Low-Sodium DASH Diet Improves Diastolic Function and Ventricular–Arterial Coupling in Hypertensive Heart Failure With Preserved Ejection Fraction

Abstract

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 (V-A) 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 BP (via radial arterial tonometry), and cardiovascular function with echocardiographic measures (all previously invasively validated). Diastolic function was quantified via the Parametrized Diastolic Filling formalism, which yields relaxation/viscoelastic (c) and passive/stiffness (k) constants through analysis of Doppler mitral inflow velocity (E-wave) contours. Effective arterial elastance (Ea) end-systolic elastance (Ees), and V-A coupling (defined as the ratio Ees:Ea) were determined using previously published techniques. Wilcoxon matched-pairs 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 mmHg, both p=.02) and central end-systolic pressure trended lower (116±18 to 111±16 mmHg, p=.12). In conjunction, diastolic function improved (c, 24.3±5.3 to 22.7±8.1 s−1;p=.03; k, 252±115 to 170±37 s−1;p=.03), Ea decreased (2.0±0.4 to 1.7±0.4 mmHg/ml;p=.007), and V-A coupling improved (Ees:Ea, 1.5±0.3 to 1.7±0.4;p=.04). Conclusions In hypertensive HFPEF patients, the sodium-restricted DASH diet was associated with favorable changes in ventricular diastolic function, arterial elastance, and V-A coupling.

Acute cardiac functional and mechanical responses to isometric exercise in prehypertensive males

“…Although not statistically significant, reductions in LV mass index, relative wall thickness and increased LV ejection fraction, stroke volume, and cardiac output were also reported (Hummel et al. 2013). …”

Practical approaches for the treatment of chronic heart failure: Frequently asked questions, overlooked points and controversial issues in current clinical practice

“…There are studies showing that salt restriction is necessary (5), however, there is also data showing that it has no benefit. It is suggested that a salt-free diet may cause neurohormonal activation in HF.…”

Diet Prevention and Therapy for Heart Failure?

“…The 2 articles published by Levitan et al 7 and Hummel et al, 8 revitalize core consideration of dietary management in HF. Levitan et al 7 explored the relationship of dietary patterns consumed before diagnosis with mortality among women with HF who were participants in the Women's Health Initiative (WHI).…”

“…In our search for the silver bullet, we have overlooked the silver plate. Using a different approach, Hummel et al 8 reported findings from a clinical trial conducted among 13 patients with treated hypertension and HF with preserved ejection fraction. Citing evidence in animal models that sodium restriction improves ventricular and vascular stiffness and function, these authors fed a sodium-restricted version (sodium intake of 50 mmol or 1150 mg/2100 kcal) of the DASH diet (DASH/sodium restricted diet [SRD]) with an anticipated outcome of improved left ventricular diastolic function.…”

“…Citing evidence in animal models that sodium restriction improves ventricular and vascular stiffness and function, these authors fed a sodium-restricted version (sodium intake of 50 mmol or 1150 mg/2100 kcal) of the DASH diet (DASH/sodium restricted diet [SRD]) with an anticipated outcome of improved left ventricular diastolic function. 8 After 21 days of consuming the DASH/SRD diet, prepared and served under observation by dietitians in a metabolic kitchen, participants demonstrated improved left ventricular diastolic function, reduced arterial elastance, and shifted V-A coupling to reflect more efficient transfer of blood between the heart and arteries. Both dietary and urinary measures corroborated adherence with highly correlated observed versus predicted measures of sodium reduction (−56%) and potassium increase (+28%).…”