Effects of Ramadan fasting on blood pressure in hypertensive patients: a systematic review

Effects of Ramadan Fasting on Blood Pressure in Hypertensive Patients: A Systematic Review Maryam Alinezhad-Namaghi1, Maryam Salehi2,3* 1. 2. 3. Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Department of Community Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Patient Safety Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran ARTICLE INFO ABSTRACT Article type: Review article Ramadan is a holy month for Muslims and fasting in this month is the rule for any healthy matured person. Nutritional and behavioral changes occurred during Ramadan fasting may lead to several physiological change, such as blood pressure Studies evaluated the effects of Ramadan fasting on blood pressure in hypertensive patients, are scarce and reported inadequate results. In this paper a systematic review was performed to accumulate the results of published literature designed to evaluate blood pressure changes in hypertensive patients due to Ramadan fasting. All prospective, English studies which evaluated the effects of Ramadan fasting on blood pressure in hypertensive patients and measured systolic and diastolic blood pressure twice at least (before Ramadan and during last week of Ramadan or after Ramadan fasting) were included in systematic review. Five studies reported the effect of Ramadan fasting on blood pressure in hypertensive patients in full text. Although significant reduction in systolic blood pressure during Ramadan fasting were seen in 3 studies, other 2 studies reported no significant difference between systolic blood pressure before and after Ramadan fasting. Among 5 studies that reviewed in this paper, 3 studies reported no significant changes in diastolic blood pressure. Two other studies reported significant reduction in systolic blood pressure after Ramadan fasting. This systematic review suggested that Ramadan fasting can be safe in treated essential hypertensive patients with continuation of previous medications. Also it can improve systolic and diastolic blood pressures. Article History: Received: 16 Jan 2016 Accepted: 5 Feb 2016 Published: 9 Feb 2016 Keywords: Blood pressure Fasting Hypertension Ramadan Systematic review Please cite this paper as: Alinezhad-Namaghi M, Salehi M. Effects of Ramadan Fasting on Blood Pressure in Hypertensive Patients: A Systematic Review. J Fasting Health. 2016; 4(1): 17-21. Introduction Ramadan is a holy month for Muslims and fasting in this month is the rule for any healthy matured person. Ramadan fasting means abstention from eating, drinking, smoking and sexual activity from dawn to sunset. Nutritional and behavioral changes occurred during Ramadan fasting may lead to several physiological change, such as blood pressure (1). high blood pressure is the first leading global risks for mortality in the world (2). High systolic blood pressure attributed to globally 51% of stroke (cerebrovascular disease) and 45% of ischemic heart disease deaths (2). One of the most important question for hypertensive patients and their physicians before Ramadan is whether fasting is safe for them or not. There are studies that evaluated the effect of Ramadan fasting on blood pressure in normotensive volunteers and explain some changes in systolic and diastolic blood pressures during Ramadan fasting and after that. Most of the studies reported not change (35) or reduced systolic (6, 7) and diastolic blood pressures (7) during Ramadan. Studies evaluated the effects of Ramadan fasting on blood pressure in hypertensive patients, are scarce and reported inadequate results. Due to high prevalence of hypertension all over the word and the number of million * Corresponding author: Maryam Salehi, Department of Community Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Email: © 2016 mums.ac.ir All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Alinezhad Namaghi M et al Muslims that they are fasting every year, it seems necessary to evaluate the results of all the studies that reported the effects of Ramadan fasting on hypertensive patients. In this paper a systematic review was performed to accumulate the results of published literature designed to evaluate the changes in blood pressure in hypertensive patients due to Ramadan fasting. Medline, Scopus and ISI databases were searched on the English articles published until September 2015. All searching procedures were performed by two independent researchers (MAN, MS) between July and October 2015. Material and methods Data sources and searches strategy Medline, Scopus and ISI databases were searched on the English articles published until September 2015. All searching procedures were performed by two independent Citations identified by search strategy (n 2764) Studies retrieved for full text evaluation (n 91) Articles reviewed in full text (n 28) Ramadan Fasting and Blood Pressure researchers (MAN, MS) between July and October 2015. Also, manual searching was done on the reference lists of the review and original articles. The combination of key words in searches of ISI database, MEDLINE and SCOPUS were ("Ramadan" OR ("Islam*" AND "fast*")) AND ("blood pres*"OR" cardiovasc*"OR " health"). The Medical Subject Headings (MeSH terms used in MEDLINE search were (effects ramadan fasting) OR (ramadan fasting cardiovascular) OR (ramadan fasting health). Study selection The study selection process is summarized in Figure 1. We read the titles and abstracts of all the searched studies and exclude clearly not relevant papers. Duplicated studies from different database were excluded and the full texts of remaining papers were evaluated about meeting the inclusion criteria. Studies excluded on basis of title and abstract (n=2673) (n 44) Studies excluded because retrieved twice from different databases (n 63) Review articles in normotensive volunteers (n 3) Original studies on effects of Ramadan fasting in normotensive volunteers (n17) Cross sectional studies that not filling inclusion criterion (n2) One study excluded because of not exists of the full text (Habbal, Azzouzi, Adnan, Tahiri, & Chraibi, 1998) Studies included in systematic review (n 5) Figure1. Flowchart showing the selection of studies included in the present systematic review of Ramadan fasting effects on blood pressure in hypertensive patients 18 J Fasting Health. 2016; 4(1):17-21. Ramadan Fasting and Blood Pressure Alinezhad Namaghi M et al Extracted data were checked by 2 authors (MAN, MS) independently. Selection criteria: P= hypertensive patients: those with usual office blood pressure of at least 140/90 mm Hg (8) I= fasting during (...truncated)