care - Persistent Medications (MPM) NCQA Diabetes Recognition Program Audit LESS Initiative PCPI PCPI Hypertension PCPI Diabetes PCPI Chronic Stable Angina PCPI Care Transitions PCPI CHF PCPI Weight Management PCPI CKD Stages IV V SETMA Lipid Audit Lipids Treatment Audit Tutorial Lipids Tutorial AQA COGNOS Project SETMA Audit for CKD Stages I III Patient Satisfaction Survey	Accreditations/Awards Achievements which have Advanced SETMA: The Time-line, Philosophy and Principles which Underlie that Advancement Awards	Diabetes Center of Excellence Education Diabetes Order Referral Form Seven Stations 2011 Advances in Diabetes Diabetes Tutorial Diabetes Prevention
EPM Tools Association of Medication and Diagnosis Automated Team Function Behavioral Health Adult Weight Management Tutorial Annual Questionnaires: Fall, Functional, Pain, Stress, Wellness Behavioral Health in SETMA's Patient-Centered Medical Home Model of Care Depression Tutorial Fall Risk Tutorial Health Insurance Portability and Accountability Act (HIPAA) Privacy Tutorial Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive LESS Initiative Tutorial Medical Home Transtheoretical Model Assessment Stages of Change Tutorial Pain Management Tutorial Reduction of Antipsychotic Medications Toolkit Smoking Cessation Tutorial Stratifying End-of-Life Risk for Hospice Services Tutorial Chronic Conditions Tutorial Chronic Renal Disease Management Tool Tutorial Calculating the Stages of Renal Disease Proteinuria Disease Management Tools Acute Coronary Syndrome Tutorial Adult Weight Management Tutorial Angina Tutorial Cardiometabolic Risk Syndrome Tutorial Chronic Renal Disease Tutorial Congestive Heart Failure Tutorial Diabetes Tutorial Hypertension Tutorial Lipids Tutorial Lipid Quality Audit Tutorial Primary Pulmonary Hypertension Tutorial Framingham Cardiovascular Risk Cardiometabolic Risk Assessment Framingham Heart Study Risk Calculators Tutorial Frederickson Classification of Dyslipidemia LDL Level Lipid Disease Management Risk Assessment General principles about ICD-9 Codes and HCC/RxHCC Codes Charge Posting Tutorial Coding to Ensure Accurate Health Risk Scoring E & M Codes Tutorial HCC & RxHCC Risk HCC/RxHCC Risk Tutorial ICD-9 Code Training Manual Hepatitis Screening Hospital Based Tools Hospital Care Summary and Post Hospital Plan of Care and Treatment Plan Tutorial Admission Orders Tutorial Daily Progress Notes Tutorial Care Transition Data Set from PCPI Tutorial Using The Clinic and Hospital Follow-up Call Templates Respiratory Failure Tutorial Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS): Tutorial for SETMA's Internal HCAHPS Survey Master GP Suite of Templates Master GP Suite of Templates Tutorial Medical Home Support Materials Department of Care Coordination, Director of Care Coordination and Care Coordination Referral Template Electronic Tickler File Electronic Tickler File Tutorial Follow-up Calls Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive Services Medical Home Coordination Review Tutorial Medical Home Plan of Care and Treatment Plan Medical Home Transtheoretical Model Assessment Stages of Change Tutorial Patient-Centered Medical Home Annual Questionnaires Patient-Centered Medical Home: SETMA's Medical Home Coordination Review (MHCR) Tutorial Patient Document for Coordination of Care Transitions of Care Management Coding (TCM Code) Tutorial Merit-Based Incentive Payment System (MIPS) Quality Metric Tool Tutorial Nursing Home Depression Tutorial Fall Risk Tutorial Hydration Assessment Tutorial Nursing Home Guidelines for Care Tutorial Nursing Home Principal Suite of Templates Nutrition Assessment Tutorial Reduction of Antipsychotic Medications Toolkit Skin Care Tutorial Outpatient Infusion Center for Intravenous Antibiotic Therapy and Other Meds Preventive Health Tools Adult Weight Management Tutorial CHF Exercise Tutorial Diabetic Exercise Tutorial Diabetes Prevention Tutorial Exercise Prescription Tutorial Hypertension Prevention Tutorial Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive Initial Preventive Physical Exam & Annual Wellness Visit Tutorial LESS Initiative Tutorial Progression to Type 2 Diabetes Smoking Cessation Tutorial Progression to Type 2 Diabetes Quality Metrics ACO and Medicare Advantage Stars HEDIS: NCQA, History, Quality, Safety, STARS, ACO ACO Quality Measures Performance Tool ACO Quality Measures Performance Tool Tutorial STARs - A Tutorial for Utilizing SETMA's Deployment of the STARS MA Program Specialized Tools Annual Questionnaires: Fall, Functional, Pain, Stress, Wellness Association of Medication & Diagnosis Chronic Conditions Tutorial Chronic Care Management Code (CCM) Tutorial Depression Tutorial Drug Interactions Tutorial Electronic Tickler File Tutorial Evaluation Lower Urinary Tract Symptoms in the Male Fall Risk Tutorial Future Labs Tutorial Hydration Assessment Tutorial HCC Risk Training Tool Hypertension: Fulfilling Quality Metrics for the PCPI Program Laboratory Results - Signing Off: Why and How Medication Module Tutorial Medication Reconciliation Tutorial Nutrition Tutorial Pain Management Tutorial Problem List Reconciliation Tutorial Progression to Type 2 Diabetes Referral Skin Care Tutorial SOAAP Opioid Risk Assessment Stratifying End-of-Life Risk for Hospice Services Tutorial Texas State Reportable Infectious Diseases Tutorial Transitions of Care Management Coding (TCM Code) Tutorial	Transforming Your Practice Library Introduction to SETMA's TCPI Library Transforming Your Practice (TCPI) Summary Document of TCPI CMS Quality 12.2015 TCPI Leadership and Governance Care Coordination HIPPA and Security Data Analytics Care Transitions LESS Initiative Medical Records Clinical Decision Support Hospital Care Tools Disease Management Tools Preventive Health Tools Behavioral Health Transformation Tools New Transformation Tools Patient-Centric Care Nursing Home Medical Home Display and Explanation of SETMA's Patient-Centered Medical Home Tools	Medical Home The Story and the Ideals Introduction to Preventive Health Tools PC-MH Patient Engagement & Alternative Payment Models Preventive Care: The Best Way to Treat Illness is Don’t Get it Coordination of Care Patient-Centric Care Population Health Transition of Care - One form of Care Coordination HCAHPS - Hospital Consumer Assessment Of Healthcare Providers and Systems CAHPS - Consumer Assessment of Health Care Provider and Systems Teaching Tool for PC-MH Course – Patient Care Activation, Engagement, Shared-Decision Making Display & Explanation of PC-MH Tools SETMA's Medical Home Pilgrimage Concierge Medicine not Medical Home Medical Neighborhood Security & HIPPA Referrals Patient Web Portal Health Information Exchange Medication Reconciliation The Automated Team Coordination of Care Medical Home Description & Standards AAAHC Joint Commission NCQA Planetree URAC NCQA Interview February 14, 2014	Facebook	Letters

Your Life Your Health - Hypertension: Part IV: The DASH Diet

James L. Holly,M.D.

July 07, 2004

Your Life Your Health - The Examiner

In our June 17, 2004, Your Life Your Health, the following statement appeared under the heading of life-style changes which improve blood pressure: Adopt DASH eating plan: Consume a diet rich in fruits, vegetables, and low fat dairy products with a reduced content of saturated and total fat -- Approximate SBP Reduction, Range: 8-14 mmHg.

History of the DASH Diet (Dietary Approaches to Stop Hypertension)

Funded by the National Heart, Lung and Blood Institute, Dietary Approaches to Stop Hypertension (DASH) is a major research study to determine whether diet can lower blood pressure. High blood pressure (hypertension) is a major risk factor for coronary artery disease (which can lead to heart attack) and carotid artery disease (which can lead to stroke). The goal of the DASH study was to determine whether a particular diet could lower blood pressure, reducing the risk of potentially fatal events. Ideally, the researchers wanted to identify a diet to lower blood pressure, as a vegetarian diet often does, but that would also include some meat to appeal to a broader group of people.

The DASH study examined the impact of three different dietary patterns on a group of 459 subjects. The average age of the group was 44.6 years old, and 49 percent of the participants were women. In addition, 59 percent of the participants were African-American.

After the participants had eaten an average, typical American diet for three weeks, their blood pressure was measured. They were then asked to do one of the following:

Group One: Continue eating the average American diet without adding or limiting any specific types of foods.
Group Two: Eat more fruits and vegetables than group one, the average American diet.
Group Three: Eat more fruits, vegetables and low-fat dairy products than one normally would, and restrict ones intake of fat and sweets. This later became known as the DASH diet.

All three groups consumed the same amount of salt (3000 mg per day, slightly less than the average intake of Americans at 3600 to 4000 mg per day) and calories. Alcohol was limited to one to two drinks a week in all groups.

After eight weeks, all participants on the DASH diet (group three) exhibited lower blood pressure. In fact, the blood pressure of participants on the DASH diet was about as low as that of patients who took medications (anti-hypertensives) to lower blood pressure. It is estimated that widespread use of the DASH diet could reduce the overall incidence of coronary artery disease by 15 percent and stroke by 27 percent. The study was published in the New England Journal of Medicine in 1997.

African-Americans and DASH

Follow-up research suggested that the DASH diet is even more effective for African-Americans than it is for Caucasians. Identifying an effective treatment for African-Americans is particularly important because they are at particularly high risk of developing high blood pressure.

Before the introduction of the DASH diet, the main dietary change recommended for patients with high blood pressure was a reduction of salt. However, the DASH study was able to show for the first time how dietary changes other than salt reduction can affect blood pressure.

To further investigate the effects of salt on blood pressure, a second phase of research was performed. The DASH-Sodium trial investigated the relationship between blood pressure and different levels of dietary sodium intake with two different diet plans. The study included 412 participants, 57 percent of whom were women and 57 percent were African American. Forty-one percent of the participants had hypertension.

The participants were assigned to two different dietary patterns:

Group One: Continue eating the average American diet without adding or limiting any specific types of foods.
Group Two: the DASH diet.

Both groups then modified the sodium content of their diet as follows:

High sodium diet (3,300 milligrams of sodium per day) for one month,
Intermediate sodium diet (2,400 milligrams of sodium per day) for the following month and lastly
Low sodium diet (1,500 milligrams of sodium per day) for one month.

Reducing sodium intake lowered blood pressure for both the average American diet and the DASH diet groups. In fact, the more the sodium level was reduced the great the blood pressure fell. However, the biggest reduction in blood pressure was found in the group that followed the DASH diet at the lowest level of sodium intake. Therefore, according to this study the DASH diet combined with a reduction in sodium intake has an additive effect on lowering blood pressure. The results of the DASH-Sodium trial were published in the New England Journal of Medicine 2001.

Dos and Don'ts for the DASH Diet

Staying true to any diet is a challenge, but keep in mind that any change you are able to make today is a step toward a healthier tomorrow. Here are some tips to help you stay on track:

Do add a serving of vegetables at lunch.
Do use half the butter, mayonnaise, salad dressing or other high-fat items that you normally use. Trying low-fat or non-fat alternatives will also help.
Do eat fruit as a snack. An apple or banana is perfect for those hungry times between meals. Want something to munch on? Try berries!
Do watch what you drink. Replace soda, sugary teas or punches and alcoholic beverages with fat-free (skim) (or 1 percent). This will not only help you cut back on your sweets, but will also help you meet the DASH diets dairy requirements.
Do learn serving sizes. Serving-sizes are a guideline to help you change not only what you are eating, but also how much of each type of food you are eating. While all the numbers and charts are initially cumbersome, they will become second nature once a daily routine has been set.
Do learn to read food labels. Much of the sodium in our diet is added to foods while processing. To lower your intake of sodium, begin by removing the salt shaker from the table. Gradually lower the amount of salt added during cooking and instead try herbs, spices, lemon or sodium-free seasoning blends to flavor your food. You can also rinse canned foods to lower their sodium content. Lastly, read food labels and compare sodium content of foods when shopping.
Do experiment with vegetarian dishes or dishes with little meat and more vegetables and grains. These include stir-fry meals, pasta dishes and casseroles. These healthy and tasty alternatives will add spice and variety to your diet.
Do change your shopping list. That way, you won't be eating the same things in the same proportions. Increase the amount of fruits and vegetables on your weekly shopping list. Don't buy as much meat. If its not there, you cant eat it.
Do feed your cravings for sweets with sugar-free gelatin or dried fruit.
Do keep it simple. Remember that you are not trying to stay on a short-term diet. You are changing your lifestyle. The simpler you keep your meals, your goals and your tasks, the easier they will be to maintain.
Do keep a record. Keeping a diary or a logbook can help you keep track of the number of servings you are eating in each category. Plus, seeing what you are eating in black and white is a great way to check your progress. It can also help you to identify patterns and triggering events that put you off track.
Do celebrate success! Reward yourself for every accomplishment (but not with food!)
Don't make meat the center of your meal. Although meat contains nutrients that are good for the body, it is also high in saturated fat and cholesterol, not to mention calories. You can continue to enjoy meat as part of a balanced meal rather than the whole meal. Remember to make this change gradually. If you typically eat more than the suggested amount of meat, reduce your portions by a third for one week. After a week, cut back another third until your serving sizes of meat are equal to the DASH serving size of 3 ounces.
Don't try to do it all at once. You will be more successful if you make gradual changes in your eating habits.
Don't be discouraged by occasional lapses. They happen. It is important, however, to determine why the lapse occurred so you can avoid that same trigger in the future. Perhaps it was a holiday party that got you off track? Stress due to a problem at work? Learn from the mistake and move on; don't beat yourself up. It's all part of the process of change.

Next week, more about the Dietary Approaches to Stop Hypertension.

Remember, it is your responsibility and it is your life and your health.

Other Articles in the Hypertension Series

	Hypertension: Part I: What is Your Hypertension IQ? Hypertension: Part II: What Can I Do? Hypertension: Part III: What Can I Do? - Continued Hypertension: Part V: Dash Diet Continued

About SETMA	In The News	Syllabus PC-MH Externship	Patient Information	Presentations
Governance Board	Your Life Your Health	Public Reporting	Accreditations/Awards	Diabetes Center of Excellence
EPM Tools	Transforming Your Practice Library	Medical Home	I-CARE Initiative	NextMD