Interactions of the DASH Diet with the Renin-Angiotensin-Aldosterone System

Stephen A Maris, Jonathan S Williams, Bei Sun, Stacey Brown, Gary F Mitchell, Paul R Conlin, Stephen A Maris, Jonathan S Williams, Bei Sun, Stacey Brown, Gary F Mitchell, Paul R Conlin

Abstract

Background: The Dietary Approaches to Stop Hypertension (DASH) diet is widely recommended to lower blood pressure, but its mechanisms of action are unclear. Lines of evidence suggest an interaction with the renin-angiotensin-aldosterone system (RAAS).

Objective: We conducted a randomized, controlled, cross-over feeding trial to test RAAS-related mechanisms underlying the DASH diet in patients with isolated systolic hypertension.

Methods: Participants entered a 1-wk run-in period on a control (CON) diet and then consumed the DASH or CON diets for 4 wk each in randomized sequence. Calorie content was controlled to maintain weight, and sodium intake was set at 3 g daily. After each diet, participants had hormonal and hemodynamic assessments obtained at baseline, in response to RAAS inhibition with captopril (CAP) 25 mg, and to graded angiotensin II (AngII) infusions (1 ng/kg and 3 ng/kg × 45 min). Primary outcomes were mean arterial pressure (MAP) and renal blood flow (RBF), and secondary outcomes were diastolic function, pulse wave velocity (PWV), plasma renin activity (PRA), and aldosterone (ALDO) responses by diet.

Results: In total, 44 (19 female) participants completed the study. DASH + CAP significantly lowered MAP compared with CON + CAP (83 ± 11 mmHg compared with 88 ± 14 mmHg, P <0.01). RBF was increased with DASH + CAP compared with CON + CAP (486 ± 149 cc/min compared with 451 ± 171 cc/min, P <0.001). Study diet did not change PWV but CAP reduced diastolic function on the DASH diet (P <0.05). DASH + CAP significantly increased PRA compared with CON + CAP (1.52 ± 1.78 ng/mL/min compared with 0.89 ± 1.17 ng/mL/min; P <0.001). ALDO sensitivity to AngII infusion was greater with DASH when compared to CON (17.4 ± 7.7 ng/mL compared with 13.8 ± 6.2 ng/dL, P <0.05) as was DASH + CAP compared with CON + CAP (15.1 ± 5.3 ng/dL compared with 13.1 ± 5.9 ng/mL, P <0.05).

Conclusions: The DASH diet interacts with the RAAS resulting in vascular and hormonal responses similar to a natriuretic effect, which appears to augment the hypotensive effect of angiotensin-converting enzyme (ACE) inhibition in individuals with isolated systolic hypertension. This trial was registered at clinicaltrials.gov as NCT00123006.

Keywords: DASH diet; blood pressure; clinical trial; intervention; lifestyle intervention; mechanism; nutrition; renin-angiotensin-aldosterone system.

Figures

FIGURE 1
FIGURE 1
Flow diagram of participants through the study.
FIGURE 2
FIGURE 2
Differences in the 4 outcome measures between Dietary Approaches to Stop Hypertension (DASH) and control (CON) diet conditions prior to captopril (CAP) administration and in response to AngII (AngII). A) AngII infusion and mean arterial pressure (MAP), B) AngII infusion and renal blood flow (RBF) C) AngII infusion and aldosterone secretion (ALDO), D) AngII infusion and plasma renin activity (PRA). Data were analyzed by repeated measures ANOVA with an interaction term, n = 44.
FIGURE 3
FIGURE 3
Differences in the 4 outcome measures between Dietary Approaches to Stop Hypertension (DASH) and control (CON) diet conditions with the addition of captopril (CAP). A) CAP and mean arterial pressure (MAP), B) CAP and renal blood flow (RBF), C) CAP and aldosterone (ALDO), D) CAP and plasma renin activity (PRA). * = P <0.05 in comparison to the CON diet. Data were analyzed by repeated measures ANOVA, n = 44.

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