Effect of Dietary Approaches to Stop Hypertension (DASH) Diet on Heart Failure Status in Older Adults

项目摘要/摘要 本申请是对PA-20-194探索性/开发性研究资助计划(家长R21 需要进行临床试验)。虽然众所周知，充足的营养可以通过以下方式提高与健康相关的生活质量 解决老年人营养不良和促进最佳功能的问题，其影响知之甚少 临床营养干预作为心力衰竭(HF)预后的一种治疗方式。以病人为中心的新理念 研究营养治疗对心力衰竭现状和进展的影响将使老年心力衰竭受益匪浅 通常经历营养不良的患者。鉴于与此相关的高昂的人力和经济成本 老年人心力衰竭并发症，营养标准的制定和临床测试代表着 亟需的、低成本和谨慎的策略可能会改善心力衰竭的结果。这项先导性研究旨在 前瞻性地测试处方、实验室准备、家庭交付的饮食方法的效果 高血压(DASH)饮食干预对心力衰竭状态临床重要指标的影响。我们将产生重要的 饮食干预对植入性心脏病患者肺动脉压的影响 心脏MEMS™血流动力学监测仪--一种新的、开创性的早期预测方法 减少急性失代偿性心力衰竭的发生率和降低心力衰竭住院率和死亡率的有效策略。我们的 目标人群是65岁以上被诊断为心力衰竭的老年人，他们在药物治疗中表现稳定。 中心假设是，短期食用DASH饮食可显著改善心力衰竭状况 在年龄较大的患者中。我们将进行随机交叉临床研究设计(n=38，50%女性)。 DASH节食4周后的结果将与4周的“自己节食”阶段进行比较 患者将根据通常的护理建议食用他们自己选择的、自己准备的饮食。我们的 具体目标是：1)确定连续4周食用DASH饮食对钠尿剂水平的影响 多肽(NP)生物标志物BNP和NT-proBNP是慢性阻塞性肺疾病患者强有力的预后标志物 2)观察DASH饮食4周对种植体植入后心衰患者PAP的影响。 心脏微机械™装置。我们预计，高频状况和项目方案将积极和及时地对 进行为期4周的2300毫克限钠饮食干预。这项研究得到了 初步数据表明，拟议干预措施的安全性、可行性和接受性 佐治亚州临床和转化科学联盟(GA CTSA)基础设施。此外，研究小组还 在心脏病学、病理生理学、营养学、公共卫生和老龄化方面有长期的经验和专业知识 在GA CTSA环境下进行相关研究，非常适合开展拟议的研究。

PROJECT SUMMARY/ABSTRACT This application is in response to PA-20-194 Exploratory/Developmental Research Grant Program (Parent R21 Clinical Trial Required). While adequate nutrition is known to promote health-related quality of life by addressing malnutrition and promoting optimal functioning among older adults, little is known about the impact of clinical nutrition intervention as a therapeutic modality on heart failure (HF) outcomes. New patient-oriented research on the effects of nutritional therapy on HF status and progression would greatly benefit older HF patients who commonly experience malnutrition. Given the high human and economic costs associated with HF complications among older adults, the development and clinical testing of nutritional standards represents a much needed, low-cost, and prudent strategy likely to improve HF outcomes. This pilot study is designed to prospectively test the effect of a prescribed, laboratory-prepared, home-delivered Dietary Approaches to Stop Hypertension (DASH) diet intervention on clinically important markers of HF status. We will generate important data of the effect of the dietary intervention on pulmonary artery pressures (PAPs) in patients with implanted CardioMEMS™ hemodynamic monitoring device, a novel and groundbreaking approach to the early prediction of acute decompensated HF and effective strategy to reduce rates of HF hospitalizations and mortality. Our target population are older adults aged 65+ years with a diagnosis of HF who are stable on pharmacotherapy. The central hypothesis is that short-term consumption of a DASH diet significantly improves HF status among older patients. We will conduct a randomized crossover clinical study design (n=38, 50% women). Outcomes after 4 weeks on the DASH diet will be compared to a 4-week “own diet” phase during which patients will consume their self-selected, self-prepared diet based on usual care recommendations. Our specific aims are: 1) to determine the effect of consuming a DASH diet for 4 weeks on levels of the natriuretic peptide (NP) biomarkers BNP and NT-ProBNP which are strong prognostic markers in patients with chronic HF; and 2) to examine the effect of consuming a DASH diet for 4 weeks on PAPs in HF patients with implanted CardioMEMS™ device. We anticipate that HF status and PAPs will respond positively and timely to the consumption of a 4-week 2,300 mg sodium-restricted DASH diet intervention. The study is supported by preliminary data demonstrating safety, feasibility, and acceptability of the proposed intervention within the Georgia Clinical and Translational Science Alliance (GA CTSA) infrastructure. In addition, the study team has long-standing experience and expertise in cardiology, pathophysiology, nutrition, public health, and aging related research within the GA CTSA environment and is well suited to carry out the proposed research.