Diet and arterial hypertension: is the sodium ion alone important?

The impact of dietary supplements on blood pressure in older adults: A network meta-analysis of randomized controlled trials

Purpose

The prevalence of hypertension (HTN) increases with age and there is a need for effective, evidence-based treatments for HTN among older adults. The objective of this study was to perform a network meta-analysis to evaluate the effectiveness of different forms of nutritional supplementation on reducing blood pressure in older adults.

Methods

A systematic review using PubMed and Clinical Key was performed to identify randomized controlled trials (RCTs) evaluating the effects of dietary supplements on blood pressure in adults older than 65 years of age. Network meta-analysis (NMA) was used to compare and rank the effects of different supplements on systolic (sBP), diastolic (dBP), and mean (mBP) blood pressure. Supplements were ranked according to P score. Meta-regressions were conducted to examine whether treatment effects were moderated by baseline BP and supplementation duration.

Findings

We identified 144 relevant studies in the literature, twelve of which met criteria for inclusion in NMA. The included studies were published between 2003 and 2022. In reducing sBP, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), inorganic nitrates, tart cherry juice, and vitamin D supplementation were more effective than placebo, and the effect of tart cherry juice outranked that of vitamin D, vitamin E, and vitamin K2. In reducing dBP, inorganic nitrates, DHA and EPA, protein, resveratrol, and vitamin D supplementation were more effective than placebo, and the effect of resveratrol outranked that of tart cherry juice, vitamin D, vitamin E, and vitamin K2. However, the effects of tart cherry juice on sBP and resveratrol on dPB were smaller than the pooled effect of placebo, and none of the pairwise differences between the effects of examined supplements were statistically significant. Caution is needed when interpreting these results given concerns about the risk of bias assessed in seven of the twelve studies included in this analysis.

Potassium excretion and blood pressure are associated with heart rate variability in healthy black adults: The African-PREDICT study

BACKGROUND AND AIMS

Heart rate variability (HRV) is a main determinant of autonomic function and related to the development of hypertension and cardiovascular (CV) disease. Hypertension develops in black populations at an earlier age, which could be due to differences in the autonomic nervous system activity and sodium/potassium handling in black and white populations. We investigated whether HRV is associated with 24 h urinary sodium and potassium excretion and blood pressure (BP) in a young bi-ethnic cohort.

METHODS AND RESULTS

We examined 423 black and 483 white healthy adults (aged 24.5 ± 3.1 years) for 24 h HRV, including standard deviation of normal RR intervals (SDNN) reflecting autonomic variations over time, and root mean square of successive differences (RMSSD) reflecting parasympathetic activity. We measured 24 h urinary sodium and potassium concentration and BP. The black group had lower SDNN and potassium excretion as well as higher RMSSD, sodium and Na/k ratio compared to the white group (all p < 0.05). Only in black individuals, urinary potassium excretion was independently and negatively associated with SDNN (β[95% CI];-0.26[-0.50;-0.02]ms) and RMSSD (-0.14[-0.27;-0.01]ms, p < 0.05). One unit increase in sodium/potassium (Na/K) ratio was associated with higher SDNN (β[95% CI]; 3.04[0.89; 5.19]ms) and RMSSD (1.60[0.41; 2.78]ms) in the black cohort only (both p < 0.001). In both groups elevated 24 h diastolic BP was associated with lower RMSSD (p < 0.05).

CONCLUSION

Lower potassium excretion and higher Na/K ratio related independently to higher HRV in young and healthy black adults. A better ethnic-specific understanding of sodium and potassium handling is required as part of preventive cardiology, especially in black individuals.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03292094; URL: https://clinicaltrials.gov/ct2/show/NCT03292094.

Maternal macro- and micronutrient intake six months after hypertensive versus normotensive pregnancy: is poor diet quality contributing to future cardiometabolic disease risk?

BACKGROUND

Hypertensive pregnancy is associated with increased long-term cardiometabolic disease risk. Assessing dietary intake patterns after hypertensive (HP) versus normotensive pregnancy (NP) may provide insights into the mechanism of this risk.

METHODS

This study was a prospective sub-study of the P4 (Postpartum, Physiology, Psychology and Paediatrics) cohort. Women were studied six months after NP versus HP (preeclampsia or gestational hypertension). Dietary energy, macronutrient and micronutrient intake were measured using a three-day food diary (FoodWorks™) and assessed against Australian and New Zealand Nutrient Reference Values to determine nutritional adequacy. Comparisons between breastfeeding and non-breastfeeding women were assessed, and linear regression modelling (using hypertensive status, breastfeeding status, and demographic/pregnancy variables) performed to assess predictors of energy intake.

RESULTS

Seventy-four women (60 NP, 14 HP) were included. HP women had higher mean body mass index (p = 0.02) and lower breastfeeding rates (29% HP versus 83% NP, p < 0.001) compared to NP women. Twenty-four-hour energy intake and total fat intake were 17% and 20% lower after HP respectively. Nutrient deficiencies were prevalent across all participants, however more HP women had inadequate magnesium, calcium and phosphorus intake. Breastfeeding women had significantly increased energy (17%), carbohydrate (15%) and total fat intake (21%), and increased vitamin A, vitamin E, riboflavin, magnesium and iron intake compared to non-breastfeeding women. HP and breastfeeding status were independent predictors of energy intake.

CONCLUSIONS

HP women had lower micronutrient intake and greater prevalence of nutritional inadequacy compared to NP women, reflecting poorer diet quality and potentially contributing to future increased cardiometabolic disease risk.

Characterisation of the flavour profile of dry fermented sausages with different NaCl substitutes using HS-SPME-GC-MS combined with electronic nose and electronic tongue

The effects of different sodium substitutes on the physical and bacterial properties, flavour profile and sensory evaluation of dry fermented sausage were investigated. There were three different salt formulations, including control (C: 100%NaCl), S1 (70%NaCl and 30%KCl) and S2 (70%NaCl, 20%KCl and 10% flavour enhancers). Higher moisture content and lactic acid bacteria count, and lower pH and Staphylococcus count were observed in NaCl substitution treatments compared to the control (P < 0.05). Sixty-two volatiles were detected in sausages, and 26 compounds were regarded as key volatile compounds based on the odour activity values. The electronic tongue result and sensory evaluation showed that the taste profile of S2 treatment was similar to control treatment; and the electronic nose, volatile compound results and hierarchical cluster analysis showed that the sodium substitutes had a more significant effect on the odour profile. Overall, S2 may be an ideal low-sodium substitute to achieve a 30% reduction in NaCl and provide a better flavour profile of fermented sausages.

Fluorescence spectroscopy coupled with independent components analysis to monitor molecular changes during heating and cooling of Cantal-type cheeses with different NaCl and KCl contents

BACKGROUND

Reduction of NaCl content of cheeses has received considerable attention by research during the past decades because of its health effects. Nonetheless, NaCl reduction is a challenge since it plays an important role in cheese quality, such as structure, texture and functional properties. Several methods were used to evaluate the effect of NaCl on these attributes. In this study, Cantal-type cheeses with different salts (NaCl and KCl) were analyzed for their structure at a molecular level and rheological properties during heating (20-60 °C) and cooling (60-20 °C). The structure was investigated by synchronous fluorescence spectroscopy (SFS) and the rheological properties by small-amplitude oscillatory test.

RESULTS

Independent components analysis (ICA) gave three independent components that were attributed to coenzyme/Maillard reaction products (IC1), tryptophan (IC2) and vitamin A (IC3). Signal proportions of each IC depicted information regarding the changes in those fluorophores with salts, heating and cooling. In addition, canonical correlation analysis (CCA) of the IC proportions and rheological measurements related modifications at a molecular level evaluated by fluorescence to cheese texture (0.34 < R² < 0.99).

CONCLUSION

This study demonstrated that SFS can monitor and characterize modification of Cantal-type cheeses at a molecular level, based on the analysis of the fluorescence spectra by ICA. The nature of correlation between signal proportions and the rheological parameters depicted that rheological attributes of cheeses observed at the macroscopic level can be derived from fluorescence spectra. © 2017 Society of Chemical Industry.

Oral potassium supplementation for management of essential hypertension: A meta-analysis of randomized controlled trials

IMPORTANCE

Increased dietary potassium intake is thought to be associated with low blood pressure (BP). Whether potassium supplementation may be used as an antihypertensive agent is a question that should be answered.

OBJECTIVE

To assess the effect of oral potassium supplementation on blood pressure in patients with primary hypertension.

SEARCH METHODS

We searched Medline, Web of Science, Scopus, Cochrane Central Register of Controlled Trials until October 2016. We also screened reference lists of articles and previous reviews. We applied no language restrictions.

SELECTION CRITERIA

We included randomized placebo-controlled clinical trials addressing the effect of potassium supplementation on primary hypertension for a minimum of 4 weeks.

DATA COLLECTION AND ANALYSIS

We extracted data on systolic and diastolic BP (SBP and DBP) at the final follow-up. We explored the heterogeneity across studies using Cochran's test and I2 statistic and assessed the probability of publication bias using Begg's and Egger's tests. We reported the mean difference (MD) of SBP and DBP in a random-effects model.

RESULTS

We found a total of 9059 articles and included 23 trials with 1213 participants. Compared to placebo, potassium supplementation resulted in modest but significant reductions in both SBP (MD -4.25 mmHg; 95% CI: -5.96 to -2.53; I2 = 41%) and DBP (MD -2.53 mmHg; 95% CI: -4.05 to -1.02; I2 = 65%). According to the change-score analysis, based on 8 out of 23 trials, compared to baseline, the mean changes in SBP (MD -8.89 mmHg; 95% CI: -13.67 to -4.11) and DBP (MD -6.42 mmHg; 95% CI: -10.99 to -1.84) was significantly higher in the intervention group than the control group.

CONCLUSIONS

Our findings indicated that potassium supplementation is a safe medication with no important adverse effects that has a modest but significant impact BP and may be recommended as an adjuvant antihypertensive agent for patients with essential hypertension.

Effect of partial NaCl substitution with KCl on the texture profile, microstructure, and sensory properties of low-moisture mozzarella cheese

The effect of partial substitution of NaCl with KCl on texture profile, soluble Ca, K, Na, and P, and microstructure of low-moisture mozzarella cheese (LMMC) was investigated. LMMC batches were prepared using four combinations of NaCl and KCl salt viz., NaCl only, NaCl:KCl, 3:1, 1:1 and 1:3 (w/w); all used at of 46 g/kg curd and plasticised in 4% brine containing the above salt mixtures. Texture profile, microstructure, and percentages of soluble Ca, K, Na, and P were determined. There were no significant differences in hardness, cohesiveness, adhesiveness, and gumminess among the experimental LMMC batches. Environmental scanning electron microscopy images showed compact and homogeneous structure of LMMC at day 27 of storage; however, no significant difference was observed among the experimental LMMC batches. Hardness increased significantly in all experimental LMMC during storage. LMMC salted with NaCl/KCl mixtures had almost similar sensory properties compared with the control. There was no significant difference in creaminess, bitterness, saltiness, sour-acid, and vinegary taste among the experimental LMMC at the same storage period.

The impact of NaCl substitution with KCl on proteinase activities cell-free extract and cell-free supernatant at different pH levels and salt concentrations: Lactobacillus delbrueckii ssp. bulgaricus and Streptococcus thermophilus

The effect of NaCl substitution with KCl at different pH levels (6.0, 5.5, and 5.0) and salt concentrations on proteinase activities of cell-free and supernatant of Lactobacillus delbrueckii ssp. bulgaricus 11824 (L. bulgaricus) and Streptococcus thermophilus MS (ST) was investigated. MRS broths were separately mixed with 4 salt treatments (NaCl only, 1NaCl:1KCl, 1NaCl:3KCl, and KCl only) at 2 different concentrations (5% and 10%) and incubated at 37 °C for 22 h. The cell pellets were used to prepare proteinase of cell-free extract and the cell-free supernatants were used as source of extracellular proteinases. The proteolytic activities and protein contents of both fractions were determined. The supernatants after incubation of both fractions with 3 milk caseins (α-, β-, κ-casein) were subjected to angiotensin-converting-enzyme inhibitory (ACE-inhibitory) activity and proteolytic activity by ortho-phthalaldehyde (OPA) method. Significant differences were observed in ACE-inhibitory activities and proteolytic (OPA) between salt treatments of cell-free extract and cell-free supernatant of L. bulgaricus and S. thermophilus at same salt concentration and same pH level. There was a significant effect of pH level and salt treatments interaction on ACE-inhibitory activity, OPA activity and azocasein activity.

PRACTICAL APPLICATION

To reduce sodium concentration in cheese by substituting of NaCl with KCl, it was important to study the effect on starter culture proteinases which play a vital role in ripening and texture profile of cheese.

Lysine, disodium guanylate and disodium inosinate as flavor enhancers in low-sodium fermented sausages

Fermented sausages were produced with 50% replacement of NaCl with KCl and with addition of lysine, disodium guanylate, and disodium inosinate. The sausage production was monitored with physical, chemical and microbiological analyses. The final products were submitted to a consumer study. The replacement of NaCl with KCl did not cause changes in the technological process. However, defects in the sensory quality were detected. Lysine at a concentration of 1% with disodium inosinate (300 mg/kg) and disodium guanylate (300 mg/kg) reduced the sensory defects caused by the replacement of 50% NaCl with KCl allowing the preparation of sensory acceptable fermented sausages with a 50% decrease in sodium.

Application of lysine, taurine, disodium inosinate and disodium guanylate in fermented cooked sausages with 50% replacement of NaCl by KCl

The effects of 50% replacement of NaCl by KCl and addition of the amino acids lysine and taurine and the 5'-ribonucleotide disodium inosinate and disodium guanylate on some sensory and physicochemical parameters of fermented cooked sausages were evaluated. The partial replacement of NaCl by KCl did not alter the manufacturing process; however, defects in the sensory quality were detected. Lysine at a concentration of 0.313% and a mixture of taurine (750 mg/kg) with disodium inosinate (300 mg/kg) and disodium guanylate (300 mg/kg) reduced the sensory defects caused by KCl, allowing the fermented cooked sausages to be elaborated with reduced sodium content and high sensory quality.

Malnutrition in the elderly patient on dialysis

Approximately one-third of all dialysis patients have mild to moderate malnutrition, while 6-8% have severe malnutrition, which is associated with increased morbidity and mortality rates and numerous pre-existing factors directly correlated with, or existing prior to, replacement hemodialysis. However, moderate to severe malnutrition (present in 10-30% of dialysis patients) is a prevalent cause of death among the elderly. Many of these patients have a particularly unstable cardiovascular and metabolic status that, independent of any underlying uremia and/or dialysis, impacts negatively on both their quality of life and clinical status. Moreover, their condition is often further exacerbated by dialysis itself, with its acute (e.g., hypotension and sensorial alterations) and chronic complications, including an exacerbation of malnutrition and systemic vascular disease. Malnutrition can occur secondary not only to erroneous dietary choices or uremia, but it may also depend on the patient's level of tolerance to dialysis and on the dialysis modality. Despite the improvements made to dialysis techniques, the nutritional condition of elderly patients on dialysis for chronic renal failure remains a cause for concern. In this patient category, it is therefore mandatory to ensure the daily supervision of nutritional status and early control when the first signs of malnutrition appear.

Dysfunction of paracellin-1 by dephosphorylation in Dahl salt-sensitive hypertensive rats

A high-salt diet reduced the levels of renal cAMP content and serine-phosphorylated paracellin-1 in Dahl salt-sensitive hypertensive rats. In MDCK cells expressing paracellin-1, protein kinase A inhibitor reduced the serine-phosphorylated paracellin-1 and transepithelial Mg(2+) transport, suggesting that a dephosphorylation of paracellin-1 induces the reduction of Mg(2+) reabsorption in salt-sensitive hypertension.

Combined calcium, magnesium and potassium supplementation for the management of primary hypertension in adults

BACKGROUND

Previous research suggests that increasing dietary intakes of calcium, potassium or magnesium separately may reduce BP to a small degree over the short term. It is unclear whether increasing intakes of a combination of these minerals produces a larger reduction in BP.

OBJECTIVES

To evaluate the effects of combined mineral supplementation as a treatment for primary hypertension in adults.

SEARCH STRATEGY

We searched the Cochrane Library, MEDLINE, EMBASE, Science Citation Index, ISI Proceedings, ClinicalTrials.gov, Current Controlled Trials, CAB abstracts, and reference lists of systematic reviews, meta-analyses and randomised controlled trials (RCTs) included in the review. The search was unrestricted by language or publication status.

SELECTION CRITERIA

Inclusion criteria were: 1) RCTs of a parallel or crossover design comparing oral supplements comprising a combination of potassium, and/or calcium, and/or magnesium with placebo, no treatment, or usual care; 2) treatment and follow-up >=8 weeks; 3) participants over 18 years old, with raised systolic blood pressure (SBP) >=140 mmHg or diastolic blood pressure (DBP) >=85 mmHg with no known primary cause; 4) SBP and DBP reported at end of follow-up. We excluded trials where participants were pregnant, or received antihypertensive medication which changed during the study.

DATA COLLECTION AND ANALYSIS

Two reviewers independently extracted data and assessed trial quality. Disagreements were resolved by discussion or a third reviewer. Random effects meta-analyses and sensitivity analyses were conducted.

MAIN RESULTS

We included three RCTs (n=277) with between 24 and 28 weeks follow-up. Three combinations of minerals were investigated: potassium & magnesium, calcium & magnesium, and calcium & potassium. One trial investigated combinations of calcium & magnesium and of calcium & potassium, and for each found a statistically non-significant increase in both SBP and DBP. All three trials investigated the combination of potassium & magnesium. None of the trials provided data on mortality or morbidity. The combination of potassium & magnesium compared to control resulted in statistically non-significant reductions in both SBP (mean difference = -4.6 mmHg, 95% CI: -9.9 to 0.7) and DBP (mean difference = -3.8 mmHg, 95% CI: -9.5 to 1.8), although the results were heterogeneous (I(2)=68% and 85% for SBP and DBP respectively).A sensitivity analysis using alternative reported values which accounted for missing data had very little effect on DBP but resulted in a larger, statistically significant reduction in SBP (mean difference = -5.8 mmHg, 95% CI: -10.5 to -1.0). The quality of the trials was not well reported.

AUTHORS' CONCLUSIONS

We found no robust evidence that supplements of any combination of potassium, magnesium or calcium reduce mortality, morbidity or BP in adults. More trials are needed to investigate whether the combination of potassium & magnesium is effective.

Potassium supplementation for the management of primary hypertension in adults

BACKGROUND

Epidemiological evidence on the effects of potassium on blood pressure is inconsistent.

OBJECTIVES

To evaluate the effects of potassium supplementation on health outcomes and blood pressure in people with elevated blood pressure.

SEARCH STRATEGY

We searched the Cochrane Library, MEDLINE, EMBASE, Science Citation Index, ISI Proceedings, ClinicalTrials.gov, Current Controlled Trials, CAB abstracts, and reference lists of systematic reviews, meta-analyses and randomised controlled trials (RCTs) included in the review.

SELECTION CRITERIA

Inclusion criteria were: 1) RCTs of a parallel or crossover design comparing oral potassium supplements with placebo, no treatment, or usual care; 2) treatment and follow-up >=8 weeks; 3) participants over 18 years, with raised systolic blood pressure (SBP) >=140 mmHg or diastolic blood pressure (DBP) >=85 mmHg); 4) SBP and DBP reported at end of follow-up. We excluded trials where: participants were pregnant; received antihypertensive medication which changed during the study; or potassium supplementation was combined with other interventions.

DATA COLLECTION AND ANALYSIS

Two reviewers independently extracted data and assessed trial quality. Disagreements were resolved by discussion or a third reviewer. Random effects meta-analyses and sensitivity analyses were conducted.

MAIN RESULTS

Six RCT's (n=483), with eight to 16 weeks follow-up, met our inclusion criteria. Meta-analysis of five trials (n=425) with adequate data indicated that potassium supplementation compared to control resulted in a large but statistically non-significant reductions in SBP (mean difference: -11.2, 95% CI: -25.2 to 2.7) and DBP (mean difference: -5.0, 95% CI: -12.5 to 2.4). The substantial heterogeneity between trials was not explained by potassium dose, quality of trials or baseline blood pressure. Excluding one trial in an African population with very high baseline blood pressure resulted in smaller overall reductions in blood pressure (SBP mean difference: -3.9, 95% CI: -8.6 to 0.8; DBP mean difference: -1.5, 95% CI: -6.2 to 3.1). Further sensitivity analysis restricted to two high quality trials (n=138) also found non-significant reductions in blood pressure (SBP mean difference: -7.1, 95% CI: -19.9 to 5.7; DBP mean difference: -5.5, 95% CI: -14.5 to 3.5).

AUTHORS' CONCLUSIONS

This systematic review found no statistically significant effect of potassium supplementation on blood pressure. Because of the small number of participants in the two high quality trials, the short duration of follow-up, and the unexplained heterogeneity between trials, the evidence about the effect of potassium supplementation on blood pressure is not conclusive. Further high quality RCTs of longer duration are required to clarify whether potassium supplementation can reduce blood pressure and improve health outcomes.

Magnesium supplementation for the management of essential hypertension in adults

BACKGROUND

Epidemiological evidence on the effects of magnesium on blood pressure is inconsistent. Metabolic and experimental studies suggest that magnesium may have a role in the regulation of blood pressure.

OBJECTIVES

To evaluate the effects of magnesium supplementation as treatment for primary hypertension in adults.

SEARCH STRATEGY

We searched the Cochrane Library, MEDLINE, EMBASE, Science Citation Index, ISI Proceedings, ClinicalTrials.gov, Current Controlled Trials, CAB abstracts, and reference lists of systematic reviews, meta-analyses and randomised controlled trials (RCTs) included in the review.

SELECTION CRITERIA

Inclusion criteria were: 1) RCTs of a parallel or crossover design comparing oral magnesium supplementation with placebo, no treatment, or usual care; 2) treatment and follow-up >/=8 weeks; 3) participants over 18 years old, with raised systolic blood pressure (SBP) >/=140 mmHg or diastolic blood pressure (DBP) >/=85 mmHg; 4) SBP and DBP reported at end of follow-up. We excluded trials where: participants were pregnant; received antihypertensive medication which changed during the study; or magnesium supplementation was combined with other interventions.

DATA COLLECTION AND ANALYSIS

Two reviewers independently abstracted data and assessed trial quality. Disagreements were resolved by discussion or a third reviewer. Random effects meta-analyses and sensitivity analyses were conducted.

MAIN RESULTS

Twelve RCTs (n=545) with eight to 26 weeks follow-up met our inclusion criteria. The results of the individual trials were heterogeneous. Combining all trials, participants receiving magnesium supplements as compared to control did not significantly reduce SBP (mean difference: -1.3 mmHg, 95% CI: -4.0 to 1.5, I(2)=67%), but did statistically significantly reduce DBP (mean difference: -2.2 mmHg, 95% CI: -3.4 to -0.9, I(2)=47%). Sensitivity analyses excluding poor quality trials yielded similar results. Sub-group analyses and meta-regression indicated that heterogeneity between trials could not be explained by dose of magnesium, baseline blood pressure or the proportion of males among the participants.

AUTHORS' CONCLUSIONS

In view of the poor quality of included trials and the heterogeneity between trials, the evidence in favour of a causal association between magnesium supplementation and blood pressure reduction is weak and is probably due to bias. This is because poor quality studies generally tend to over-estimate the effects of treatment. Larger, longer duration and better quality double-blind placebo controlled trials are needed to assess the effect of magnesium supplementation on blood pressure and cardiovascular outcomes.