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A plant-based diet and hypertension

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Journal of Geriatric Cardiology (2017) 14: 327330
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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
budget.[3]
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: sarah_alexander@rush.edu
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-
sure.[816]
328 Alexander S. Plant-based diet and hypertension
Journal of Geriatric Cardiology | jgc@jgc301.com; http://www.jgc301.com
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.
References
1 Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and
stroke statistics-2016 update: a report from the American
Heart Association. Circulation 2016; 133: e38–e360.
2 Lim SS, Vos T, Flaxman AD, et al. A comparative risk
assessment of burden of disease and injury attributable to 67
Alexander S. Plant-based diet and hypertension 329
http://www.jgc301.com; jgc@mail.sciencep.com | Journal of Geriatric Cardiology
risk factors and risk factor clusters in 21 regions, 1990–2010:
a systematic analysis for the Global Burden of Disease Study
2010. Lancet 2012; 380: 2224–2260.
3 CMS. Chronic conditions among medicare beneficiaries,
Chartbook, 2012 Edition; 2012.
4 Appel LJ. Lifestyle modification as a means to prevent and
treat high blood pressure. J Am Soc Nephrol 2003; 14 (suppl 2):
S99–S102.
5 Fontana L, Meyer TE, Klein S, Holloszy JO. Long-term
low-calorie low-protein vegan diet and endurance exercise are
associated with low cardiometabolic risk. Rejuvenation Res
2007; 10: 225–234.
6 Klemmer P, Grim CE, Luft FC. Who and what drove Walter
Kempner? The rice diet revisited. Hypertension 2014; 64:
684–688.
7 Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the
effects of dietary patterns on blood pressure. N Engl J Med
1997; 336: 1117–1124.
8 Du H, Li L, Bennett D, et al. Fresh fruit consumption and
major cardiovascular disease in China. N Engl J Med 2016;
374: 1332–1343.
9 Wang L, Manson JE, Gaziano JM, et al. Fruit and vegetable
intake and the risk of hypertension in middle-aged and older
women. Am J Hypertens 2012; 25: 180–189.
10 Steffen LM, Kroenke CH, Yu X, et al. Associations of plant
food, dairy product, and meat intakes with 15-year incidence
of elevated blood pressure in young black and white adults:
the Coronary Artery Risk Development in Young Adults
(CARDIA) Study. Am J Clin Nutr 2005; 82: 1169–1177.
11 Chan Q, Stamler J, Brown IJ, et al. Relation of raw and cooked
vegetable consumption to blood pressure: the INTERMAP
study. J Hum Hypertens 2014; 28: 353–359.
12 Alonso A, de la Fuente C, Martin-Arnau AM, et al. Fruit and
vegetable consumption is inversely associated with blood
pressure in a Mediterranean population with a high vege-
table-fat intake: the Seguimiento Universidad de Navarra
(SUN) Study. Br J Nutr 2004; 92: 311–319.
13 Tighe P, Duthie G, Vaughan N, et al. Effect of increased
consumption of whole-grain foods on blood pressure and
other cardiovascular risk markers in healthy middle-aged
persons: a randomized controlled trial. Am J Clin Nutr 2010;
92: 733–740.
14 Mohammadifard N, Salehi-Abargouei A, Salas-Salvado J, et
al. The effect of tree nut, peanut, and soy nut consumption on
blood pressure: a systematic review and meta-analysis of
randomized controlled clinical trials. Am J Clin Nutr 2015;
101: 966–982.
15 Esmaillzadeh A, Kimiagar M, Mehrabi Y, et al. Fruit and
vegetable intakes, C-reactive protein, and the metabolic syn-
drome. Am J Clin Nutr 2006; 84: 1489–1497.
16 Djoussé L, Rudich T, Gaziano JM. Nut consumption and risk
of hypertension in US male physicians. Clin Nutr 2009; 28:
10–14.
17 Appleby PN, Davey GK, Key TJ. Hypertension and blood
pressure among meat eaters, fish eaters, vegetarians and
vegans in EPIC-Oxford. Public Health Nutr 2002; 5: 645–654.
18 Borgi L, Curhan GC, Willett WC, et al. Long-term intake of
animal flesh and risk of developing hypertension in three
prospective cohort studies. J Hypertens 2015; 33: 2231–2238.
19 Wang L, Manson JE, Buring JE, Sesso HD. Meat intake and
the risk of hypertension in middle-aged and older women. J
Hypertens 2008; 26: 215–222.
20 Miura K, Greenland P, Stamler J, et al. Relation of vegetable,
fruit, and meat intake to 7-year blood pressure change in
middle-aged men: the Chicago Western Electric Study. Am J
Epidemiol 2004; 159: 572–580.
21 Lajous M, Bijon A, Fagherazzi G, et al. Processed and un-
processed red meat consumption and hypertension in women.
Am J Clin Nutr 2014; 100: 948–952.
22 Gillum RF, Mussolino ME, Madans JH. Fish consumption
and hypertension incidence in African Americans and Whites:
the NHANES I Epidemiologic Follow-up Study. J Natl Med
Assoc 2001; 93: 124–128.
23 Pettersen BJ, Anousheh R, Fan J, et al. Vegetarian diets and
blood pressure among white subjects: results from the
Adventist Health Study-2 (AHS-2). Public Health Nutr 2012;
15: 1909–1916.
24 Singh PN, Sabate J, Fraser GE. Does low meat consumption
increase life expectancy in humans? Am J Clin Nutr 2003; 78
(3 Suppl): S526–S532.
25 Le LT, Sabaté J. Beyond meatless, the health effects of vegan
diets: findings from the adventist cohorts. Nutrients 2014; 6:
2131–2147.
26 Fraser G, Katuli S, Anousheh R, et al. Vegetarian diets and
cardiovascular risk factors in black members of the adventist
health study-2. Public Health Nutr 2015; 18: 537–545.
27 Golzarand M, Bahadoran Z, Mirmiran P, et al. Dietary phy-
tochemical index is inversely associated with the occurrence
of hypertension in adults: a 3-year follow-up (the Tehran Lipid
and Glucose Study). Eur J Clin Nutr 2015; 69: 392–398.
28 Chuang SY, Chiu TH, Lee CY, et al. Vegetarian diet reduces
the risk of hypertension independent of abdominal obesity
and inflammation: a prospective study. J Hypertens 2016; 34:
2164–2171.
29 Kent L, Morton D, Rankin P, et al. The effect of a low-fat,
plant-based lifestyle intervention (CHIP) on serum HDL
levels and the implications for metabolic syndrome status: a
cohort study. Nutr Metab (Lond) 2013; 10: 58.
30 McDougall J, Thomas LE, McDougall C, et al. Effects of
7 days on an ad libitum low-fat vegan diet: the McDougall
Program cohort. Nutr J 2014; 13: 99.
31 Lindahl O, Lindwall L, Spangberg A, et al. A vegan regimen
with reduced medication in the treatment of hypertension. Br J
Nutr 1984; 52: 11–20.
32 Tielemans SM, Kromhout D, Altorf-van der Kuil W,
Geleijnse JM. Associations of plant and animal protein intake
with 5-year changes in blood pressure: the Zutphen Elderly
Study. Nutr Metab Cardiovasc Dis 2014; 24: 1228–1233.
330 Alexander S. Plant-based diet and hypertension
Journal of Geriatric Cardiology | jgc@jgc301.com; http://www.jgc301.com
33 Suter PM, Sierro C, Vetter W. Nutritional factors in the
control of blood pressure and hypertension. Nutr Clin Care
2002; 5: 9–19.
34 Vogel RA, Corretti MC, Plotnick GD. Effect of a single
high-fat meal on endothelial function in healthy subjects. Am J
Cardiol 1997; 79: 350–354.
35 Hodgson JM. Effects of tea and tea flavonoids on endothelial
function and blood pressure: a brief review. Clin Exp Phar-
macol Physiol 2006; 33: 838–841.
36 Yokoyama Y, Nishimura K, Barnard ND, et al. Vegetarian
diets and blood pressure: a meta-analysis. JAMA Intern Med
2014; 174: 577–587.
37 Baradaran A, Nasri H, Rafieian-Kopaei M. Oxidative stress
and hypertension: Possibility of hypertension therapy with
antioxidants. J Res Med Sci 2014; 19: 358–367.
38 Manning RD, Jr., Tian N, Meng S. Oxidative stress and
antioxidant treatment in hypertension and the associated renal
damage. Am J Nephrol 2005; 25: 311–317.
39 Galleano M, Pechanova O, Fraga CG. Hypertension, nitric
oxide, oxidants, and dietary plant polyphenols. Curr Pharm
Biotechnol 2010; 11: 837–848.
40 Turner-McGrievy GM, Wirth MD, Shivappa N, et al. Rando-
mization to plant-based dietary approaches leads to larger short-
term improvements in dietary inflammatory index scores and
macronutrient intake compared with diets that contain meat.
Nutr Res 2015; 35: 97–106.
41 Watzl B. Anti-inflammatory effects of plant-based foods and
of their constituents. Int J Vitam Nutr Res 2008; 78: 293–298.
42 Pauletto P, Rattazzi M. Inflammation and hypertension: the
search for a link. Nephrol Dial Transplant 2006; 21: 850–853.
43 Asgary S, Afshani MR, Sahebkar A, et al. Improvement of
hypertension, endothelial function and systemic inflammation
following short-term supplementation with red beet (Beta
vulgaris L.) juice: a randomized crossover pilot study. J Hum
Hypertens 2016; 30: 627–632.
44 Upadhyay S, Dixit M. Role of polyphenols and other phy-
tochemicals on molecular signaling. Oxid Med Cell Longev
2015; 2015: 504253.
45 Zhou MS, Wang A, Yu H. Link between insulin resistance
and hypertension: What is the evidence from evolutionary
biology? Diabetol Metab Syndr 2014; 6: 12.
46 Viguiliouk E, Stewart SE, Jayalath VH, et al. Effect of replac-
ing animal protein with plant protein on glycemic control in
diabetes: a systematic review and meta-analysis of rando-
mized controlled trials. Nutrients 2015; 7: 9804–9824.
47 Anderson JW, Ward K. High-carbohydrate, high-fiber diets
for insulin-treated men with diabetes mellitus. Am J Clin Nutr
1979; 32: 2312–2321.
48 Eddouks M, Bidi A, El Bouhali B, et al. Antidiabetic plants
improving insulin sensitivity. J Pharm Pharmacol 2014; 66:
1197–1214.
49 Ernst E, Pietsch L, Matrai A, Eisenberg J. Blood rheology in
vegetarians. Br J Nutr 1986; 56: 555–560.
50 McCarty MF. Favorable impact of a vegan diet with exercise
on hemorheology: implications for control of diabetic neuro-
pathy. Med Hypotheses 2002; 58: 476–486.
51 Chen Q, Turban S, Miller ER, Appel LJ. The effects of dietary
patterns on plasma renin activity: results from the dietary
approaches to stop hypertension trial. J Hum Hypertens 2012;
26: 664–669.
52 Dizdarevic LL, Biswas D, Uddin MD, et al. Inhibitory effects
of kiwifruit extract on human platelet aggregation and plasma
angiotensin-converting enzyme activity. Platelets 2014; 25:
567–575.
53 Marques FZ, Nelson EM, Chu PY, et al. High fibre diet and
acetate supplementation change the gut microbiota and prevent
the development of hypertension and heart failure in DOCA-
salt hypertensive mice. Circulation. Published Online First:
December 7, 2016. DOI: 10.1161/CIRCULATIONAHA.116.
024545.
54 Park SK, Tucker KL, O'Neill MS, et al. Fruit, vegetable, and
fish consumption and heart rate variability: the Veterans
Administration Normative Aging Study. Am J Clin Nutr 2009;
89: 778–786.
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). ...
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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]. ...
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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 . ...
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... 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]. ...
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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. ...
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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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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.
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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: ClinicalTrials.gov 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.
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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.
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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.)
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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.