Tailoring the DASH diet for hypertension control in lower-middle-income countries: A culturally and socioeconomically adapted framework for Sri Lanka

Cardiovascular diseases (CVDs) are a leading cause of non-communicable disease mortality worldwide, with a disproportionate burden in lower-middle-income countries (LMIC). Hypertension is a signifi cant risk factor for CVDs, and its prevalence is on the rise, posing considerable challenges to public health. This paper provides a narrative overview of the global burden of hypertension, emphasizing its disproportionate impact on LMICs, and then shifts its focus to Sri Lanka, a South Asian low-er-middle-income country, where one-third of the adults are hypertensive and discusses awareness, diagnosis, and control rates in the country. The core of this paper explores the evolution of dietary interventions, specifi cally the Dietary Approaches to Stop Hypertension (DASH) diet, in managing hypertension. From the inception of the DASH study in 1994 to its subsequent impact on blood pressure reduction, the article presents a detailed analysis of the diet’s components and effectiveness. A signifi cant contribution is proposing a culturally and socio-economically adapted DASH diet tailored to the Sri Lankan setting. Addressing challenges related to adherence and compliance, the article emphasizes the importance of community involvement and policy changes to sustain DASH. The conclusion highlights the research gap in Sri Lanka, where very limited studies have explored the exclusive use of the DASH diet. By outlining contextual challenges and key research priorities, this paper aims to inform prospective research in Sri Lanka and comparable LMIC settings, underscoring the importance of tailoring dietary interventions to specifi c cultural and socio-economic contexts for effective hypertension control.