Abstract P372: The Effect of Periodic Fasting on Patients With Hypertension and Metabolic Syndrome

Abstract

Periodic fasting may serve as therapeutic strategy for the management of hypertension and metabolic syndrome. We hypothesize that fasting affects the gut microbiome and promotes immune cell homeostasis resulting in lower blood pressure. Patients suffering from metabolic syndrome and hypertension were randomized either to 7-day periodic fasting combined with lifestyle change or Dietary Approaches to Stop Hypertension (DASH) intervention. Data derived from clinical parameters, 16S sequencing of the gut microbiome and immunophenotyping were collected at baseline, at day 7 and 3 months post intervention. At baseline, 21 out 30 patients in the fasting and 23 out of 31 in the DASH group had elevated systolic office blood pressure (SBP >130 mmHg), which dropped significantly by 10 mmHg after fasting, and remained lower 3 months post intervention (7 mmHg). In the DASH group, SBP significantly decreased by 12 mmHg after 1 week and 8 mmHg after 3 months. At 3 months post intervention, 24-h ABPM confirmed the decrease in fasting, but not in DASH. Fasting, but not DASH significantly reduced body weight and BMI after 7 days compared to baseline, and this effect persisted for 3 months post-intervention. Furthermore, 50 % (15/30) of patients in fasting and 23 % (7/31) in DASH were able to decrease their use of medications for treatment of metabolic syndrome. Spearman correlation tests showed that fasting, but not DASH, altered the gut microbiome. After fasting Bacteroides , Lachnoclostridium , Coprococcus , and Ruminococcus Operational Taxonomic Units (OTUs) decreased, while the Eubacterium rectale OTU increased. In contrast to DASH, fasting significantly reduced the frequency of CD4+ Th17 cells, active CD69+ mucosa-associated invariant T cells (MAIT) and IFNg+IL-2+ or TNFa+ MAITs indicating the anti-inflammatory effect of fasting. While some of these changes reverted to baseline after 3 months, several persisted. Despite a similar decrease in office SBP in both study arms, the periodic fasting intervention is more beneficial in reducing body weight and BMI compared to baseline. Fasting altered the prevalence of certain gut microbes and influenced immune cell signatures whereas DASH did not, suggesting a distinct role of fasting for improving cardiometabolic health.