Low-sodium DASH diet improves diastolic function and ventricular-arterial coupling in hypertensive heart failure with preserved ejection fraction.
Study Goal
The researchers aimed to determine if a sodium-restricted DASH diet (DASH/SRD) improves left ventricular diastolic function, arterial elastance, and ventricular-arterial coupling in hypertensive patients with heart failure with preserved ejection fraction (HFPEF).
Results Summary
The DASH/SRD reduced clinic and 24-hour brachial systolic pressure, improved diastolic function, decreased arterial elastance, and enhanced ventricular-arterial coupling in hypertensive HFPEF patients.
Population
Thirteen patients with treated hypertension and compensated HFPEF.
Effective Dosage
Target sodium intake of 50 mmol/2100 kcal.
Duration
21 days.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
sodium-restricted dietary approaches to stop hypertension diet (DASH/SRD) | decrease | clinic brachial systolic pressure | patients with treated hypertension and compensated HFPEF | 155 ± 35 to 138 ± 30 mm Hg | reduced | #1 |
sodium-restricted dietary approaches to stop hypertension diet (DASH/SRD) | decrease | 24-hour brachial systolic pressure | patients with treated hypertension and compensated HFPEF | 130 ± 16 to 123 ± 18 mm Hg | reduced | #2 |
sodium-restricted dietary approaches to stop hypertension diet (DASH/SRD) | decrease | central end-systolic pressure | patients with treated hypertension and compensated HFPEF | 116 ± 18 to 111 ± 16 mm Hg | trended lower | #3 |
sodium-restricted dietary approaches to stop hypertension diet (DASH/SRD) | decrease | diastolic function (relaxation/viscoelastic constant c) | patients with treated hypertension and compensated HFPEF | 24.3 ± 5.3 to 22.7 ± 8.1 g/s | improved | #4 |
sodium-restricted dietary approaches to stop hypertension diet (DASH/SRD) | decrease | diastolic function (passive/stiffness constant k) | patients with treated hypertension and compensated HFPEF | 252 ± 115 to 170 ± 37 g/s(2) | improved | #5 |
sodium-restricted dietary approaches to stop hypertension diet (DASH/SRD) | decrease | effective arterial elastance (Ea) | patients with treated hypertension and compensated HFPEF | 2.0 ± 0.4 to 1.7 ± 0.4 mm Hg/mL | decreased | #6 |
sodium-restricted dietary approaches to stop hypertension diet (DASH/SRD) | increase | ventricular-arterial coupling (Ees:Ea) | patients with treated hypertension and compensated HFPEF | 1.5 ± 0.3 to 1.7 ± 0.4 | improved | #7 |
BACKGROUND: Heart failure with preserved ejection fraction (HFPEF) involves failure of cardiovascular reserve in multiple domains. In HFPEF animal models, dietary sodium restriction improves ventricular and vascular stiffness and function. We hypothesized that the sodium-restricted dietary approaches to stop hypertension diet (DASH/SRD) would improve left ventricular diastolic function, arterial elastance, and ventricular-arterial coupling in hypertensive HFPEF. METHODS AND RESULTS: Thirteen patients with treated hypertension and compensated HFPEF consumed the DASH/SRD (target sodium, 50 mmol/2100 kcal) for 21 days. We measured baseline and post-DASH/SRD brachial and central blood pressure (via radial arterial tonometry) and cardiovascular function with echocardiographic measures (all previously invasively validated). Diastolic function was quantified via the parametrized diastolic filling formalism that yields relaxation/viscoelastic (c) and passive/stiffness (k) constants through the analysis of Doppler mitral inflow velocity (E-wave) contours. Effective arterial elastance (Ea) end-systolic elastance (Ees) and ventricular-arterial coupling (defined as the ratio Ees:Ea) were determined using previously published techniques. Wilcoxon matched-pairs signed-rank tests were used for pre-post comparisons. The DASH/SRD reduced clinic and 24-hour brachial systolic pressure (155 ± 35 to 138 ± 30 and 130 ± 16 to 123 ± 18 mm Hg; both P=0.02), and central end-systolic pressure trended lower (116 ± 18 to 111 ± 16 mm Hg; P=0.12). In conjunction, diastolic function improved (c=24.3 ± 5.3 to 22.7 ± 8.1 g/s; P=0.03; k=252 ± 115 to 170 ± 37 g/s(2); P=0.03), Ea decreased (2.0 ± 0.4 to 1.7 ± 0.4 mm Hg/mL; P=0.007), and ventricular-arterial coupling improved (Ees:Ea=1.5 ± 0.3 to 1.7 ± 0.4; P=0.04). CONCLUSIONS: In patients with hypertensive HFPEF, the sodium-restricted DASH diet was associated with favorable changes in ventricular diastolic function, arterial elastance, and ventricular-arterial coupling. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00939640.