Essential hypertension, fast heart rate, low heart rate variability, sympathetic nervous\nsystem dominance over parasympathetic, arterial stiffness, endothelial dysfunction and poor\nflow-mediated arterial dilatation are all associated with cardiovascular mortality and morbidity.\nThis review of randomised controlled trials and other studies demonstrates that caloric restriction\n(CR) is capable of significantly improving all these parameters, normalising blood pressure (BP) and\nallowing patients to discontinue antihypertensive medication, while never becoming hypotensive.\nCR appears to be effective regardless of age, gender, ethnicity, weight, body mass index (BMI) or a\ndiagnosis of metabolic syndrome or type 2 diabetes, but the greatest benefit is usually observed in\nthe sickest subjects and BP may continue to improve during the refeeding period. Exercise enhances\nthe effects of CR only in hypertensive subjects. There is as yet no consensus on the mechanism of\neffect of CR and it may be multifactorial. Several studies have suggested that improvement in BP is\nrelated to improvement in insulin sensitivity, as well as increased nitric oxide production through\nimproved endothelial function. In addition, CR is known to induce SIRT1, a nutrient sensor, which is\nlinked to a number of beneficial effects in the body.
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