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

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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.