Nutrients and Nutraceuticals for the Management of High Normal Blood Pressure: An Evidence-Based Consensus Document

Effect of resveratrol and curcumin and the potential synergism on hypertension: A mini-review of human and animal model studies

Resveratrol (RES) and curcumin (CUR) are two of the most extensively studied bioactive compounds in cardiovascular research from the past until today. These compounds have effectively lowered blood pressure by downregulating the renin-angiotensin system, exerting antioxidant effects, and exhibiting antiproliferative activities on blood vessels. This study aims to summarize the results of human and animal studies investigating the effects of CUR, RES, and their combination on hypertension and the molecular mechanisms involved. The published trials' results are controversial regarding blood pressure reduction with different doses of RES and CUR, highlighting the need to address this issue.

Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension

Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools.

Effect of dietary supplementation with Diuripres® on blood pressure, vascular health, and metabolic parameters in individuals with high-normal blood pressure or stage I hypertension: The CONDOR randomized clinical study

Our aim was to evaluate if a nutritional intervention with a dietary supplement (Diuripres®) containing magnesium, standardized extract of orthosiphon, hawthorn, and hibiscus could positively affect blood pressure (BP), vascular health, and metabolic parameters in 60 individuals with high-normal BP or stage I hypertension. Participants followed a low-fat low-sodium Mediterranean diet for 4 weeks before being randomly allocated to 8-week treatment with two pills each day of either Diuripres® or placebo. Diuripres® significantly decreased systolic BP compared to placebo after 4 weeks (3.1 ± 0.8 mmHg; p < 0.05) and more consistently after 8 weeks (3.4 ± 0.9 mmHg; p < 0.05). At 8-week follow-up, after correction for multiple testing, dietary supplementation with Diuripres® was associated with significant improvements in diastolic BP (-3.1 ± 0.6 mmHg; p < 0.05), aortic BP (-4.3 ± 0.4 mmHg; p < 0.05), and high-sensitivity C-reactive protein (hs-CRP; 0.04 ± 0.01 mg/dL; p < 0.05) in comparison with baseline. The reductions in diastolic BP (--3.8 ± 0.7 mmHg; p < 0.05), aortic BP (-5.2 ± 1.0 mmHg; p < 0.05), and hs-CRP (-0.03 ± 0.01 mg/dL; p < 0.05) were also significant compared to placebo. Therefore, our study shows that dietary supplementation with Diuripres® may be useful in individuals with high-normal BP or stage I hypertension.

Dietary modification for prevention and control of high blood pressure

Hypertension (HT) remains the leading cause of cardiovascular and premature death around the world. Diet is one of the important factors that contributes to the development of HT. We review the current evidence of how different dietary factors may influence blood pressure (BP) and consequent development of HT. There is evidence that BP is positively associated with higher consumption of sodium, alcohol, animal-based protein such as red meat, low-quality carbohydrates such as sugar-sweetened beverages, and saturated fatty acids. On the contrary, other dietary constituents have BP-lowering effects. These include potassium, calcium, magnesium, yogurt, eggs, plant-based proteins such as soy and legumes, mono- and polyunsaturated fatty acids, and high-quality carbohydrates such as whole grain and fruits. Dietary fibre is unrelated to BP lowering, possibly due to the different mechanisms of various types of fibre. The effects of caffeine, hibiscus tea, pomegranate, and sesame on BP are also unclear as evidence is hard to assess due to the varying concentrations and different types of drinks used in studies. Implementing dietary changes such as the Dietary Approaches to Stop Hypertension (DASH diet) or adopting a Mediterranean diet has been shown to reduce and control BP. Although the effect of diet on BP control has been established, the optimal amount of each dietary component and consequent ability to devise a personalized diet for HT prevention and BP control for different populations still require further investigation.

Metabolic status and vascular endothelial structure in obese hypertensive patients treated with non-pharmacological therapies: A systematic review and meta-analysis

OBJECTIVE

This meta-analysis aimed to evaluate the efficacy of non-drug treatment on metabolism and vascular endothelium in obese hypertension.

METHODS

Relevant publications were searched in the PubMed, Embase, and Cochrane Library databases for clinical studies on the effects of non-pharmacological treatments in obese hypertensive patients published from inception to April 2022. After searching and screening the literature, information was extracted, and the quality of the literature was evaluated by the investigators. Data processing was performed using Rev Man 5.3 statistical analysis software, while the TSA 0.9 software was used for sequential analysis of blood pressure and endothelial-related indicators.

RESULTS

A total of 8 literature articles with 480 patients were included. The analysis showed that non-pharmacological treatment effectively reduced systolic blood pressure, diastolic blood pressure, heart rate, body weight, body mass index, glucose levels, soluble intercellular adhesion molecule 1, triglycerides, triglycerides, Low-density lipoprotein. For tumor necrosis factor α, soluble vascular cell adhesion molecule 1, high-density lipoprotein, C-reactive protein, high-sensitive C-reactive protein, and total antioxidant status by dietary supplements mainly. In contrast, no significant treatment effect was observed for Endothelin-1. Sequential analysis of the trial showed definitive evidence for improvement in blood pressure and inflammation.

CONCLUSION

Non-pharmacological treatment of obese hypertensive patients may reduce blood pressure, body weight, and blood glucose, control inflammatory factor release and improve vascular endothelium to some extent.

A Comprehensive Review on Nutraceuticals: Therapy Support and Formulation Challenges

Nutraceuticals are the nourishing components (hybrid of nutrition and pharmaceuticals) that are biologically active and possess capability for maintaining optimal health and benefits. These products play a significant role in human health care and its endurance, most importantly for the future therapeutic development. Nutraceuticals have received recognition due to their nutritional benefits along with therapeutic effects and safety profile. Nutraceuticals are globally growing in the field of services such as health care promotion, disease reduction, etc. Various drug nutraceutical interactions have also been elaborated with various examples in this review. Several patents on nutraceuticals in agricultural applications and in various diseases have been stated in the last section of review, which confirms the exponential growth of nutraceuticals' market value. Nutraceuticals have been used not only for nutrition but also as a support therapy for the prevention and treatment of various diseases, such as to reduce side effects of cancer chemotherapy and radiotherapy. Diverse novel nanoformulation approaches tend to overcome challenges involved in formulation development of nutraceuticals. Prior information on various interactions with drugs may help in preventing any deleterious effects of nutraceuticals products. Nanotechnology also leads to the generation of micronized dietary products and other nutraceutical supplements with improved health benefits. In this review article, the latest key findings (clinical studies) on nutraceuticals that show the therapeutic action of nutraceutical's bioactive molecules on various diseases have also been discussed.

The effect of nigella supplementation on blood pressure: A systematic review and dose-response meta-analysis

This study was performed to assess the effect of nigella supplementation on blood pressure levels among the adult population. A comprehensive search was carried out through PubMed, Scopus, Web of Science, and Cochrane Library by using relevant keywords to find out the randomized clinical trials evaluating the effect of nigella administration on systolic blood pressure (SBP) and diastolic blood pressure (DBP). A random-effect model was applied to achieve the overall effect size. Subgroup analysis and meta-regression were used to explore the source of heterogeneity and the effects of the possible moderators. Of the twenty-two trials that were eligible for the present study, seventeen studies consisting of 1048 participants were included in the meta-analysis. The results indicated that nigella administration could significantly reduce both SBP (-4.58 mmHg; 95%CI: -6.22, -2.94) and DBP (-3.08 mmHg; 95%CI: -4.62, -1.55). Subgroup analysis did not show any superiority between subgroups of variables. Dose-response analysis detected a nonlinear association between dose and duration of administration and change in blood pressure outcomes, highlighting that maximum SBP and DBP reduction was experienced at 2000 mg/day and 8 weeks of nigella administration, respectively. The present study suggests that nigella supplementation can be beneficial for managing blood pressure.

Single-pill fixed-dose drug combinations to reduce blood pressure: the right pill for the right patient

Arterial hypertension is one of the major causes of cardiovascular morbidity and mortality worldwide. Effective and sustained reduction in blood pressure is essential to reduce individual cardiovascular risk. In daily clinical practice, single-pill fixed-dose combinations of different drug classes are important therapeutic resources that could improve both treatment adherence and cardiovascular risk management by targeting distinct pathophysiological mechanisms. The aim of this practical narrative review is to help physicians choosing the right single-pill fixed-dose combination for the right patient in the daily clinical practice, based on the individual clinical phenotype and cardiovascular risk profile.

The Effects of Berry Polyphenols on the Gut Microbiota and Blood Pressure: A Systematic Review of Randomized Clinical Trials in Humans

Berry consumption has beneficial effects on blood pressure. Intestinal microbiota transform berry phytochemicals into more bioactive forms. Thus, we performed a systematic review of randomized clinical trials to determine whether berry polyphenols in foods, extracts or supplements have effects on both the profile of gut microbiota and systolic and diastolic blood pressure in humans. PubMed, Cochrane Library, Scopus, and CAB Abstracts (EBSCOhost) were searched for randomized clinical trials in humans published from 1 January 2011 to 29 October 2021. Search results were imported into Covidence for screening and data extraction by two blinded reviewers, who also performed bias assessment independently. The literature search identified 216 publications; after duplicates were removed, 168 publications were screened with 12 full-text publications assessed for eligibility. Ultimately three randomized clinical trials in humans met the eligibility criteria. One randomized clinical trial showed a low risk of bias while the other two randomized clinical trials included low, high or unclear risk of bias. Together the randomized clinical trials showed that berry consumption (Aronia berry, strawberries, raspberries, cloudberries and bilberries) for 8–12 weeks had no significant effect on both blood pressure and the gut microbiota. More randomized clinical trials are needed to determine the effects of berry consumption on the profile of gut microbiota and blood pressure in humans.

Hypertension and Dyslipidemia Combined Therapeutic Approaches

Treating blood pressure (BP) alone may provide only limited benefits while it is recommendable to manage the total cardiovascular risk. To date, several studies have shown that concomitant treatment of hypertension and dyslipidemia with non-pharmacological approaches and/or metabolically neutral antihypertensive drugs and statins produce a significantly greater reduction of the risk of developing cardiovascular disease. Thus, in this review article, we summarize the available evidence regarding non-pharmacological and pharmacological approaches with a favourable effect on both BP and lipids.

Reduction of High Cholesterol Levels by a Preferably Fixed-Combination Strategy as the First Step in the Treatment of Hypertensive Patients with Hypercholesterolemia and High/Very High Cardiovascular Risk: A Consensus Document by the Italian Society of Hypertension

The primary and secondary prevention strategies of atherosclerotic cardiovascular disease (ASCVD) largely rely on the management of arterial hypertension and hypercholesterolemia, two major risk factors possibly linked in pathophysiological terms by the renin-angiotensin system activation and that often coexist in the same patient synergistically increasing cardiovascular risk. The classic pharmacologic armamentarium to reduce hypercholesterolemia has been based in the last two decades on statins, ezetimibe, and bile acid sequestrants. More recently numerous novel, additive resources targeting different pathways in LDL cholesterol metabolism have emerged. They include drugs targeting the proprotein convertase subtilisin/kexin type 9 (PCSK9) (inhibitory antibodies; small-interfering RNAs), the angiopoietin-like protein 3 (inhibitory antibodies), and the ATP-citrate lyase (the inhibitory oral prodrug, bempedoic acid), with PCSK9 inhibitors and bempedoic acid already approved for clinical use. With the potential of at least halving LDL cholesterol levels faster and more effectively with the addition of ezetimibe than with high-intensity statin alone, and even more with the addition of the novel available drugs, this document endorsed by the Italian Society of Hypertension proposes a novel paradigm for the treatment of the hypertensive patient with hypercholesterolemia at high and very high ASCVD risk. Our proposal is based on the use as a first-line of a preferably fixed combination of lipid-lowering drugs, under the motto “Our goal: achieve control. No setback: combine and check”.

The Blood-Pressure-Lowering Effect of Food-Protein-Derived Peptides: A Meta-Analysis of Recent Clinical Trials

Although clinical trials of food-protein-derived peptides in the management of hypertension have been published, the results are controversial, which compelled us to conduct a meta-analysis to evaluate the pooled effect of peptide intervention. In this study, we searched for studies published between 2010 and 2021 and selected 12 eligible studies for a meta-analysis. The pooled effect of peptide intervention for systolic blood pressure (SBP) and diastolic blood pressure (DBP) was −3.28 mmHg (95% CI: −4.54, −2.03, p < 0.001) and −1.82 mmHg (95% CI: −3.46, −0.18, p = 0.03), respectively. Sub-group analyses showed that the reduction in BP in participants with higher basal BP (>140/85 mmHg) was greater (p = 0.007 for SBP and p = 0.01 for DBP), and the effect was stronger in Asian participants as compared with non-Asian participants (p = 0.01 for SBP and p = 0.04 for DBP). In addition, the effect of peptide intervention was more pronounced on SBP in participant groups with a lower ratio of male to female (≤0.5) as well as in participants with a mean age ≥50 years old. In conclusion, food-protein-derived antihypertensive peptides can significantly reduce BP in prehypertensive and hypertensive patients. Findings from this study could provide guidance for the design of clinical trials of antihypertensive peptides.

Dietary Intervention to Improve Blood Pressure Control: Beyond Salt Restriction

Lifestyle improvement is a cornerstone of cardiovascular disease prevention and has a relevant effect on blood pressure control. During the last decades the attention of the researcher has focused on low-salt diets as the lifestyle modification most effective in blood pressure reduction. Current international guidelines thus suggest to stress the importance of the implementation of the dietary approach to stop hypertension (DASH) diet and of a low-salt Mediterranean diet to achieve the best results in term of blood pressure decrease. However, salt reduction in diet could be not the only nor the main determinant of blood pressure reduction under dietary treatment. DASH and low-salt Mediterranean diet are also characterized by a high intake of vegetables (NO and polyphenol sources), whole grains, some low-fat dairy products, and low intake of red meat, sugar, and trans-hydrogenated fats. Lacto-ovo vegetarian diet are also per se associated to a significant improvement in blood pressure levels. Moreover, these diets are particularly effective when associated with a significant weight loss. Furthermore, blood pressure can also be lowered by some nutraceuticals (beetroot, magnesium, vitamin C, catechin-rich beverages, lycopene, etc). The aim of this narrative review is to critically resume the most recent evidence supporting a complete approach to dietary counseling for hypertension prevention and management.

Acute and Long Term Effects of a Nutraceutical Combination on Lipid Profile, Glucose Metabolism and Vascular Function in Patients with Dyslipidaemia with and Without Cigarette Smoking

Introduction

Lifestyle changes present a fundamental role in cardiovascular prevention. Nutraceuticals also supplementing diet could help in controlling the cardiometabolic risk.

Aim

(1) to evaluate acute effects of a combination of nutraceuticals (cNUT) on vascular function, BP, metabolism in dyslipidaemic patients before and after smoking; (2) to evaluate 12 weeks effects of the cNUT on lipid profile, insulin resistance and vascular function in patients with hypercholesterolemia not on statins.

Methods

After 14 d run-in period, 33 patients assumed a cNUT [patented formula containing: berberine (531.25 mg), red yeast rice powder (220 mg, 3.3 mg monacolin K) and leaf extract of Morus alba (200 mg) (LopiGLIK^®, Akademy Pharma)]. To evaluate acute effects, cNUT or cNUT + smoking (in smoking subjects) on the morning of the first day of the study and then 26 patients prolonged 12 weeks effects.

Results

In non smokers, cNUT improved FMD (p = 0.041 for treatment). In smokers, FMD decreased after smoking, this was counteracted by intake of cNUT. In smokers, DBP increased after smoking a cigarette (p = 0.042 for treatment), counteracted by the cNUT intake. In non smokers, thermogenesis was increased after cNUT administration (p < 0.0001 for treatment). After 12 weeks of cNUT, FMD significantly increased (p < 0.05) and SBP (p = 0.04), total cholesterol and LDL cholesterol (p = 0.03) decreased.

Conclusions

Our study suggests benefits of cNUT on cardiovascular prevention in hypercolesterolemic patients, non statin treated, that goes beyond the cholesterol and insulin resistance reduction protecting the subject from negative effects induced by smoking too.

Nutraceuticals and blood pressure control: a European Society of Hypertension position document

: High-normal blood pressure (BP) is associated with an increased risk of cardiovascular disease, however the cost-benefit ratio of the use of antihypertensive treatment in these patients is not yet clear. Some dietary components and natural products seems to be able to significantly lower BP without significant side effects. The aim of this position document is to highlight which of these products have the most clinically significant antihypertensive action and wheter they could be suggested to patients with high-normal BP. Among foods, beetroot juice has the most covincing evidence of antihypertensive effect. Antioxidant-rich beverages (teas, coffee) could be considered. Among nutrients, magnesium, potassium and vitamin C supplements could improve BP. Among nonnutrient-nutraceuticals, soy isoflavones could be suggested in perimenopausal women, resveratrol in insulin-resistant patients, melatonin in study participants with night hypertension. In any case, the nutracutical approach has never to substitute the drug treatment, when needed.

Impact of functional foods and nutraceuticals on high blood pressure with a special focus on meta-analysis: review from a public health perspective

In recent times many researchers are expressing immense interest in nutraceuticals and functional foods for combating various diseases or abnormal conditions, especially against hypertension (HT). Persistent HT is medically referred to as chronic high blood pressure (BP) and considered to be one of the major risk factors for the deadliest diseases including cardiovascular disease (CVD) and cerebrovascular diseases. Hence HT poses a serious socio-economic burden worldwide, particularly to developing countries. The current treatment strategy for HT includes standard anti-hypertensive drugs, which are associated with many adverse effects and lower drug adherence rates. Therefore, an alternative or complementary natural therapy (functional foods or nutraceuticals or dietary supplements) would be the alternate choice along with a modified lifestyle pattern that might help to manage or combat HT and its related complications. During this review, the author would like to shed light on the basic science behind HT including pathophysiology and the impact of dietary salt on HT and the impact of various functional foods or nutraceuticals against HT in humans (meta-analysis and systemic review). This contribution gives a better idea (public health perspective) for choosing the best functional foods/nutraceuticals for the prevention, management or delaying the onset of HT and its associated conditions along with modified lifestyle patterns and standard anti-hypertensive drugs.

Impact of Micronutrients on Hypertension: Evidence from Clinical Trials with a Special Focus on Meta-Analysis

Hypertension (HT) is one of the pivotal risk factors for various detrimental diseases like cardiovascular diseases (CVDs), cerebrovascular disease, and renal dysfunction. Currently, many researchers are paying immense attention to various diet formula (dietary approach) with a special focus on micro and macronutrients along with modified lifestyle and standard anti-hypertensive drugs. Micronutrients (minerals/vitamins) play a central role in the regulation of blood pressure (BP) as they aid the function of macronutrients and also improve the anti-hypertensive functions of some anti-hypertensive agents. Even though several studies have demonstrated the beneficial effects of micronutrients on controlling BP, still some ambiguity exists among the nutritionists/doctors, which combination or individual mineral (dietary approach) contributes to better BP regulation. Therefore, this critical review article was attempted to delineate the underlying role of micronutrients (minerals and vitamins) for the management and prevention or delaying of HT and their related complications with strong affirmation from clinical trials as well as its mechanism of controlling BP. Moreover, the major source and recommended daily allowance (RDA) of various micronutrients are included in this review for guiding common readers (especially HT subjects) and dieticians to choose/recommend a better micronutrient and their combinations (other nutrients and standard anti-hypertensive drugs) for lowering the risk of HT and its related co-morbid conditions like CVDs.

Grapefruit juice enhances the systolic blood pressure-lowering effects of dietary nitrate-containing beetroot juice

AIMS

Dietary nitrate from sources such as beetroot juice lowers blood pressure (BP) via the nitrate-nitrite-nitric oxide (NO) pathway. However, NO and nitrite are inactivated via reoxidation to nitrate, potentially limiting their activity. Cytochrome P450-3A4 inhibition with troleandomycin prevents nitrite re-oxidation to nitrate in rodent liver. Grapefruit juice contains the CYP3A4 inhibitor furanocoumarin. We therefore hypothesized that grapefruit juice would enhance BP-lowering with beetroot juice by maintaining circulating [nitrite].

METHODS

We performed a randomized, placebo-controlled, 7-hour crossover study in 11 healthy volunteers, attending on 3 occasions, receiving: a 70-mL shot of active beetroot juice (Beet-It) and either (i) 250 mL grapefruit juice (Active Beet+GFJ), or (ii) 250 mL water (Buxton, Active Beet+H2 O); or (iii) Placebo Beet+GFJ.

RESULTS

The addition of grapefruit juice to active beetroot juice lowered systolic BP (SBP): Active Beet+GFJ vs Active Beet+H2 O (P = .02), and pulse pressure, PP (P = .0003). Peak mean differences in SBP and PP were seen at T = 5 hours: -3.3 mmHg (95% confidence interval [CI] -6.43 to -0.15) and at T = 2.5 hours: -4.2 mmHg (95% CI -0.3 to -8.2), respectively. Contrary to the hypothesis, plasma [nitrite] was lower with Active Beet+GFJ vs Active Beet+H2 O (P = .006), as was salivary nitrite production (P = .002) and saliva volume (-0.34 mL/min [95% CI -0.05 to -0.68]). The taste score of Beet+GFJ was 1.4/10 points higher than Beet+H2 O (P = .03).

CONCLUSION

Grapefruit juice enhanced beetroot juice's effect on lowering SBP and PP despite decreasing plasma [nitrite]. Besides suggesting more complex mechanisms, there is potential for maximising the clinical benefit of dietary nitrate and targeting isolated systolic hypertension.

Effect of proanthocyanidins on blood pressure: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Hypertension is a common chronic disease that can lead to serious health problems. Previous studies have not drawn a consistent conclusion about the effect of proanthocyanidins (PCs) on blood pressure (BP). This systematic review and meta-analysis aims to evaluate the effect of PCs supplementation on blood pressure (BP).

METHODS

A comprehensive literature search was performed in 6 databases (Pubmed, Scopus, ISI Web of Science, the Cochrane Library, Embase and Google Scholar) to identify the randomized controlled trials (RCTs) that evaluated the BP-lowering effect of PCs. Subgroup and sensitivity analyses were conducted to evaluate the potential heterogeneity. Meta-regression analysis was used to evaluate dose effects of PCs on BP.

RESULTS

A total of 6 studies comprising 376 subjects were included in our meta-analysis to estimate the pooled effect size. This meta-analysis suggested that PCs supplementation could significantly reduce systolic blood pressure (SBP) (WMD: -4.598 mmHg; 95 % CI: -8.037, -1.159; I² = 33.7 %; p = 0.009), diastolic blood pressure (DBP) (WMD: -2.750 mmHg; 95 % CI: -5.087, -0.412; I² = 0.0 %; p = 0.021) and mean arterial pressure (MAP) (WMD: -3.366 mmHg; 95 % CI: -6.719, -0.041 mmHg; I² = 0.0 %; p = 0.049), but had no significant effect on pulse pressure (PP) (WMD: -2.131 mmHg; 95 % CI: -6.292, 2.030; I² = 0.0 %; p = 0.315). When the studies were stratified according to the duration of the study, there was a significant reduction on SBP in the subset of the trials with <12 weeks of duration. On the contrary, there was a significant reduction on DBP in the subset of the trials with ≥12 weeks of duration. The Subgroup analysis by BMI indicated that a significant reduction on SBP for people with a higher BMI (BMI ≥ 25) and a significant reduction on DBP for people with a lower BMI (BMI < 25). Additional subgroup analysis revealed low-dose-PCs (<245 mg/day) could significantly reduce SBP, DBP and MAP. The meta-regression analyses did not indicate the dose effects of PCs on SBP, DBP, PP and MAP.

CONCLUSION

Based on the current findings, PCs supplementation may be a useful treatment of hypertensive patients as well as a preventive measure in the prehypertensive and healthy subjects. However, further investigation is needed to confirm these results.

Nutraceuticals in Chronic Coronary Syndromes: Preclinical Data and Translational Experiences

Non-pharmacological treatments have always been considered important in the management of Chronic Coronary Syndromes. Nutraceuticals ("Nutrition" + "Pharmaceutical") could fall both under the definition of non-pharmacological treatment and pharmacological one or, probably more correctly, in the middle of these two kinds of therapies. However, the word "nutraceuticals" never appears in the latest guidelines on this issue. This is probably determined by the fact that evidences on this topic are scarce and most of the published articles are based on preclinical data while translational experiences are available only for some molecules. In this review we will focus on nutraceutical strategies that act on the ischemic myocardium itself and not only on the cardiovascular risk factors. As demonstrated by the important number of papers published in recent years, this is an evolving topic and evaluated substances principally act on two mechanisms (cardiac energetics and ischemia-reperfusion damage) that will be also reviewed.

Non-pharmacological Strategies Against Systemic Inflammation: Molecular Basis and Clinical Evidence

Systemic inflammation is a common denominator to a variety of cardiovascular (CV) and non-CV diseases and relative risk factors, including hypertension and its control, metabolic diseases, rheumatic disorders, and those affecting the gastrointestinal tract. Besides medications, a non-pharmacological approach encompassing lifestyle changes and other complementary measures is mentioned in several updated guidelines on the management of these conditions. We performed an updated narrative review on the mechanisms behind the systemic impact of inflammation and the role of non-pharmacological, complementary measures centered on lowering systemic phlogosis for preserving or restoring a good global health. The central role of genetics in shaping the immune response is discussed in conjunction with that of the microbiome, highlighting the interdependence and mutual influences between the human genome and microbial integrity, diversity, and functions. Several plausible strategies to modulate inflammation and restore balanced crosstalk between the human genome and the microbiome are then recapitulated, including dietary measures, active lifestyle, and other potential approaches to manipulate the resident microbial community. To date, evidence from high-quality human studies is sparse to allow the unconditioned inclusion of understudied, though plausible solutions against inflammation into public health strategies for global wellness. This gap claims further focused, well-designed research targeted at unravelling the mechanisms behind future personalized medicine.

Blood Pressure Target Achievement Under Monotheraphy: A Real-Life Appraisal

INTRODUCTION

Despite hypertension guidelines suggest that the most effective treatment strategy to improve blood pressure (BP) target achievement is to implement the use of combination treatment, monotherapy is still widely used in the clinical practice of hypertension.

AIM

To investigate BP control under monotherapy in the setting of real-life.

METHODS

We extracted data from a medical database of adult outpatients who were referred to the Hypertension Unit, Sant'Andrea Hospital, Rome (IT), including anthropometric data, CV risk factors and comorbidities, presence or absence of antihypertensive therapy and concomitant medications. Among treated hypertensive patients, we identified only those under single antihypertensive agent (monotherapy). Office BP treatment targets were defined according to 2018 ESC/ESH guidelines as: (a) < 130/80 mmHg in individuals aged 18-65 years; (b) < 140/80 mmHg in those aged > 65 years.

RESULTS

From an overall sample of 7797 records we selected 1578 (20.2%) hypertensive outpatients (47.3% female, age 59.5 ± 13.6 years, BMI 26.6 ± 4.4 kg/m²) treated with monotherapies, among whom 30.5% received ACE inhibitors, 37.7% ARBs, 15.8% beta-blockers, 10.6% CCBs, 3.0% diuretics, and 2.0% alpha-blockers. 36.6% of these patients reached the conventional clinic BP goal of < 140/90 mmHg, whilst the 2018 European guidelines BP treatment targets were fulfilled only in 14.0%. In particular, 10.2% patients aged 18-65 years and 20.4% of those aged > 65 years achieved the recommended BP goals. All these proportions results significantly lower than those achieved with dual (18.2%) or triple (22.2%) combination therapy, though higher than those obtained with life-style changes (10.8%). Proportions of patients on monotherapies with normal home and 24-h BP levels were 22.0% and 30.2%, respectively, though only 5.2% and 7.3% of these patients achieved sustained BP control, respectively. Ageing and dyslipidaemia showed significant and independent positive predictive value for the achievement of the recommended BP treatment targets, whereas European SCORE resulted a negative and independent predictor in outpatients treated with monotherapies.

CONCLUSIONS

Our data showed a persistent use of monotherapy in the clinical practice, though with unsatisfactory BP control, especially in light of the BP treatment targets suggested by the last hypertension guidelines.

Usefulness of resveratrol supplementation in decreasing cardiometabolic risk factors comparing subjects with metabolic syndrome and healthy subjects with or without obesity: meta-analysis using multinational, randomised, controlled trials

Introduction

Resveratrol (RES), a natural polyphenolic compound, has been linked to some beneficial effects against cardiovascular disease (CVD).

Material and methods

We conducted a systematic search to conduct a meta-analysis on cardiometabolic risk factors modulated by RES targeting patients with metabolic syndrome (Met-S) and Obese/Healthy (O/H) subjects. The PICO (Patient, Intervention, Comparison, Outcome) research question was: Does RES among patients with Met-S and O/H subjects reduce the cardiometabolic risk? The first group was affected with MetS, which is defined as a clustering of abdominal obesity, dyslipidaemia, hyperglycaemia, and hypertension in a single individual. The second group was composed of 'obese/healthy' individuals, i.e. healthy subjects with or without obesity. We performed a literature search of MEDLINE/ PubMed, Scopus, and Google Scholar for randomised, controlled trials (RCT) that estimated the effects of RES on cardiometabolic risk factors.

Results

We found 780 articles, of which 63 original articles and reviews were identified. Data from 17 well-conducted RCT studies, comprising 651 subjects, were extracted for analysis. Overall, RES had a significant influence on Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), resulting in a mean difference of -0.520665 (95% CI: -1.12791; -0.01439; p = 0.00113). In Met-S, RES significantly reduced glucose, low-density lipoprotein-cholesterol (LDL-C), and total cholesterol (T-Chol) as detected by the mean difference of -1.069 (95% CI: -2.107, -0.032; p = 0.043), -0.924 (95% CI: -1.804, -0.043; p = 0.040), and -1.246 (95% CI: -2.314, -0.178; p = 0.022), respectively.

Conclusions

Despite some heterogeneity in the populations, RES supplementation seems to improve cardiometabolic health, decreasing some risk factors (HOMA-IR, LDL-C, and T-Chol) associated with CVD.

The effects of regular consumption of green or black tea beverage on blood pressure in those with elevated blood pressure or hypertension: A systematic review and meta-analysis

OBJECTIVE

As a popular beverage, there has been much interest in studying the effects of tea intake on hypertension (HTN), a particular risk factor for cardiovascular disorders (CVDs). We have thus aimed to isolate the randomized controlled trials investigating the efficacy of black or green tea as a beverage in subjects with elevated blood pressure (BP), or HTN.

METHODS

PubMed, Scopus, Web of Science, and ProQuest dissertations and theses databases were searched from February 1, 1995, up to July 20, 2019, to identify relevant studies.

RESULTS

The search strategy generated 1119 trials, of which finally five trials fulfilled the criteria for being included in the current study. Three out of 5 articles showed a low risk of bias. According to nine measurements derived from 5 trials on 408 individuals, it was found that regular tea intake resulted in the reduction in SBP (weighted mean difference (WMD): -4.81 mmHg, 95 %CI: -8.40 to -1.58, P = .004) and DBP (WMD:-1.98 mmHg, 95 %CI: -3.77 to -0.20, P = .029); however, excluding the most heterogeneous trials showed that regular tea intake might reduce SBP and DBP by about -3.53 and -0.99 mmHg, respectively. Based on meta-regression findings, we found the longer the duration of tea intake (≥3months), the higher the decrease in both SBP and DBP. Categorized studies, according to the tea type, revealed that the hypotensive effects of green tea were more pronounced compared to black tea. None of the studies reported any side effects.

CONCLUSION

These results suggest the positive effects of regular tea intake on BP in subjects with elevated BP or HTN. Hence, it may be applicable to physicians, health care providers, and particularly HTN patients.

Effect of Lactobacillusplantarum containing probiotics on blood pressure: A systematic review and meta-analysis

Previous studies have recommended that probiotics may have blood pressure (BP)-lowering effects. However, they examined all probiotic strains (multi/single probiotics) simultaneously. In respect to strain specificity properties of probiotic, the aim of the present study was to systematically investigate the role of Lactobacillus plantarum as an anti-hypertensive agent by performing a meta-analysis of randomized controlled trials. PubMed, Scopus, Cochrane Library and Google Scholar were used from inception until October 2018 to identify eligible trials. We used random-effects model as the preferable method to assess the combined treatment effect. We further conducted sensitivity analysis and stratified analysis. Seven studies with 653 participants were included in the meta-analysis. The pooled weighted mean difference (WMD) with the random effects model showed a significant effects of Lactobacillus plantarum supplementation on improvement of SBP with no statistically significant heterogeneity (WMD: -1.58 mmHg, 95 % CI: -3.05 to 0.11) (heterogeneity P = 0.14; I² = 36 %). The overall effect in the DBP showed significant pooled estimates (WMD: -0.92 mmHg, 95 % CI: -1.49 to -0.35) with a complete homogeneity between the studies (heterogeneity P = 0.46; I² = 0 %). The findings of the present meta-analysis study support the use of Lactobacillus plantarum supplementation for lowering systolic and diastolic blood pressure. The clinical significance of blood pressure-lowering effect of Lactobacillus Plantarum supplementation is not considerable; however, given the overarching benefits evident and concurrent lack of specific side effects, further trials are warranted to clarify the effects of Lactobacillus Plantarum probiotics particularly for hypertensive patients.

Whey Protein Hydrolysate and Pumpkin Pectin as Nutraceutical and Prebiotic Components in a Functional Mousse with Antihypertensive and Bifidogenic Properties

Systematical consumption of functional products has a significant positive effect on health and can reduce the risk of diseases. The aim of this study was to investigate the possibility of using whey protein hydrolysate (WPH) and pumpkin pectin as ingredients in a functional mousse, to evaluate the mousse’s antioxidant and hypotensive activities in vitro, and to evaluate the effect of the long-term intake of mousse samples on the progression of hypertension in spontaneously hypertensive rats (SHRs) and on the microbiome status in Wistar rats with antibiotic-induced dysbiosis. The experimental mousse’s in vitro antioxidant activity (oxygen radical absorbance capacity) increased by 1.2 times. The hypotensive (angiotensin-1-converting enzyme inhibitory) activity increased by 6 times in comparison with a commercial mousse. Moreover, the addition of pectin allowed the elimination of the bitter aftertaste of WPH. In vivo testing confirmed the hypotensive properties of the experimental mousse. The systolic blood pressure in SHRs decreased by 18 mmHg and diastolic blood pressure by 12 mmHg. The experimental mousse also showed a pronounced bifidogenic effect. The Bifidobacterium spp. population increased by 3.7 times in rats orally administered with the experimental mousse. The results of these studies confirm that WPH and pumpkin pectin are prospective ingredients for the development of functional mousses.

The role of nutraceuticals in prevention and treatment of hypertension: An updated review of the literature

Hypertension (HTN) is a worldwide epidemic in both developed and developing countries. It is one of the leading causes of major health problems such as cardiovascular disease, stroke, and heart attack. In recent years, several studies have reported associations between specific dietary ingredients and improving HTN. Nutraceuticals are natural food components with pharmacological properties. Reports suggest that functional foods and nutraceutical ingredients might support patients to obtain the desired therapeutic blood pressure (BP) goals and reduce cardiovascular risks by modulating various risk factors such as oxidative stress, renin-angiotensin system hyperactivity, inflammation, hyperlipidemia, and vascular resistance. We review the recent clinical experiments that have evaluated the biological and pharmacological activities of several types of nutraceuticals, including sour tea, cocoa, common spices, vitamin C, vitamin E, lycopene, flavonoids, coenzyme Q10, milk's tripeptides, calcium, magnesium, polyunsaturated fatty acids, and prebiotics in preventing and treating HTN. This review summarizes recent knowledge about the impact of common nutraceuticals for the regulation of BP.

Effects of pycnogenol on cardiometabolic health: A systematic review and meta-analysis of randomized controlled trials

AIM

Clinical trials on the effect of pycnogenol supplementation on cardiometabolic health have been controversial. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the potential effect of pycnogenol supplementation on cardiometabolic profile.

METHODS

PubMed, Scopus, and ISI Web of Science databases were searched until October 2018. RCTs that evaluated the effects of pycnogenol on cardiometabolic parameters were included. DerSimonian and Laird random-effect models were used to compute the weighted mean differences (WMDs) and 95% confidence intervals (CIs).

RESULTS

Twenty-four RCTs including 1594 participants were included in the meta-analysis. Pycnogenol significantly reduced fasting blood glucose (WMD: -5.86 mg/dl; 95% CI: -9.56, -2.15), glycated hemoglobin (WMD = -0.29%, 95%CI: -0.56, -0.01), systolic blood pressure (WMD: -2.54 mmhg; 95% CI: -4.08, -0.99), diastolic blood pressure (WMD: -1.76 mmhg; 95% CI: -3.12, -0.41), body mass index (WMD: -0.47 kg/m²; 95% CI: -0.90, -0.03), LDL cholesterol (WMD: -7.12 mg/dl; 95% CI: -13.66, -0.58) and increased HDL cholesterol (WMD: 3.27 mg/dl; 95% CI: 0.87, 5.66).

CONCLUSION

This meta-analysis suggests that pycnogenol may have a role in preventing cardiometabolic disease. However, further well-designed RCTs are recommended to evaluate its long-term effects and explore the optimal duration of use and dosage.

The Effects of Resveratrol Supplementation on Endothelial Function and Blood Pressures Among Patients with Metabolic Syndrome and Related Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

INTRODUCTION

There are current trials investigating the effect of resveratrol supplementation on endothelial function and blood pressures among patients with metabolic syndrome (MetS); however, the findings are controversial.

AIM

This systematic review and meta-analysis of randomized controlled trials (RCTs) were carried out to summarize the effects of resveratrol supplementation on endothelial activation and blood pressures among patients with MetS and related disorders.

METHODS

We searched systematically online databases including: PubMed-Medline, Embase, ISI Web of Science and Cochrane Central Register of Controlled Trials until October, 2018. Two independent authors extracted data and assessed the quality of included articles. Data were pooled using the fixed- or random-effects model and considered as standardized mean difference (SMD) with 95% confidence intervals (95% CI).

RESULTS

Out of 831 electronic citations, 28 RCTs (with 33 findings reported) were included in the meta-analyses. The findings showed that resveratrol intervention significantly increased flow-mediated dilatation (FMD) levels (SMD 1.77; 95% CI 0.25, 3.29; P = 0.02; I²: 96.5). However, resveratrol supplements did not affect systolic blood pressure (SBP) (SMD - 0.27; 95% CI - 0.57, 0.03; P = 0.07; I²: 88.9) and diastolic blood pressure (DBP) (SMD - 0.21; 95% CI - 0.52, 0.11; P = 0.19; I²: 89.8).

CONCLUSIONS

Resveratrol supplementation significantly increased FMD among patients with MetS and related disorders, but did not affect SBP and DBP. Additional prospective studies are needed to investigate the effect of resveratrol supplementation on endothelial function and blood pressures, using higher-dose of resveratrol with longer durations.

Potential Factors Influencing the Effects of Anthocyanins on Blood Pressure Regulation in Humans: A Review

Dietary intake of anthocyanins (ACNs) is associated with a reduced risk of cardiovascular and coronary heart disease. While the anti-inflammatory, antioxidant, and lipid-lowering effects of ACN consumption have been consistently reported, their effect(s) on blood pressure regulation is less consistent and results from human studies are mixed. The objective of this review is attempting to identify potential patterns which may explain the variability in results related to blood pressure. To do so, we review 66 human intervention trials testing the effects on blood pressure of purified ACN or ACN-rich extracts, or whole berries, berry juices, powders, purees and whole phenolic extracts, from berries that are rich in ACN and have ACNs as predominant bioactives. Several factors appear to be involved on the mixed results reported. In particular, the baseline characteristics of the population in terms of blood pressure and total flavonoid intake, the dose and duration of the intervention, the differential effects of individual ACN and their synergistic effects with other phytochemicals, the ACN content and bioavailability from the food matrix, and individual differences in ACN absorption and metabolism related to genotype and microbiota enterotypes.