Dataset Information

Left Ventricular Mass Reduction by a Low-Sodium Diet in Treated Hypertensive Patients.

ABSTRACT:

Objective

To evaluate the left ventricular mass (LVM) reduction induced by dietary sodium restriction.

Patients and methods

A simple sodium-restricted diet was advised in 138 treated hypertensives. They had to avoid common salt loads, such as cheese and salt-preserved meat, and were switched from regular to salt-free bread. Blood pressure (BP), 24-h urinary sodium (UNaV) and LVM were recorded at baseline, after 2 months. and after 2years.

Results

In 76 patients UNaV decreased in the recommended range after 2 months and remained low at 2 years. In 62 patients UNaV levels decreased after 2 months and then increased back to baseline at 2 years. Initially the two groups did not differ in terms of BP (134.3 ± 16.10 / 80.84 ± 12.23 vs.134.2 ± 16.67 / 81.55 ± 11.18 mmHg, mean ± SD), body weight (72.64 ± 15.17 vs.73.79 ± 12.69 kg), UNaV (161.0 ± 42.22 vs.158.2 ± 48.66 mEq/24 h), and LVM index (LVMI; 97.09 ± 20.42 vs.97.31 ± 18.91 g/m²). After 2years. they did not differ in terms of BP (125.3 ± 10.69 / 74.97 ± 7.67 vs.124.5 ± 9.95 / 75.21 ± 7.64 mmHg) and body weight (71.14 ± 14.29 vs.71.50 ± 11.87 kg). Significant differences were seen for UNaV (97.3 ± 23.01 vs.152.6 ± 49.96 mEq/24 h) and LVMI (86.38 ± 18.17 vs.103.1 ± 21.06 g/m²). Multiple regression analysis: UNaV directly and independently predicted LVMI variations, either as absolute values (R² = 0.369; ? = 0.611; p < 0.001), or changes from baseline to +2years. (R² = 0.454; ? = 0.677; p < 0.001). Systolic BP was a weaker predictor of LVMI (R² = 0.369; ? = 0.168; p = 0.027; R² = 0.454; ? = 0.012; p = 0.890), whereas diastolic BP was not correlated with LVMI. The prevalence of left ventricular hypertrophy decreased (29/76 to 15/76) in the first group while it increased in the less compliant patients (25/62 to 36/62; Chi²p = 0.002).

Conclusion

LVM seems linked to sodium consumption in patients already under proper BP control by medications.

SUBMITTER: Musso N

PROVIDER: S-EPMC7761364 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Publications

Left Ventricular Mass Reduction by a Low-Sodium Diet in Treated Hypertensive Patients.

Musso Natale N Gatto Federico F Nista Federica F Dotto Andrea A Shen Zhongyi Z Ferone Diego D

Nutrients 20201130 12

<h4>Objective</h4>To evaluate the left ventricular mass (LVM) reduction induced by dietary sodium restriction.<h4>Patients and methods</h4>A simple sodium-restricted diet was advised in 138 treated hypertensives. They had to avoid common salt loads, such as cheese and salt-preserved meat, and were switched from regular to salt-free bread. Blood pressure (BP), 24-h urinary sodium (UNaV) and LVM were recorded at baseline, after 2 months. and after 2years.<h4>Results</h4>In 76 patients UNaV decreas ...[more]

PMID: 33266329

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Project description: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.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).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.URL: http://www.clinicaltrials.gov. Unique identifier: NCT00939640.

Project description:BackgroundArterial hypertension, especially when coexisting with other cardiovascular risk factors, could determine an imbalance between myocardial energetic demand and altered efficiency, leading to an early left ventricular (LV) systolic dysfunction, even in terms of echo-derived mechano-energetic efficiency indexed for myocardial mass (MEEi). We aim to analyse an improvement in LV MEEi, if any, in a population of hypertensive patients with a long-term follow-up and to identify clinical, metabolic and therapeutic determinants of LV MEEi amelioration.Materials and methodsIn total, 7,052 hypertensive patients, followed-up for 5.3 ± 4.5 years, enrolled in the Campania Salute Network, underwent echocardiographic and clinical evaluation. LV MEEi was obtained as the ratio between stroke volume and heart rate and normalized per grams of LV mass and ΔMEEi was calculated as difference between follow-up and baseline MEEi. Patients in the highest ΔMEEi quartile (≥0.0454 mL/s/g) (group 1) were compared to the merged first, second and third quartiles (<0.0454 mL/s/g) (group 2). METS-IR (Metabolic Score for Insulin Resistance), an established index of insulin sensitivity, was also derived.ResultsPatients with MEEi improvement experienced a lower rate of major cardiovascular events (p = 0.02). After excluding patients experiencing cardiovascular events, patients in group 1 were younger (p < 0.0001), less often diabetic (p = 0.001) and obese (p = 0.035). Group 1 experienced more frequently LV mass index reduction, lower occurrence of LV ejection fraction reduction, and had a better metabolic control in terms of mean METS-IR during the follow-up (all p < 0.0001). Beta-blockers were more often used in group 1 (p < 0.0001) than group 2. A logistic regression analysis showed that younger age, lower mean METS-IR values, more frequent LV mass index reduction and therapy with beta-blockers were significantly associated with LV MEEi improvement, independently of presence of diabetes and obesity.ConclusionMetabolic control and therapy with beta-blockers could act in a synergic way, determining an improvement in LV MEEi in hypertensive patients over time, possibly confining cardiac damage and hampering progression toward heart failure.

Dataset Information

Left Ventricular Mass Reduction by a Low-Sodium Diet in Treated Hypertensive Patients.

Objective

Patients and methods

Results

Conclusion

Publications

Left Ventricular Mass Reduction by a Low-Sodium Diet in Treated Hypertensive Patients.

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