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A plant-based diet and hypertension

Journal of Geriatric Cardiology (2017) 14: 327330
©2017 JGC All rights reserved;; | Journal of Geriatric Cardiology
Perspective Open Access
A plant-based diet and hypertension
Sarah Alexander1,*, Robert J Ostfeld2, Kathleen Allen3, Kim A Williams1
1Rush University Medical Center, Division of Cardiology, Chicago, IL, USA
2Montefiore Medical Center, Division of Cardiology, Bronx, NY, USA
3New York University, Department of Nutrition & Food Studies, NY, USA
J Geriatr Cardiol 2017; 14: 327330. doi:10.11909/j.issn.1671-5411.2017.05.014
Keywords: Hypertension; Vegan; Vegetarian; Plant-based diet
Hypertension is an insidious, common, and deadly dis-
ease, often detected incidentally at a routine doctor’s visit or
workplace health screening. Worldwide, it is estimated that
one billion people have hypertension and approximately 80
million Americans 20 years of age and older are hyperten-
sive.[1] The National Health and Nutrition Data Examination
Survey found that only 54% of hypertensive adults in the
United States had their high blood pressure controlled and
17% remained undiagnosed.[1] These findings translate into
poor outcomes as the number of deaths due to hypertension
increased by 35% from 2003–2013.[1] In the Global Burden
of Disease 2010 study, hypertension was identified as the
number one risk factor worldwide for deaths and disabil-
ity-adjusted life years.[2] In the United States, clinic visits,
medications and the treatment of complications from hy-
pertension, including heart failure, stroke, and renal disease
now account for a substantial portion of the Medicare
First line therapies for all stages of hypertension include
exercise and weight loss.[4] However, results from one small
cross-sectional study suggest that a plant-based diet is the
more important intervention. This study compared the blood
pressure of sedentary vegans, endurance athletes (matched
for body mass index with the vegan group) consuming a
Western diet and running an average of 48 miles per week,
and sedentary subjects consuming a Western diet. Blood
pressure was significantly lower in the vegan group.[5] Al-
though the benefits of exercise and weight loss seem to be
inherently understood by most, the definition and perception
of a “healthy” diet is one that has not yet reached consensus.
In the late 1930 s, Dr. Walter Kempner of Duke Univer-
sity introduced the “rice diet” as therapy for renal failure
and hypothesized that “we could radically alter the patients’
diets and thereby save lives.”[6] The rice diet was high in
*Correspondence to:
complex carbohydrates, consisting mainly of rice and fruit,
and low in fat, protein (< 20 g/day) and sodium (< 150
mg/day). He first demonstrated its effectiveness in a dia-
betic, hypertensive patient with renal and congestive heart
failure: post intervention, this patient exhibited decreased
cardiac silhouette size as measured by chest X-ray, nor-
malization of a left ventricular strain pattern on ECG, and
improvement in hypertensive retinopathy. Similarly, in his
first cohort of hypertensive patients, 107 of 192 patients
demonstrated marked improvement, including decreased
blood pressure, cholesterol levels, retinopathy, and cardiac
silhouette size. Despite his findings, Kempner’s work was
not widely accepted by the scientific community, which
favored randomized control trials to substantiate these findings.
The first, major randomized control trial to evaluate diet
and hypertension was the Dietary Approaches to Stop Hy-
pertension (DASH) study of the mid-1990s. DASH, a con-
trolled feeding study, examined three different diets: (1) a
control diet, representative of a “typical” American diet, (2)
the DASH diet, high in fruits and vegetables and low in
saturated and total fat, and (3) a diet high in fruits and vege-
tables but otherwise similar to the control diet. Patients were
given standardized meals, and their weight and dietary so-
dium intake were kept stable.[7] The DASH diet reduced
both systolic and diastolic blood pressure by 5.5 mmHg and
3.0 mmHg, respectively, when compared to control. The
diet high in fruits and vegetables but otherwise similar to the
control diet also lowered blood pressure but not to the same
extent as the DASH diet. The DASH collaborative research
group stated that they could not identify the individual
components of the DASH diet that made it effective, but
other studies have shown that specific components of the
DASH diet, such as fruits, vegetables, whole grains, and
nuts were each associated with decreased blood pres-
328 Alexander S. Plant-based diet and hypertension
Journal of Geriatric Cardiology |;
The Coronary Artery Risk Development in Young Adults
(CARDIA) study prospectively followed 5115 young (aged
18 to 30 years), black and white men and women over a 15
year time period and monitored them for the development of
cardiovascular disease risk factors.[10] A CARDIA hyper-
tension sub-study of 4304 subjects revealed a dose de-
pendent inverse relationship between plant-based food con-
sumption, including fruits, whole grains, and nuts, and blood
pressure. The opposite relationship was found, however,
with meat intake. Greater red and processed meat intake
was associated with higher blood pressure. Accordingly, in
a cross-sectional analysis of 11,004 British men and women
in the European Prospective Investigation into Cancer and
Nutrition-Oxford study, among four dietary types: (1) meat
eaters, (2) fish eaters, (3) vegetarians, and (4) vegans, the
vegans had the lowest prevalence of hypertension.[17]
Similarly, Borgi, et al.,[18] found a positive association
between animal flesh consumption and hypertension risk in
an analysis of three prospective cohorts [Nurses’ Health
Study I (NHS I), Nurses’ Health Study II (NHS II), and
Health Professionals Follow-up Study (HPFS)] totaling
188,518 participants with 2,936,359 person-years of fol-
low-up. In this largest prospective study to date on animal
consumption and incident hypertension, the positive rela-
tionship between animal flesh (including red and processed
meat, poultry and seafood) and hypertension was inde-
pendent of fruit, vegetable, and whole grain consumption.
Whereas, red and processed meats were associated with
increased hypertension risk in all three cohorts, poultry and
seafood intake were correlated with higher rates in two
(NHS II, HPFS). The findings of greater animal flesh (red
meat, processed meat, and poultry) consumption and in-
creased hypertension risk are consistent with other prospec-
tive cohort studies.[1921] In the few published prospective
studies of seafood consumption and hypertension risk, greater
seafood consumption appears either positively associated
with hypertension risk or neutral.[18,20,22]
The first study to compare blood pressure among habit-
ual vegans, lacto-ovo vegetarians, and non-vegetarians was
the Adventist Health Study-2 (AHS-2) calibration sub-study,
which included a cohort of 500 mostly white subjects.[23] Of
note, non-vegetarian Seventh Day Adventists tend to consume
less meat than persons consuming a typical Western diet.[24,25]
Nevertheless, the investigators found that vegans and
lacto-ovo vegetarians had significantly lower systolic and
diastolic blood pressure, and significantly lower odds of
hypertension (0.37 and 0.57, respectively), when compared
to non-vegetarians. Furthermore, the vegan group, as com-
pared to lacto-ovo vegetarians, not only was taking fewer
antihypertensive medications but, after adjustment for body
mass index, also had lower blood pressure readings. An-
other sub-study of AHS-2 examined hypertension in a black
population and found that the combined vegetarian/vegan
group had significantly lower odds of hypertension (0.56)
compared to non-vegetarians.[26]
Other studies found similar results. In a prospective co-
hort study of 1546 non-hypertensive subjects followed for
three years, those consuming more phytochemical rich
foods (plant-based foods) had lower risk of developing hy-
pertension.[27] In a matched cohort study of 4109 non-hy-
pertensive subjects followed for a median of 1.6 years,
vegetarians had a 34% lower risk of developing hyperten-
sion than non-vegetarians.[28] In studies of 5046 and 1615
subjects encouraged to adopt a plant-based diet as part of a
health improvement program for 30 days and 7 days, re-
spectively, systolic and diastolic blood pressure fell signifi-
cantly in both.[29,30] In a study of 26 subjects with medically
treated hypertension and then placed on a vegan diet for one
year, blood pressure fell, and 20 of the 26 subjects were able
to discontinue their anti-hypertensive medications.[31] In a
cohort study of 272 non-hypertensive men followed for five
years, greater plant protein intake was associated with lower
blood pressure.[32] The totality of evidence taken from these
studies indicates that plant-based diets have a meaningful
effect on both prevention and treatment of hypertension.
There are a variety of mechanisms proposed by which
plant-based nutrition leads to decrease in blood pressure.
They include improved vasodilation,[3336] greater antioxidant
content and anti-inflammatory effects,[3744] improved insu-
lin sensitivity,[33,4548] decreased blood viscosity,[49,50] altered
baroreceptors,[33] modifications in both the renin-angioten-
sin,[36,5153] and sympathetic nervous systems,[33,54] and mo-
dification of the gut microbiota.[53]
Long-term randomized controlled trials examining the
impact of plant-based diets on various health outcomes,
including hypertension, will further inform medical guide-
line creation and refine our understanding of the relationship
between diet and disease. However, in lieu of such informa-
tion and in the context of the data within this Special Issue,
we believe that consuming a diet that is mostly or exclu-
sively plant-based appears prudent for the prevention and
treatment of hypertension.
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This article is part of a Special Issue “A plant-based diet and cardiovascular disease”.
Guest Editors: Robert J Ostfeld & Kathleen E Allen
... Traditional lifestyle changes include weight management, smoking cessation, low-sodium diets, and decreasing alcohol and caffeine consumption [6]. Plant-based diets are also associated with lower risk of HTN [64]. However, it is becoming increasingly clear that functional ingredients in foods, such as dietary fibers, phenolic acids, functional peptides, and amino acids, can impact BP through numerous mechanisms (Figure 1). ...
Full-text available
Hypertension (HTN) is a major risk factor for cardiovascular disease (CVD) and cognitive decline. Elevations in blood pressure (BP) leading to HTN can be found in young adults with increased prevalence as people age. Oats are known to decrease CVD risk via an established effect of β-glucan on the attenuation of blood cholesterol. Many past studies on CVD and oats have also reported a decrease in BP; however, a thorough assessment of oats and BP has not been conducted. Moreover, oats deliver several beneficial dietary components with putative beneficial effects on BP or endothelial function, such as β-glucan, γ-amino butyric acid (GABA), and phytochemicals such as avenanthramides. We conducted a comprehensive search for systematic reviews, meta-analyses, and clinical intervention studies on oats and BP and identified 18 randomized controlled trials (RCTs) and three meta-analyses that supported the role of oats in decreasing BP. Emerging data also suggest oat consumption may reduce the use of anti-hypertensive medications. The majority of these studies utilized whole oats or oat bran, which include a vast array of oat bioactives. Therefore, we also extensively reviewed the literature on these bioactives and their putative effect on BP-relevant mechanisms. The data suggest several oat components, such as GABA, as well as the delivery of high-quality plant protein and fermentable prebiotic fiber, may contribute to the anti-HTN effect of oats. In particular, GABA is enhanced in oat sprouts, which suggests this food may be particularly beneficial for healthy BP management.
... Hu et al. presented that greater following HEI 2015 was significantly lessened CVDs incidence (HR: 0.84; [23]. Plant-based diets are generally higher in terms of diet quality than non-plant-based diets due to their high content of fiber, antioxidants, potassium, and low saturated fat and sodium [31][32][33]. A plant-based diet prevents incident HTN with beneficial effects on blood viscosity, vasodilation and reduced insulin resistance [28,34]. ...
Full-text available
Background Since hypertension (HTN) is responsible for more than half of all deaths from cardiovascular disease, it is vital to understand the nutritional factors that reduce its risk. Little information, however, is known about it in the Kurdish population. This study was aimed to evaluate the healthy eating index (HEI) 2015 and major dietary patterns concerning incident HTN. Methods This case-cohort study was designed using Ravansar non-communicable diseases (RaNCD) cohort study data (294 participants with incident HTN and 1295 participants as representative random sub-cohort). HEI 2015 and major dietary patterns were extracted using data from their dietary intake, and three major dietary patterns were identified, including plant-based, high protein, and unhealthy dietary patterns. To analyses the association between HEI 2015 and major dietary patterns with incident HTN Cox proportional hazards regression models were applied. Results There was a significant positive correlation between HEI 2015 and plant-based diet (r = 0.492). The participants in the highest quartile of HEI-2015 had a 39% and 30% lower risk of incident HTN, compared to participants in the first quartile in both crude and adjusted model (HR: 0.61; 95% CI: 0.46–0.82) and (HR: 0.70; 95% CI: 0.51–0.97), respectively. Furthermore, participants with the highest tertile of the plant-based dietary pattern were at lower risk of incident HTN in both crude and adjusted models (HR: 0.69; 95% CI: 0.54–0.9) and (HR: 0.70; 95% CI: 0.53–0.94), respectively. However, the other two identified dietary patterns showed no significant association with incident HTN. Conclusions We found evidence indicating higher adherence to HEI 2015 and plant- based diet had protective effects on incident HTN. The HEI 2015 emphasizes limited sodium intake and adequate intake of vegetables and fruits.
... Although subject to methodological safeguard issues 171 , in the PREDIMED trial, a Mediterranean diet enriched with extra-virgin olive oil reduced the incidence of AF, and the follow-up PREDIMAR trial is currently testing a similar intervention in secondary prevention 172,173 . While research into the effect of plant-based diets in those with AF is limited, these diets reduce the risk and prevalence of hypertension [174][175][176] , diabetes 177-181 , obesity 182-185 , inflammation [186][187][188] , and obstructive sleep apnoea 189 and, in addition, prevent and reverse atherosclerosis and coronary artery disease events 190,191 . Owing to these health effects, this diet is likely to decrease AF risk by reducing the traditional AF risk factors 192,193 . ...
Atrial fibrillation (AF) is the most common cardiac arrhythmia despite substantial efforts to understand the pathophysiology of the condition and develop improved treatments. Identifying the underlying causative mechanisms of AF in individual patients is difficult and the efficacy of current therapies is suboptimal. Consequently, the incidence of AF is steadily rising and there is a pressing need for novel therapies. Research has revealed that defects in specific molecular pathways underlie AF pathogenesis, resulting in electrical conduction disorders that drive AF. The severity of this so-called electropathology correlates with the stage of AF disease progression and determines the response to AF treatment. Therefore, unravelling the molecular mechanisms underlying electropathology is expected to fuel the development of innovative personalized diagnostic tools and mechanism-based therapies. Moreover, the co-creation of AF studies with patients to implement novel diagnostic tools and therapies is a prerequisite for successful personalized AF management. Currently, various treatment modalities targeting AF-related electropathology, including lifestyle changes, pharmaceutical and nutraceutical therapy, substrate-based ablative therapy, and neuromodulation, are available to maintain sinus rhythm and might offer a novel holistic strategy to treat AF. Atrial fibrillation (AF) is the most common cardiac arrhythmia and is increasing in prevalence as populations age. This Primer provides an overview of AF epidemiology, the mechanisms underlying electropathology in AF, and the diagnostic approaches and treatments, and highlights important directions to improve understanding and management of AF in co-creation with patients.
... In further support of a DASH dietary pattern, large prospective cohort studies reinforce the beneficial impact of fruit and vegetable consumption on blood pressure, while also demonstrating an association between greater red and processed meat consumption and higher blood pressure [79][80][81][82][83]. In a recent meta-analysis of 36 randomized controlled trails and seven crossover studies, a plant based dietary pattern significantly lowered systolic and diastolic blood pressure [84]. ...
Full-text available
Despite numerous advances in all areas of cardiovascular care, cardiovascular disease (CVD) is the leading cause of death in the United States (US). There is compelling evidence that interventions to improve diet are effective in cardiovascular disease prevention. This clinical practice statement emphasizes the importance of evidence-based dietary patterns in the prevention of atherosclerotic cardiovascular disease (ASCVD), and ASCVD risk factors, including hyperlipidemia, hypertension, diabetes, and obesity. A diet consisting predominantly of fruits, vegetables, legumes, nuts, seeds, plant protein and fatty fish is optimal for the prevention of ASCVD. Consuming more of these foods, while reducing consumption of foods with saturated fat, dietary cholesterol, salt, refined grain, and ultra-processed food intake are the common components of a healthful dietary pattern. Dietary recommendations for special populations including pediatrics, older persons, and nutrition and social determinants of health for ASCVD prevention are discussed.
... Mainly due to their potentially lower environmental impact, there is increasing interest in plant proteins in relation to obesity development (Lin et al., 2015), hypertension, overall cardiovascular health (Alexander et al., 2017), cardiometabolic risk factors (Zhubi-Bakijaa et al., 2021) and overall and cause-specific mortality (Huang et al., 2020). The conclusions of Zhubi-Bakijaa et al. (2021) are of note. ...
Cardiovascular diseases (CVD) are a significant and growing burden on global health services, and it is now accepted that impairment of vascular function represents a major preliminary step in the development of CVD. There is considerable interest in identifying both causal factors of impaired vascular function, as well as related nutritional factors that may lower the risk of developing CVD, and food‐derived bioactive peptides and amino acids have emerged as one such area. Dairy foods contain two groups of proteins, whey proteins and caseins, which represent a rich source of bioactive peptides that are released during food processing and/or digestion. These peptides have a number of physiological activities including the potential to reduce blood pressure. Research, including acute and longer‐term randomised controlled trials, animal models and in vitro models has demonstrated the potential impact of dairy proteins on vascular function. The purpose of this paper is to narratively review the evidence, primarily from randomised controlled trials, examining the effects of whey proteins, their peptides and amino acids on vascular function and related issues including blood pressure. In addition, it will explore the potential underlying mechanisms responsible for these effects. It concludes that there is increasing evidence that whey proteins, and notably the bioactive peptides and amino acids released during their digestion, can have beneficial effects on aspects of vascular function and thus contribute to CVD risk reduction. It also highlights a number of beneficial effects of whey proteins including those on blood pressure, arterial stiffness, nitric oxide production and inflammation.
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Penyakit kardiovaskular merupakan penyebab utama kematian dan kecacatan di dunia, salah satunya adalah hipertensi. Hipertensi tidak selalu menimbulkan gejala, sehingga penderita tidak menyadari dan tidak mendapatkan pengobatan. Untuk mengurangi risiko hipertensi, dapat dilakukan dengan modifikasi pola hidup dengan diet sehat yaitu makan dengan kalori seimbang, perbanyak buah dan sayur, mengonsumsi produk rendah lemak jenuh, rendah kolesterol, juga rendah garam dan gula. Diet vegetarian sebagian besar, rendah ataupun tidak mengandung produk hewani, juga lebih rendah lemak total, lemak jenuh dan kolesterol dibandingkan diet non vegetarian. Studi ini berupa analitik cross-sectional yang dilakukan terhadap 68 subjek dengan tujuan untuk melihat adanya perbedaan rerata tekanan darah antara kelompok vegetarian dan non-vegetarian. Data diperoleh menggunakan Food Frequency Questionnaire (FFQ) dan Food Recall 24 hour serta pengukuran tekanan darah. Studi ini memperoleh hasil secara statistik signifikan dengan p-value 0,0001 bahwa terdapat perbedaan tekanan darah yang bermakna antara kelompok vegetarian dan non-vegetarian, dengan hasil tekanan darah pada kelompok non vegetarian lebih tinggi dibandingkan kelompok vegetarian.
The typical Western diet, high in processed and animal-based foods, is nutritionally and ethically problematic. Beyond the well-documented cruelty to animals that characterizes the practices of the factory-farming industry, current patterns of meat consumption contribute to medical and moral harm in humans on both an individual level and a public health scale. We aim to deconstruct, by highlighting their fallacies, the common positive and normative arguments that are used to defend current nutritional patterns. Animal-based foods promote the mechanisms that underlie chronic cardiometabolic disease, whereas whole-food plant-based nutrition can reverse them. Factory farming of animals also contributes to climate change, antibiotic resistance, and the spread of infectious diseases. Finally, the current allocation of nutritional resources in the United States is unjust. A societal shift toward more whole-food plant-based patterns of eating stands to provide significant health benefits and ethical advantages, and the medical profession has a duty to advocate accordingly. Although it remains important for individuals to make better food choices to promote their own health, personal responsibility is predicated on sound advice and on resource equity, including the availability of healthy options. Nutrition equity is a moral imperative and should be a top priority in the promotion of public health.
Objective Plant-based diets can delay the progression of Chronic Kidney Disease (CKD) and help manage complications and co-morbid conditions such as hypertension, acidosis, diabetes and cardiovascular disease. The objective of this study was to understand nephrology patients’ familiarity, perception and use of plant-based diets. Design & Methods: A survey was shared via the National Kidney Foundation’s social media channels. Analysis included 844 responses. Survey items were evaluated with descriptive statistics. Differences across items were determined using chi-square tests. Results Most respondents were 61-70 years of age (26.7%, n=225), female (56.5%, n=477) and achieved a Bachelor’s or advanced degree (49.9%, n=421). The majority of respondents suffered from non-dialysis dependent CKD (34%) or received a kidney transplant (34%). About half (45%) of respondents were familiar with plant-based diets and most (58%) were aware that plant-based diets can improve CKD. Twenty-two percent reported following some version of a vegetarian diet, and 29% reported “eating less meat”. Respondents were not confident (Mdn=2, IQR=2, on a scale of 1-5) in their ability to plan a balanced plant-based meal, and were moderately confident that a plant-based diet could help blood pressure (Mdn=3, IQR=2) and slow progression of CKD (Mdn=3, IGR=2). Family eating preference, meal planning skills, preference for meat, figuring out what is healthy to eat, food cost, time constraints and ease of cooking were rated as equal barriers to following a plant based diet (Mdn=3). A sample meal plan, individual counseling session with a Registered Dietitian Nutritionist (RDN), handouts and cooking classes were resources rated most helpful to transition to a plant-based diet (Mdn=4). Conclusion Approximately half of respondents were aware that plant-based diets can be beneficial for CKD. Many patients are following a vegetarian or plant-based eating pattern. More research should be done to see how effective RDNs are in educating and moving patients towards a plant-based eating pattern, as they are an underutilized resource in the CKD population.
Vegetarians are reported to have lower body weight, blood pressure (BP) and cardiovascular disease (CVD) risk compared to omnivores, yet the mechanisms remain unclear. A vegetarian diet may protect the vascular endothelium, reducing the risk of atherosclerosis and CVD. This cross-sectional study compared vascular function between omnivores (OMN) and vegetarians (VEG). We hypothesized that VEG would have greater vascular function compared to OMN. Fifty-eight normotensive young healthy adults participated (40W/18M; 28 OMN (15W/13M) and 30 VEG (25W/5M); 26±7 yr; BP: 112±11 / 67±8 mm Hg). Arterial stiffness, assessed by carotid-to-femoral pulse wave velocity (OMN: 5.6±0.8 m/s, VEG: 5.3±0.8 m/s; P=0.17) and wave reflection assessed by aortic augmentation index (OMN: 6.9±12.3%, VEG: 8.8±13.5%; P=0.57) were not different between groups. However, central pulse pressure (OMN: 32±5; VEG: 29±5 mmHg; P=0.048) and forward wave reflection were greater in omnivores (O: 26±3; V: 24±3 mmHg P=0.048). Endothelial-dependent dilation measured by brachial artery flow-mediated dilation was not different between groups (OMN: 6.0±2.9 %, VEG: 6.9±3.3 %; P=0.29). Percent change in femoral blood flow from baseline during passive leg movement, another assessment of nitric oxide-mediated endothelial dilation, was similar between groups (OMN: 203±88 mL/min, VEG: 253±192 mL/min; P=0.50). These data suggest that healthy young adults, normotensive vegetarians do not have significantly improved vascular function compared to omnivores however, they have a lower central pulse pressure and forward wave amplitude which may lower the risk of future CVD.
Introduction: Cardiovascular diseases are the leading cause of death worldwide and are associated with increased morbidity and mortality by COVID-19. Lifestyle Medicine immersion programs consist of a residential internship that performs a multidisciplinary professional follow-up. Objective: To evaluate the effect of the residential lifestyle medicine program on risk factors for cardiovascular disease: weight, blood pressure and glycemia. Methods: Longitudinal, comparative study, with intervention of a Lifestyle Medicine Program. Retrospective data from 2019-2021 of patients who had completed the intervention for 14 days were used. This consisted of a comprehensive follow-up: medical, nutritional, psychological, physical and spiritual of the patients. Results: Of the 53 patients evaluated, 26 underwent the intervention before the pandemic, who were hospitalized with the main reason for weight loss 34.62%. Of the patients who underwent the intervention within the pandemic (N=27), the main reason for hospitalization was for treatment of chronic diseases 33.33%. Glycemia: Initial M=186.64, SD=81.73; Final M=119.93, SD=35.02. Mean reduction of 66.71 mg/dl, statistically significant (t=4.3460, p=0.0008). SBP: Initial M=127.76, SD=16.36; Final M=115.21, SD=14.87. Mean reduction of 12.55 mmHg, statistically significant (t=4.7048, p=0.0001). Conclusions: The effect of the intervention was significant in the cardiovascular risk factors evaluated: weight, glycemia and systolic blood pressure. It was possible to reduce the risk factors for cardiovascular disease with intensive lifestyle changes. In times of pandemic, the relevance of lifestyle medicine intervention is emphasized.
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Background: -Dietary intake of fruit and vegetables is associated with lower incidence of hypertension, but the mechanisms involved have not been elucidated. Here we evaluated the effect of a high fibre diet and supplementation with the short-chain fatty acid (SFCA) acetate on the gut microbiota and the prevention of cardiovascular disease. Methods: -Gut microbiome, cardiorenal structure/function and blood pressure were examined in sham and mineralocorticoid-excess treated mice with a control diet, high fibre diet or acetate supplementation. We also determined the renal and cardiac transcriptome of mice treated with the different diets. Results: -We found that high consumption of fibre modified the gut microbiota populations and increased the abundance of acetate-producing bacteria, independently of mineralocorticoid-excess. Both fibre and acetate decreased gut dysbiosis, measured by the ratio of Firmicutes to Bacteroidetes, and increased the prevalence of Bacteroides acidifaciens Compared to mineralocorticoid-excess mice fed a control diet, both high fibre diet and acetate supplementation significantly reduced systolic and diastolic blood pressure, cardiac fibrosis and left ventricular hypertrophy. Acetate had similar effects and also markedly reduced renal fibrosis. Transcriptome analyses showed that the protective effects of high fibre and acetate were accompanied by the down-regulation of cardiac and renal Egr1, a master cardiovascular regulator involved in cardiac hypertrophy, cardiorenal fibrosis and inflammation. We also observed the up-regulation of a network of genes involved in circadian rhythm in both tissues, while down-regulated the renin-angiotensin system in the kidney and mitogen-activated protein kinases (MAPK) signalling in the heart. Conclusions: -A diet high in fibre led to changes in the gut microbiota which played a protective role in the development of cardiovascular disease. The favourable effects of fibre may be explained by the generation and distribution of one of the main metabolites of the gut microbiota, the SCFA acetate. Acetate effected several molecular changes associated with improved cardiovascular health and function.
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Hypertension is a major risk factor for cardiovascular disease and has a prevalence of about one billion people worldwide. It has been shown that adherence to a diet rich in fruits and vegetables helps in decreasing blood pressure (BP). This study aimed to investigate the effect of raw beet juice (RBJ) and cooked beet (CB) on BP of hypertensive subjects. In this randomized crossover study, 24 hypertensive subjects aged 25-68 years old were divided into two groups. One group took RBJ for 2 weeks and the other group took CB. After 2 weeks of treatment, both groups had a washout for 2 weeks then switched to the alternate treatment. Each participant consumed 250 ml day(-1) of RBJ or 250 g day(-1) of CB each for a period of 2 weeks. Body weight, BP, flow-mediated dilation (FMD), lipid profile and inflammatory parameters were measured at baseline and after each period. According to the results, high-sensitivity C-reactive protein (hs-CRP) and tumour necrosis factor alpha (TNF-α) were significantly lower and FMD was significantly higher after treatment with RBJ compared with CB (P<0.05). FMD was significantly (P<0.05) increased, but systolic and diastolic BP, intracellular adhesion molecule-1 (ICAM-1), vascular endothelial adhesion molecule-1 (VCAM-1), hs-CRP, interleukin-6, E-selectin and TNF-α were significantly (P<0.05) decreased with RBJ or CB. Total antioxidant capacity was increased and non-high-density lipoprotein (HDL), low-density lipoprotein (LDL) and total cholesterol (TC) were decreased with RBJ but not with CB. Although both forms of beetroot were effective in improving BP, endothelial function and systemic inflammation, the raw beetroot juice had greater antihypertensive effects. Also more improvement was observed in endothelial function and systemic inflammation with RBJ compared with CB.Journal of Human Hypertension advance online publication, 9 June 2016; doi:10.1038/jhh.2016.34.
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Unlabelled: Previous research on the effect of replacing sources of animal protein with plant protein on glycemic control has been inconsistent. We therefore conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effect of this replacement on glycemic control in individuals with diabetes. We searched MEDLINE, EMBASE, and Cochrane databases through 26 August 2015. We included RCTs ≥ 3-weeks comparing the effect of replacing animal with plant protein on HbA1c, fasting glucose (FG), and fasting insulin (FI). Two independent reviewers extracted relevant data, assessed study quality and risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q-statistic) and quantified (I²-statistic). Thirteen RCTs (n = 280) met the eligibility criteria. Diets emphasizing a replacement of animal with plant protein at a median level of ~35% of total protein per day significantly lowered HbA1c (MD = -0.15%; 95%-CI: -0.26, -0.05%), FG (MD = -0.53 mmol/L; 95%-CI: -0.92, -0.13 mmol/L) and FI (MD = -10.09 pmol/L; 95%-CI: -17.31, -2.86 pmol/L) compared with control arms. Overall, the results indicate that replacing sources of animal with plant protein leads to modest improvements in glycemic control in individuals with diabetes. Owing to uncertainties in our analyses there is a need for larger, longer, higher quality trials. Trial registration: registration number: NCT02037321.
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Optimized nutrition through supplementation of diet with plant derived phytochemicals has attracted significant attention to prevent the onset of many chronic diseases including cardiovascular impairments, cancer, and metabolic disorder. These phytonutrients alone or in combination with others are believed to impart beneficial effects and play pivotal role in metabolic abnormalities such as dyslipidemia, insulin resistance, hypertension, glucose intolerance, systemic inflammation, and oxidative stress. Epidemiological and preclinical studies demonstrated that fruits, vegetables, and beverages rich in carotenoids, isoflavones, phytoestrogens, and phytosterols delay the onset of atherosclerosis or act as a chemoprotective agent by interacting with the underlying pathomechanisms. Phytochemicals exert their beneficial effects either by reducing the circulating levels of cholesterol or by inhibiting lipid oxidation, while others exhibit anti-inflammatory and antiplatelet activities. Additionally, they reduce neointimal thickening by inhibiting proliferation of smooth muscle cells and also improve endothelium dependent vasorelaxation by modulating bioavailability of nitric-oxide and voltage-gated ion channels. However, detailed and profound knowledge on specific molecular targets of each phytochemical is very important to ensure safe use of these active compounds as a therapeutic agent. Thus, this paper reviews the active antioxidative, antiproliferative, anti-inflammatory, or antiangiogenesis role of various phytochemicals for prevention of chronic diseases.
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Although several studies have assessed the effects of nut consumption (tree nuts, peanuts, and soy nuts) on blood pressure (BP), the results are conflicting. The aim was to conduct a systematic review and meta-analysis of published randomized controlled trials (RCTs) to estimate the effect of nut consumption on BP. The databases MEDLINE, SCOPUS, ISI Web of Science, and Google Scholar were searched for RCTs carried out between 1958 and October 2013 that reported the effect of consuming single or mixed nuts (including walnuts, almonds, pistachios, cashews, hazelnuts, macadamia nuts, pecans, peanuts, and soy nuts) on systolic BP (SBP) or diastolic BP (DBP) as primary or secondary outcomes in adult populations aged ≥18 y. Relevant articles were identified by screening the abstracts and titles and the full text. Studies that evaluated the effects for <2 wk or in which the control group ingested different healthy oils were excluded. Mean ± SD changes in SBP and DBP in each treatment group were recorded for meta-analysis. Twenty-one RCTs met the inclusion criteria. Our findings suggest that nut consumption leads to a significant reduction in SBP in participants without type 2 diabetes [mean difference (MD): -1.29; 95% CI: -2.35, -0.22; P = 0.02] but not in the total population. Subgroup analyses of different nut types suggest that pistachios, but not other nuts, significantly reduce SBP (MD: -1.82; 95% CI: -2.97, -0.67; P = 0.002). Our study suggests that pistachios (MD: -0.80; 95% CI: -1.43, -0.17; P = 0.01) and mixed nuts (MD: -1.19; 95% CI: -2.35, -0.03; P = 0.04) have a significant reducing effect on DBP. We found no significant changes in DBP after the consumption of other nuts. Total nut consumption lowered SBP in participants without type 2 diabetes. Pistachios seemed to have the strongest effect on reducing SBP and DBP. Mixed nuts also reduced DBP. © 2015 American Society for Nutrition.
Objectives: A vegetarian diet may prevent elevation of blood pressures and lower the risk for hypertension through lower degrees of obesity, inflammation, and insulin resistance. This study investigated the association between a vegetarian diet and hypertension incidence in a cohort of Taiwanese adult nonsmokers and examined whether this association was mediated through inflammation, abdominal obesity, or insulin resistance (using fasting glucose as a proxy). Methods: This matched cohort study was from the 1994-2008 MJ Health Screening Database. Each vegetarian was matched with five nonvegetarians by age, sex, and study site. The analysis included 4109 nonsmokers (3423 nonvegetarians and 686 vegetarians), followed for a median of 1.61 years. The outcome includes hypertension incidence, as well as SBP and DBP levels. Regression analysis was performed to assess the association between vegetarian diet and hypertension incidence or future blood pressure levels in the presence/absence of potential mediators. Results: Vegetarians had a 34% lower risk for hypertension, adjusting for age and sex (odds ratio: 0.66, 95% confidence interval: 0.50-0.87; SBP: -3.3 mmHg, P < 0.001; DBP: -1.5 mmHg, P < 0.001). The results stay statistically significant after further adjustment for C-reactive protein, waist circumference, and fasting glucose (odds ratio: 0.72, 95% confidence interval: 0.55-0.86; SBP: -2.4 mmHg, P < 0.05; DBP: -1.1 mmHg, P < 0.05). The protective association between vegetarian diet and hypertension appeared to be consistent across age groups. Conclusion: Taiwanese vegetarians had lower incidence of hypertension than nonvegetarians. Vegetarian diets may protect against hypertension beyond lower abdominal obesity, inflammation, and insulin resistance.
Background In Western populations, a higher level of fruit consumption has been associated with a lower risk of cardiovascular disease, but little is known about such associations in China, where the consumption level is low and rates of stroke are high. Methods Between 2004 and 2008, we recruited 512,891 adults, 30 to 79 years of age, from 10 diverse localities in China. During 3.2 million person-years of follow-up, 5173 deaths from cardiovascular disease, 2551 incident major coronary events (fatal or nonfatal), 14,579 ischemic strokes, and 3523 intracerebral hemorrhages were recorded among the 451,665 participants who did not have a history of cardiovascular disease or antihypertensive treatments at baseline. Cox regression yielded adjusted hazard ratios relating fresh fruit consumption to disease rates. Results Overall, 18.0% of participants reported consuming fresh fruit daily. As compared with participants who never or rarely consumed fresh fruit (the “nonconsumption” category), those who ate fresh fruit daily had lower systolic blood pressure (by 4.0 mm Hg) and blood glucose levels (by 0.5 mmol per liter [9.0 mg per deciliter]) (P<0.001 for trend for both comparisons). The adjusted hazard ratios for daily consumption versus nonconsumption were 0.60 (95% confidence interval [CI], 0.54 to 0.67) for cardiovascular death, and 0.66 (95% CI, 0.58 to 0.75), 0.75 (95% CI, 0.72 to 0.79), and 0.64 (95% CI, 0.56 to 0.74), respectively, for incident major coronary events, ischemic stroke, and hemorrhagic stroke. There was a strong log-linear dose–response relationship between the incidence of each outcome and the amount of fresh fruit consumed. These associations were similar across the 10 study regions and in subgroups of participants defined by baseline characteristics. Conclusions Among Chinese adults, a higher level of fruit consumption was associated with lower blood pressure and blood glucose levels and, largely independent of these and other dietary and nondietary factors, with significantly lower risks of major cardiovascular diseases. (Funded by the Wellcome Trust and others.)
Prospective data are scarce on the relation of red meat, seafood, and poultry consumption with hypertension risk. Although red and processed meats are generally considered to have adverse cardiovascular consequences, seafood is believed to be protective and poultry's effect is controversial. We prospectively examined the independent association of long-term intake of animal flesh with incident hypertension in three longitudinal cohort studies of nonhypertensive individuals: Nurses' Health Study (NHS, n = 62 273 women), Nurses' Health Study II (NHS II, n = 88 831 women), and Health Professionals Follow-Up Study (HPFS, n = 37 414 men). We used multivariable Cox proportional hazards regression to study the associations of different types of animal flesh with the risk of developing hypertension while controlling for other hypertension risk factors. We then used fixed-effects meta-analysis to derive pooled estimates of effect. Compared with participants whose consumption was less than 1 serving/month, the pooled hazard ratios among those whose intake was at least 1 serving/day were 1.30 (95% confidence interval 1.23-1.39) for total meat (a combination of processed and unprocessed red meat), 1.22 (1.12-1.34) for poultry, and 1.05 (0.98-1.13) for seafood. Seafood was associated with an increased risk of hypertension in HPFS and NHS II, but not NHS. Consumption of any animal flesh at least 1 serving/day was associated with an increased hypertension risk [pooled hazard ratio = 1.30 (1.16-1.47)]. Long-term intake of meat and poultry were associated with increased risk of hypertension. In contrast to our hypothesis, we found a weak but significant trend toward an increased risk of hypertension with increasing seafood consumption.