title: Low-sodium dietary approaches to stop hypertension diet reduces blood pressure, arterial stiffness, and oxidative stress in hypertensive heart failure with preserved ejection fraction.
abstract: Recent studies suggest that oxidative stress and vascular dysfunction contribute to heart failure with preserved ejection fraction (HFPEF). In salt-sensitive HFPEF animal models, diets low in sodium and high in potassium, calcium, magnesium, and antioxidants attenuate oxidative stress and cardiovascular damage. We hypothesized that the sodium-restricted Dietary Approaches to Stop Hypertension diet (DASH/SRD) would have similar effects in human hypertensive HFPEF. Thirteen patients with treated hypertension and compensated HFPEF consumed the DASH/SRD for 21 days (all food/most beverages provided). The DASH/SRD reduced clinic systolic (155-138 mm Hg; P=0.02) and diastolic blood pressure (79-72 mm Hg; P=0.04), 24-hour ambulatory systolic (130-123 mm Hg; P=0.02) and diastolic blood pressure (67-62 mm Hg; P=0.02), and carotid-femoral pulse wave velocity (12.4-11.0 m/s; P=0.03). Urinary F2-isoprostanes decreased by 31% (209-144 pmol/mmol Cr; P=0.02) despite increased urinary aldosterone excretion. The reduction in urinary F2-isoprostanes closely correlated with the reduction in urinary sodium excretion on the DASH/SRD. In this cohort of HFPEF patients with treated hypertension, the DASH/SRD reduced systemic blood pressure, arterial stiffness, and oxidative stress. These findings are characteristic of salt-sensitive hypertension, a phenotype present in many HFPEF animal models and suggest shared pathophysiological mechanisms linking these 2 conditions. Further dietary modification studies could provide insights into the development and progression of hypertensive HFPEF.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 East Medical Center Dr, CVC Room 2383, SPC 5853, Ann Arbor, MI 48109, USA. scothumm@med.umich.edu
authors.forename: Scott L
authors.initials: SL
authors.lastname: Hummel
authors.forename: E Mitchell
authors.initials: EM
authors.lastname: Seymour
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brook
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Kolias
authors.forename: Samar S
authors.initials: SS
authors.lastname: Sheth
authors.forename: Hannah R
authors.initials: HR
authors.lastname: Rosenblum
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Wells
authors.forename: Alan B
authors.initials: AB
authors.lastname: Weder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D004039:Diet, Sodium-Restricted; D028441:F2-Isoprostanes / Q000652:urine; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000178:diet therapy* / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000178:diet therapy* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000502:physiology; D012964:Sodium / Q000652:urine; D013997:Time Factors; D016896:Treatment Outcome; D059289:Vascular Stiffness / Q000502:physiology
chemical_list: D028441:F2-Isoprostanes; D012964:Sodium