Impact of Ketogenic and Fasting Diets on Ambulatory Blood Pressure in Obesity

Overview

This randomized clinical trial sub-analysis evaluated the effects of five hypocaloric diets with varying ketogenic potential on 24-hour ambulatory blood pressure in obese individuals. Modified alternate-day fasting (mADF) showed the most significant improvements in blood pressure parameters, while other diets had lesser or no significant effects despite all improving anthropometric measures.

Background

Hypertension is a leading cause of cardiovascular morbidity and mortality worldwide, with obesity being a major contributing factor. Lifestyle modifications, including dietary interventions, are first-line strategies to reduce blood pressure and prevent hypertension. While traditional diets like DASH and Mediterranean have demonstrated benefits, emerging ketogenic and intermittent fasting diets are gaining popularity for weight loss and potential blood pressure reduction. However, comparative evidence on their effects on ambulatory blood pressure is limited.

Data Highlights

Key Findings

• All five hypocaloric diets led to statistically significant weight loss and reductions in body fat in obese participants.
• Modified alternate-day fasting (mADF) produced the greatest improvements in 24-hour ambulatory systolic blood pressure and other ABPM parameters.
• Evening time-restricted eating (lTRE) showed some beneficial effects on blood pressure, whereas early time-restricted eating (eTRE), ketogenic diet (KD), and Mediterranean diet control group did not show significant ABPM changes.
• Improvements in blood pressure were linked to reductions in body fat rather than age or sex.
• The antihypertensive effect of mADF was independent of ketone production or body composition changes.

Clinical Implications

For obese patients seeking blood pressure reduction through dietary interventions, modified alternate-day fasting may offer superior benefits compared to ketogenic or time-restricted eating diets. Clinicians should consider incorporating mADF as a viable hypocaloric strategy to improve ambulatory blood pressure alongside weight loss. Monitoring 24-hour blood pressure can provide valuable insights into the effectiveness of dietary interventions beyond office measurements.

Conclusion

Different hypocaloric diets with varying ketogenic potential can reduce blood pressure in obesity, but modified alternate-day fasting demonstrates the most pronounced improvements in ambulatory blood pressure. These findings support the use of mADF as an effective dietary approach for managing hypertension in obese individuals.

References

1. NCT04453150 -- Randomized Clinical Trial on Diet and Blood Pressure
2. European Society of Hypertension Guidelines -- Lifestyle Modifications for Hypertension
3. Fu et al. Meta-analysis -- Low-Calorie Diet Effects on Blood Pressure