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AlShanableh Z, Ray EC. Magnesium in hypertension: mechanisms and clinical implications. Front Physiol 2024; 15:1363975. [PMID: 38665599 PMCID: PMC11044701 DOI: 10.3389/fphys.2024.1363975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Hypertension is associated with increased risk of cardiovascular disease and death. Evidence suggests that Mg2+ depletion contributes to hypertension. It is estimated that 25% or more of the United States population experiences chronic, latent Mg2+ depletion. This review explores mechanisms by which Mg2+ influences blood pressure, modifying risk of hypertension and complicating its treatment. Mechanisms addressed include effects upon i) sympathetic tone, via the modulation of N-methyl-D-aspartate (NMDA) receptor and N-type Ca2+ channel activity, influencing catecholamine release from sympathetic nerve endings; ii) vascular tone, via alteration of L-type Ca2+ and endothelial nitric oxide synthase (eNOS) activity and prostacyclin release; iii) renal K+ handling, influencing systemic K+ balance and potentially indirectly influencing blood pressure; iv) aldosterone secretion from the adrenal cortex; and v) modulation of pro-hypertensive inflammatory processes in dendritic cells and macrophages, including activation of the NLR family pyrin domain containing 3 (NLRP3) inflammasome and stimulation of isolevuglandin (IsoLG) production. Discovery of these mechanisms has furthered our understanding of the pathogenesis of hypertension, with implications for treatment and has highlighted the role of Mg2+ balance in hypertension and cardiovascular disease.
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Affiliation(s)
| | - Evan C. Ray
- Renal-Electrolyte Division, UPMC and University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Onor IO, Hill LM, Famodimu MM, Coleman MR, Huynh CH, Beyl RA, Payne CJ, Johnston EK, Okogbaa JI, Gillard CJ, Sarpong DF, Borghol A, Okpechi SC, Norbert I, Sanne SE, Guillory SG. Association of Serum Magnesium with Blood Pressure in Patients with Hypertensive Crises: A Retrospective Cross-Sectional Study. Nutrients 2021; 13:4213. [PMID: 34959763 PMCID: PMC8709166 DOI: 10.3390/nu13124213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 12/02/2022] Open
Abstract
The role of magnesium in blood pressure has been studied among hypertensive patients; however, there is a dearth of studies exploring the role of magnesium in hypertensive crises. The primary objective of this study was to evaluate the relationship between serum magnesium and blood pressure in patients with hypertensive crises. This was a single-center, retrospective, chart review, cross-sectional study of patients with hypertensive crises. Patients were included if they were eighteen years of age or older, with an international classification disease ninth revision (ICD-9) code of 401.9 (hypertensive crises: emergency or urgency) and a documented magnesium level on their electronic medical record. The primary outcome of the study was the correlation between serum magnesium and blood pressure (systolic blood pressure and diastolic blood pressure) in patients with hypertensive crises. Two hundred and ninety-three patients were included in the study. The primary outcome result showed that serum magnesium was positively correlated with systolic blood pressure (r = 0.143, p = 0.014), but not diastolic blood pressure. Conclusion: This study found a significant positive association between magnesium and systolic blood pressure, but not diastolic blood pressure, among patients with hypertensive crises. This positive association of serum magnesium with systolic blood pressure was maintained after adjusting for covariates. This study's findings suggest a potential role of magnesium in blood pressure among patients with hypertensive crises.
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Affiliation(s)
- IfeanyiChukwu O. Onor
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, 1 Drexel Drive, New Orleans, LA 70125, USA; (L.M.H.); (M.M.F.); (M.R.C.); (C.H.H.); (C.J.P.); (E.K.J.); (J.I.O.); (C.J.G.); (D.F.S.); (A.B.); (I.N.)
- Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, 1542 Tulane Avenue, New Orleans, LA 70112, USA; (S.E.S.); (S.G.G.)
- Department of Pharmacy, University Medical Center New Orleans, 2000 Canal Street, New Orleans, LA 70112, USA
| | - Lashira M. Hill
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, 1 Drexel Drive, New Orleans, LA 70125, USA; (L.M.H.); (M.M.F.); (M.R.C.); (C.H.H.); (C.J.P.); (E.K.J.); (J.I.O.); (C.J.G.); (D.F.S.); (A.B.); (I.N.)
| | - Modupe M. Famodimu
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, 1 Drexel Drive, New Orleans, LA 70125, USA; (L.M.H.); (M.M.F.); (M.R.C.); (C.H.H.); (C.J.P.); (E.K.J.); (J.I.O.); (C.J.G.); (D.F.S.); (A.B.); (I.N.)
| | - Mallory R. Coleman
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, 1 Drexel Drive, New Orleans, LA 70125, USA; (L.M.H.); (M.M.F.); (M.R.C.); (C.H.H.); (C.J.P.); (E.K.J.); (J.I.O.); (C.J.G.); (D.F.S.); (A.B.); (I.N.)
| | - Carolkim H. Huynh
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, 1 Drexel Drive, New Orleans, LA 70125, USA; (L.M.H.); (M.M.F.); (M.R.C.); (C.H.H.); (C.J.P.); (E.K.J.); (J.I.O.); (C.J.G.); (D.F.S.); (A.B.); (I.N.)
| | - Robbie A. Beyl
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA;
| | - Casey J. Payne
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, 1 Drexel Drive, New Orleans, LA 70125, USA; (L.M.H.); (M.M.F.); (M.R.C.); (C.H.H.); (C.J.P.); (E.K.J.); (J.I.O.); (C.J.G.); (D.F.S.); (A.B.); (I.N.)
| | - Emily K. Johnston
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, 1 Drexel Drive, New Orleans, LA 70125, USA; (L.M.H.); (M.M.F.); (M.R.C.); (C.H.H.); (C.J.P.); (E.K.J.); (J.I.O.); (C.J.G.); (D.F.S.); (A.B.); (I.N.)
| | - John I. Okogbaa
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, 1 Drexel Drive, New Orleans, LA 70125, USA; (L.M.H.); (M.M.F.); (M.R.C.); (C.H.H.); (C.J.P.); (E.K.J.); (J.I.O.); (C.J.G.); (D.F.S.); (A.B.); (I.N.)
- Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, 1542 Tulane Avenue, New Orleans, LA 70112, USA; (S.E.S.); (S.G.G.)
| | - Christopher J. Gillard
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, 1 Drexel Drive, New Orleans, LA 70125, USA; (L.M.H.); (M.M.F.); (M.R.C.); (C.H.H.); (C.J.P.); (E.K.J.); (J.I.O.); (C.J.G.); (D.F.S.); (A.B.); (I.N.)
- Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, 1542 Tulane Avenue, New Orleans, LA 70112, USA; (S.E.S.); (S.G.G.)
- Department of Pharmacy, University Medical Center New Orleans, 2000 Canal Street, New Orleans, LA 70112, USA
| | - Daniel F. Sarpong
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, 1 Drexel Drive, New Orleans, LA 70125, USA; (L.M.H.); (M.M.F.); (M.R.C.); (C.H.H.); (C.J.P.); (E.K.J.); (J.I.O.); (C.J.G.); (D.F.S.); (A.B.); (I.N.)
- Center for Minority Health and Health Disparities Research and Education, College of Pharmacy, Xavier University of Louisiana, 1 Drexel Drive, New Orleans, LA 70125, USA
| | - Amne Borghol
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, 1 Drexel Drive, New Orleans, LA 70125, USA; (L.M.H.); (M.M.F.); (M.R.C.); (C.H.H.); (C.J.P.); (E.K.J.); (J.I.O.); (C.J.G.); (D.F.S.); (A.B.); (I.N.)
- Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, 1542 Tulane Avenue, New Orleans, LA 70112, USA; (S.E.S.); (S.G.G.)
- Department of Pharmacy, University Medical Center New Orleans, 2000 Canal Street, New Orleans, LA 70112, USA
| | - Samuel C. Okpechi
- Department of Biochemistry and Molecular Biology, Louisiana State University School of Medicine and Health Sciences Center, 1901 Perdido Street, New Orleans, LA 70112, USA;
| | - Ifeyinwa Norbert
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, 1 Drexel Drive, New Orleans, LA 70125, USA; (L.M.H.); (M.M.F.); (M.R.C.); (C.H.H.); (C.J.P.); (E.K.J.); (J.I.O.); (C.J.G.); (D.F.S.); (A.B.); (I.N.)
| | - Shane E. Sanne
- Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, 1542 Tulane Avenue, New Orleans, LA 70112, USA; (S.E.S.); (S.G.G.)
| | - Shane G. Guillory
- Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, 1542 Tulane Avenue, New Orleans, LA 70112, USA; (S.E.S.); (S.G.G.)
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Onor IO, Johnston EK, Little NG, Hill LM, Lawal OE, Payne CJ, Coleman MR, Huynh CH, Bilbe SE, Ayyad AA, Jones KJ, Kinnard JD, Dastoori R, Rolland DK, Miller AS, Beyl RA, Gillard CJ, Okogbaa JI, Sarpong DF, Hadgu RM, Borghol A, Okpechi SC, Naljayan MV, Sanne SE, Guillory SG. Evaluation of serum magnesium differences in hypertensive crises and control patients: A randomly matched case-control study. J Clin Hypertens (Greenwich) 2021; 23:1229-1238. [PMID: 33963802 PMCID: PMC8169553 DOI: 10.1111/jch.14244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/04/2022]
Abstract
Although the role of magnesium in blood pressure has been well studied among hypertensive patients, no study has explored the role of magnesium in hypertensive crises. The primary objective of this study is to evaluate the differences in serum magnesium levels between hypertensive crises patients and matched controls (age‐, sex‐, race‐, and diabetes‐matched) in a 1:1 random match. This study is a single‐center, retrospective, chart review, case‐control study of patients with hypertensive crises (case group) and patients without hypertensive crises (control group). Patients were included in the case group if they were 18 years of age or older with hypertensive crises and have a documented magnesium level. The control group patients were required to be 18 years of age or older, have no diagnosis of hypertensive crises, and have a documented magnesium level. The primary outcome of the study was to compare the mean serum magnesium in patients with hypertensive crises versus patients without hypertensive crises. Three hundred and fifty‐eight patients were included in the study: 179 patients in both the case group and control group. The primary outcome results showed that serum magnesium concentration was not significantly different between the case group (1.89 ± 0.29 mg/dl) and control group (1.90 ± 0.31 mg/dl) (p = .787). This study found no significant difference in serum magnesium levels in patients with hypertensive crises compared to a random matched control group. Larger observational or experimental studies may be useful to evaluate the effect of magnesium on blood pressure in hypertensive crises.
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Affiliation(s)
- IfeanyiChukwu O Onor
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA.,Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA.,Department of Pharmacy, University Medical Center New Orleans, New Orleans, LA, USA
| | - Emily K Johnston
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA
| | - Nicole G Little
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA
| | - Lashira M Hill
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA
| | - Oluwabunmi E Lawal
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA
| | - Casey J Payne
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA
| | - Mallory R Coleman
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA
| | - Carolkim H Huynh
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA
| | - Sarah E Bilbe
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA
| | - Ahlam A Ayyad
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA
| | - Kabrea J Jones
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA
| | - Jasmine D Kinnard
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA
| | - Rosanna Dastoori
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA
| | - Devinn K Rolland
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA
| | - Amanda S Miller
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA
| | - Robbie A Beyl
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Christopher J Gillard
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA.,Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA.,Department of Pharmacy, University Medical Center New Orleans, New Orleans, LA, USA
| | - John I Okogbaa
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA.,Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
| | - Daniel F Sarpong
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA.,Center for Minority Health and Health Disparities Research and Education, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA
| | - Rim M Hadgu
- Midwestern University College of Pharmacy - Glendale, Glendale, AZ, USA
| | - Amne Borghol
- CardioRenal Research Group (CRRG), College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA.,Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA.,Department of Pharmacy, University Medical Center New Orleans, New Orleans, LA, USA
| | - Samuel C Okpechi
- Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Mihran V Naljayan
- Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
| | - Shane E Sanne
- Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
| | - Shane G Guillory
- Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
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Rosanoff A, Costello RB, Johnson GH. Effectively Prescribing Oral Magnesium Therapy for Hypertension: A Categorized Systematic Review of 49 Clinical Trials. Nutrients 2021; 13:E195. [PMID: 33435187 PMCID: PMC7827637 DOI: 10.3390/nu13010195] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 12/17/2022] Open
Abstract
Trials and meta-analyses of oral magnesium for hypertension show promising but conflicting results. An inclusive collection of 49 oral magnesium for blood pressure (BP) trials were categorized into four groups: (1) Untreated Hypertensives; (2) Uncontrolled Hypertensives; (3) Controlled Hypertensives; (4) Normotensive subjects. Each group was tabulated by ascending magnesium dose. Studies reporting statistically significant (p < 0.05) decreases in both systolic BP (SBP) and diastolic BP (DBP) from both baseline and placebo (if reported) were labeled "Decrease"; all others were deemed "No Change." Results: Studies of Untreated Hypertensives (20 studies) showed BP "Decrease" only when Mg dose was >600 mg/day; <50% of the studies at 120-486 mg Mg/day showed SBP or DBP decreases but not both while others at this Mg dosage showed no change in either BP measure. In contrast, all magnesium doses (240-607 mg/day) showed "Decrease" in 10 studies on Uncontrolled Hypertensives. Controlled Hypertensives, Normotensives and "magnesium-replete" studies showed "No Change" even at high magnesium doses (>600 mg/day). Where magnesium did not lower BP, other cardiovascular risk factors showed improvement. Conclusion: Controlled Hypertensives and Normotensives do not show a BP-lowering effect with oral Mg therapy, but oral magnesium (≥240 mg/day) safely lowers BP in Uncontrolled Hypertensive patients taking antihypertensive medications, while >600 mg/day magnesium is required to safely lower BP in Untreated Hypertensives; <600 mg/day for non-medicated hypertensives may not lower both SBP and DBP but may safely achieve other risk factor improvements without antihypertensive medication side effects.
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Affiliation(s)
- Andrea Rosanoff
- CMER Center for Magnesium Education &Research, Pahoa, HI 96778, USA;
| | | | - Guy H. Johnson
- Johnson Nutrition Solutions LLC, Minneapolis, MN 55416, USA;
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Quantitative Association Between Serum/Dietary Magnesium and Cardiovascular Disease/Coronary Heart Disease Risk: A Dose-Response Meta-analysis of Prospective Cohort Studies. J Cardiovasc Pharmacol 2020; 74:516-527. [PMID: 31815866 DOI: 10.1097/fjc.0000000000000739] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The quantitative association between serum/dietary magnesium and cardiovascular disease (CVD) remains unclear. We conducted a dose-response meta-analysis to evaluate the quantitative association between serum/dietary magnesium and CVD, including coronary heart disease (CHD). METHODS PubMed, China National Knowledge Infrastructure, and Web of Science were searched for publications. STATA 12.0 was used to analyze data. We used the random-effects model to reduce heterogeneity. RESULTS Eighteen prospective cohort studies with 544,581 participants and 22,658 CVD cases were included. The follow-up duration was 1-28 years. The pooled relative risk (RR) of CVD for the relatively normal versus lowest serum and dietary magnesium level was 0.64 {[95% confidence interval (CI): 0.51-0.80] and 0.90 [95% CI: 0.84-0.96]}. The pooled RR of CHD for the relatively normal versus lowest serum and dietary magnesium level was 0.70 (95% CI: 0.57-0.85) and 0.86 (95% CI: 0.77-0.94). We noted a significant association between increasing serum magnesium levels (per 0.1-mg/dL increase) and risk of CVD (RR: 0.93, 95% CI: 0.88-0.97) and CHD (RR: 0.90, 95% CI: 0.84-0.96) and between dietary magnesium levels (per 100-mg/d increase) and risk of CVD (RR: 0.90, 95% CI: 0.83-0.96) and CHD (RR: 0.92, 95% CI: 0.82-0.98). Serum/dietary Mg level comparisons presented a 7%-10% decrease in CVD/CHD risk. The dose-response meta-analyses showed linear relationships between serum magnesium and CVD (Pnonlinearity = 0.833) or CHD (Pnonlinearity = 0.193) and dietary magnesium and CVD (Pnonlinearity = 0.463) or CHD (Pnonlinearity = 0.440). CONCLUSIONS Increasing dietary magnesium or serum magnesium level is linearly and inversely associated with the risk of total CVD and CHD events.
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Averin EE, Nikitin AE, Pozdnyak AO, Fedorova EL, Zhuk VS, Davydov SI, Fridman IL, Kompaniets OG, Kirpichnikova NV, Dudarenkova MR, Ginzburg ML, El Sharif MA, Martemyanova EG, Sozykin AV. [Expert Council Resolution. Practical Aspects of the Diagnosis and Correction of Potassium and Magnesium Deficiency States]. ACTA ACUST UNITED AC 2020; 60:155-164. [PMID: 32345211 DOI: 10.18087/cardio.2020.2.n972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 11/18/2022]
Abstract
The article analyzes properties of potassium and magnesium, which may exert vasodilatory, anti-inflammatory, anti-ischemic, antiaggregant, and antiarrhythmic effects. These are extremely important microelements and potentially beneficial therapeutic agents for treatment of cardiovascular diseases.
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Affiliation(s)
- E E Averin
- Central Clinical Hospital of the Russian Academy of Sciences, Moscow
| | - A E Nikitin
- Central Clinical Hospital of the Russian Academy of Sciences, Moscow
| | - A O Pozdnyak
- Kazan State Medical Academy, Branch of the Russian Medical Academy of Continuous Professional Education
| | | | - V S Zhuk
- N.I. Pirogov Multidisciplinary Clinic, St. Petersburg
| | | | | | | | | | | | | | | | | | - A V Sozykin
- N.I. Pirogov Russian National Research Medical University, Moscow
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Workinger JL, Doyle RP, Bortz J. Challenges in the Diagnosis of Magnesium Status. Nutrients 2018; 10:E1202. [PMID: 30200431 PMCID: PMC6163803 DOI: 10.3390/nu10091202] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 12/31/2022] Open
Abstract
Magnesium is a critical mineral in the human body and is involved in ~80% of known metabolic functions. It is currently estimated that 60% of adults do not achieve the average dietary intake (ADI) and 45% of Americans are magnesium deficient, a condition associated with disease states like hypertension, diabetes, and neurological disorders, to name a few. Magnesium deficiency can be attributed to common dietary practices, medications, and farming techniques, along with estimates that the mineral content of vegetables has declined by as much as 80⁻90% in the last 100 years. However, despite this mineral's importance, it is poorly understood from several standpoints, not the least of which is its unique mechanism of absorption and sensitive compartmental handling in the body, making the determination of magnesium status difficult. The reliance on several popular sample assays has contributed to a great deal of confusion in the literature. This review will discuss causes of magnesium deficiency, absorption, handling, and compartmentalization in the body, highlighting the challenges this creates in determining magnesium status in both clinical and research settings.
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Affiliation(s)
- Jayme L Workinger
- Human Nutrition and Pharma, Balchem Corporation, 52 Sunrise Park Road, New Hampton, NY 10958, USA.
| | - Robert P Doyle
- Department of Chemistry, Center for Science and Technology, Syracuse University, 111 College Place, Syracuse, NY 13244, USA.
| | - Jonathan Bortz
- Human Nutrition and Pharma, Balchem Corporation, 52 Sunrise Park Road, New Hampton, NY 10958, USA.
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Abstract
BACKGROUND Although magnesium is important in the biology of blood pressure regulation, little clinical data exist on the association of hypermagnesemia and blood pressure. METHOD We examined the association of hypermagnesemia and SBP in a cross-sectional study of 10 521 ICU patients from a single tertiary care medical center, 6% of whom had a serum magnesium above 2.6 mg/dl at time of admission. RESULTS In a multivariable analysis, hypermagnesemia was associated with SBP 6.2 mmHg lower [95% confidence interval (CI) -8.2, -4.2, P < 0.001] than in patients with admission values of serum magnesium 2.6 mg/dl or less. Each mg/dl increase in serum magnesium was associated with a decrease in SBP of 4.3 mmHg (95% CI -5.5, -3.1, P < 0.001). In addition, hypermagnesemic patients had a 2.48-fold greater likelihood (95% CI 2.06, 3.00, P < 0.001) of receiving intravenous vasopressors during the first 24 h of ICU care, independent of admission SBP. CONCLUSION Our findings add support to the biologic importance of magnesium regulation in blood pressure control.
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Guasch-Ferré M, Bulló M, Estruch R, Corella D, Martínez-González MA, Ros E, Covas M, Arós F, Gómez-Gracia E, Fiol M, Lapetra J, Muñoz MÁ, Serra-Majem L, Babio N, Pintó X, Lamuela-Raventós RM, Ruiz-Gutiérrez V, Salas-Salvadó J. Dietary magnesium intake is inversely associated with mortality in adults at high cardiovascular disease risk. J Nutr 2014; 144:55-60. [PMID: 24259558 DOI: 10.3945/jn.113.183012] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The relation between dietary magnesium intake and cardiovascular disease (CVD) or mortality was evaluated in several prospective studies, but few of them have assessed the risk of all-cause mortality, which has never been evaluated in Mediterranean adults at high cardiovascular risk. The aim of this study was to assess the association between magnesium intake and CVD and mortality risk in a Mediterranean population at high cardiovascular risk with high average magnesium intake. The present study included 7216 men and women aged 55-80 y from the PREDIMED (Prevención con Dieta Mediterránea) study, a randomized clinical trial. Participants were assigned to 1 of 2 Mediterranean diets (supplemented with nuts or olive oil) or to a control diet (advice on a low-fat diet). Mortality was ascertained by linkage to the National Death Index and medical records. We fitted multivariable-adjusted Cox regressions to assess associations between baseline energy-adjusted tertiles of magnesium intake and relative risk of CVD and mortality. Multivariable analyses with generalized estimating equation models were used to assess the associations between yearly repeated measurements of magnesium intake and mortality. After a median follow-up of 4.8 y, 323 total deaths, 81 cardiovascular deaths, 130 cancer deaths, and 277 cardiovascular events occurred. Energy-adjusted baseline magnesium intake was inversely associated with cardiovascular, cancer, and all-cause mortality. Compared with lower consumers, individuals in the highest tertile of magnesium intake had a 34% reduction in mortality risk (HR: 0.66; 95% CI: 0.45, 0.95; P < 0.01). Dietary magnesium intake was inversely associated with mortality risk in Mediterranean individuals at high risk of CVD. This trial was registered at controlled-trials.com as ISRCTN35739639.
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Affiliation(s)
- Marta Guasch-Ferré
- Human Nutrition Unit, University Hospital of Sant Joan de Reus, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Spain
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Cunha AR, Medeiros F, Umbelino B, Oigman W, Touyz RM, Neves MF. Altered vascular structure and wave reflection in hypertensive women with low magnesium levels. ACTA ACUST UNITED AC 2013; 7:344-52. [DOI: 10.1016/j.jash.2013.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/03/2013] [Accepted: 04/21/2013] [Indexed: 11/15/2022]
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Qu X, Jin F, Hao Y, Li H, Tang T, Wang H, Yan W, Dai K. Magnesium and the risk of cardiovascular events: a meta-analysis of prospective cohort studies. PLoS One 2013; 8:e57720. [PMID: 23520480 PMCID: PMC3592895 DOI: 10.1371/journal.pone.0057720] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 01/25/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Prospective studies that have examined the association between dietary magnesium intake and serum magnesium concentrations and the risk of cardiovascular disease (CVD) events have reported conflicting findings. We undertook a meta-analysis to evaluate the association between dietary magnesium intake and serum magnesium concentrations and the risk of total CVD events. METHODOLOGY/PRINCIPAL FINDINGS We performed systematic searches on MEDLINE, EMBASE, and OVID up to February 1, 2012 without limits. Categorical, linear, and nonlinear, dose-response, heterogeneity, publication bias, subgroup, and meta-regression analysis were performed. The analysis included 532,979 participants from 19 studies (11 studies on dietary magnesium intake, 6 studies on serum magnesium concentrations, and 2 studies on both) with 19,926 CVD events. The pooled relative risks of total CVD events for the highest vs. lowest category of dietary magnesium intake and serum magnesium concentrations were 0.85 (95% confidence interval 0.78 to 0.92) and 0.77 (0.66 to 0.87), respectively. In linear dose-response analysis, only serum magnesium concentrations ranging from 1.44 to 1.8 mEq/L were significantly associated with total CVD events risk (0.91, 0.85 to 0.97) per 0.1 mEq/L (P(nonlinearity)= 0.465). However, significant inverse associations emerged in nonlinear models for dietary magnesium intake (P(nonlinearity)= 0.024). The greatest risk reduction occurred when intake increased from 150 to 400 mg/d. There was no evidence of publication bias. CONCLUSIONS/SIGNIFICANCE There is a statistically significant nonlinear inverse association between dietary magnesium intake and total CVD events risk. Serum magnesium concentrations are linearly and inversely associated with the risk of total CVD events.
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Affiliation(s)
- Xinhua Qu
- Shanghai Key Laboratory of Orthopaedic Implant, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fangchun Jin
- Shanghai Key Laboratory of Orthopaedic Implant, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yongqiang Hao
- Shanghai Key Laboratory of Orthopaedic Implant, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Huiwu Li
- Shanghai Key Laboratory of Orthopaedic Implant, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tingting Tang
- Shanghai Key Laboratory of Orthopaedic Implant, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hao Wang
- Department of Pharmacology and Biostatistics, Institute of Medical Sciences, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weili Yan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kerong Dai
- Shanghai Key Laboratory of Orthopaedic Implant, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Jin K, Kim TH, Kim YH, Kim YW. Additional antihypertensive effect of magnesium supplementation with an angiotensin II receptor blocker in hypomagnesemic rats. Korean J Intern Med 2013; 28:197-205. [PMID: 23526071 PMCID: PMC3604610 DOI: 10.3904/kjim.2013.28.2.197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 03/06/2012] [Accepted: 06/21/2012] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/AIMS Magnesium (Mg) is an essential element for vascular function and blood pressure regulation. Several studies have demonstrated that Mg concentration is inversely associated with blood pressure, and that Mg supplementation attenuates hypertension. The purpose of this study was to evaluate the effect of dietary Mg supplementation on the blood pressure effects of an angiotensin II receptor blocker (ARB) in hypomagnesemic rats. METHODS Fifty male Sprague-Dawley rats were randomly divided into Mg-deficient (n = 30), normal diet plus Mg (n = 10), and control groups (n = 10). Mg-free, high-Mg, and normal-Mg diets were respectively fed to the rats. After 14 weeks, 10 of the 30 Mg-deficient rats were treated with Mg, 10 Mg-deficient rats received an ARB, and 10 Mg-deficient rats received an ARB plus Mg for 4 weeks. RESULTS Systolic blood pressure was significantly higher in the Mg-deficient rats than in the control rats at week 14. Hypomagnesemic rats exhibited decreased systolic blood pressure after treatment with Mg, and systolic blood pressure showed a greater decrease after ARB treatment. Treatment with the ARB/Mg combination resulted in the greatest decrease in systolic blood pressure. Mg deficiency did not affect the serum angiotensin II level, but did increase the serum aldosterone concentration. Concomitant Mg/ARB supplementation significantly decreased the elevated serum aldosterone level in hypomagnesemic rats. Kidney tissues of the hypomagnesemic rats revealed mild to moderate inflammatory infiltrates. Mg and/or ARB treatment did not reverse the inflammatory reaction in the kidneys of hypomagnesemic rats. CONCLUSIONS Concurrent dietary Mg supplementation can enhance ARB-induced blood pressure reduction in rats with hypomagnesemic hypertension.
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Affiliation(s)
- Kyubok Jin
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Tae Hee Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Yeong Hoon Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Yang Wook Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
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Magnesium and vascular changes in hypertension. Int J Hypertens 2012; 2012:754250. [PMID: 22518291 PMCID: PMC3299255 DOI: 10.1155/2012/754250] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 12/19/2011] [Indexed: 12/15/2022] Open
Abstract
Many factors have been implicated in the pathogenesis of hypertension, including changes in intracellular concentrations of calcium, sodium, potassium, and magnesium. There is a significant inverse correlation between serum magnesium and incidence of cardiovascular diseases. Magnesium is a mineral with important functions in the body such as antiarrhythmic effect, actions in vascular tone, contractility, glucose metabolism, and insulin homeostasis. In addition, lower concentrations of magnesium are associated with oxidative stress, proinflammatory state, endothelial dysfunction, platelet aggregation, insulin resistance, and hyperglycemia. The conflicting results of studies evaluating the effects of magnesium supplements on blood pressure and other cardiovascular outcomes indicate that the action of magnesium in the vascular system is present but not yet established. Therefore, this mineral supplementation is not indicated as part of antihypertensive treatment, and further studies are needed to better clarify the role of magnesium in the prevention and treatment of cardiovascular diseases.
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Kass L, Weekes J, Carpenter L. Effect of magnesium supplementation on blood pressure: a meta-analysis. Eur J Clin Nutr 2012; 66:411-8. [PMID: 22318649 DOI: 10.1038/ejcn.2012.4] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
To date, there has been inconclusive evidence regarding the effect of magnesium supplements on blood pressure (BP). This meta-analysis was conducted to assess the effect of magnesium supplementation on BP and to establish the characteristics of trials showing the largest effect size. Primary outcome measures were systolic blood pressure (SBP) and diastolic blood pressure (DBP) at the end of the follow-up period. One hundred and forty-one papers were identified, of which 22 trials with 23 sets of data (n=1173), with 3 to 24 weeks of follow-up met the inclusion criteria, with a supplemented elemental magnesium range of 120-973 mg (mean dose 410 mg). 95% confidence intervals (CI) were calculated using DerSimonian and Laird's random-effects model, with effect size calculated using Hedges G. Combining all data, an overall effect of 0.36 and 0.32 for DBP and SBP, respectively, was observed (95% CI 0.27-0.44 for DBP and 0.23-0.41 for SBP), with a greater effect being seen for the intervention in crossover trials (DBP 0.47, SBP 0.51). Effect size increased in line with increased dosage. Although not all individual trials showed significance in BP reduction, combining all trials did show a decrease in SBP of 3-4 mm Hg and DBP of 2-3 mm Hg, which further increased with crossover designed trials and intake >370 mg/day. To conclude, magnesium supplementation appears to achieve a small but clinically significant reduction in BP, an effect worthy of future prospective large randomised trials using solid methodology.
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Affiliation(s)
- L Kass
- School of Life Sciences, University of Hertfordshire, Hatfield, UK.
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16
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The effects of dietary patterns on plasma renin activity: results from the Dietary Approaches to Stop Hypertension trial. J Hum Hypertens 2011; 26:664-9. [PMID: 22048714 DOI: 10.1038/jhh.2011.87] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A diet rich in fruits, vegetables and low-fat dairy products, and reduced in saturated fat, total fat and cholesterol (the 'DASH' diet) significantly lowers blood pressure (BP). Previous studies have documented that certain therapies that lower BP increase plasma renin activity (PRA). Using data from the Dietary Approaches to Stop Hypertension (DASH) trial, we assessed the effects of dietary patterns on PRA and determined the relationship of change in PRA with change in BP on each diet. After eating a control diet for 3 weeks, participants were then randomized to receive for 8 weeks: the control diet, a diet rich in fruits and vegetables (F/V), or the DASH diet. Baseline and follow-up levels of PRA were available in 381 participants. Compared with the control diet, the DASH diet increased PRA by 0.37 ng ml(-1) h(-1) (P=0.01). In multivariable linear regression analyses, there was an inverse association of PRA change with systolic BP change on the control diet (slope=-0.35, P=0.001), but PRA did not differ by BP change on the F/V diet (slope=-0.002, P=0.98) or DASH diet (slope=-0.08, P=0.32). These data suggest that a blunted counter-regulatory response of the renin-angiotensin system is associated with the BP-lowering effect of the F/V and DASH diets.
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Feasibility and antihypertensive effect of replacing regular salt with mineral salt -rich in magnesium and potassium- in subjects with mildly elevated blood pressure. Nutr J 2011; 10:88. [PMID: 21888642 PMCID: PMC3175151 DOI: 10.1186/1475-2891-10-88] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 09/02/2011] [Indexed: 12/04/2022] Open
Abstract
Background High salt intake is linked to hypertension whereas a restriction of dietary salt lowers blood pressure (BP). Substituting potassium and/or magnesium salts for sodium chloride (NaCl) may enhance the feasibility of salt restriction and lower blood pressure beyond the sodium reduction alone. The aim of this study was to determine the feasibility and effect on blood pressure of replacing NaCl (Regular salt) with a novel mineral salt [50% sodium chloride and rich in potassium chloride (25%), magnesium ammonium potassium chloride, hydrate (25%)] (Smart Salt). Methods A randomized, double-blind, placebo-controlled study was conducted with an intervention period of 8-weeks in subjects (n = 45) with systolic (S)BP 130-159 mmHg and/or diastolic (D)BP 85-99 mmHg. During the intervention period, subjects consumed processed foods salted with either NaCl or Smart Salt. The primary endpoint was the change in SBP. Secondary endpoints were changes in DBP, daily urine excretion of sodium (24-h dU-Na), potassium (dU-K) and magnesium (dU-Mg). Results 24-h dU-Na decreased significantly in the Smart Salt group (-29.8 mmol; p = 0.012) and remained unchanged in the control group: resulting in a 3.3 g difference in NaCl intake between the groups. Replacement of NaCl with Smart Salt resulted in a significant reduction in SBP over 8 weeks (-7.5 mmHg; p = 0.016). SBP increased (+3.8 mmHg, p = 0.072) slightly in the Regular salt group. The difference in the change of SBP between study groups was significant (p < 0.002). Conclusions The substitution of Smart Salt for Regular salt in subjects with high normal or mildly elevated BP resulted in a significant reduction in their daily sodium intake as well as a reduction in SBP. Trial Registration ISRCTN: ISRCTN01739816
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Beckstrand RL, Pickens JS. Beneficial Effects of Magnesium Supplementation. J Evid Based Complementary Altern Med 2011. [DOI: 10.1177/2156587211401746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Magnesium is an essential mineral necessary for optimal cellular health and well-being. Many adults in the United States fail to get recommended amounts of magnesium from their diets. Even so, symptoms of magnesium deficiency are rarely seen; however, maintaining normal body stores could be preventative against common diseases.
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19
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Scientific Opinion on the substantiation of health claims related to magnesium and “hormonal health” (ID 243), reduction of tiredness and fatigue (ID 244), contribution to normal psychological functions (ID 245, 246), maintenance of normal blood glucose c. EFSA J 2010. [DOI: 10.2903/j.efsa.2010.1807] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Hatzistavri LS, Sarafidis PA, Georgianos PI, Tziolas IM, Aroditis CP, Zebekakis PE, Pikilidou MI, Lasaridis AN. Oral magnesium supplementation reduces ambulatory blood pressure in patients with mild hypertension. Am J Hypertens 2009; 22:1070-5. [PMID: 19617879 DOI: 10.1038/ajh.2009.126] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Accumulating evidence implicates a role of Mg(2+) in the pathophysiology of essential hypertension. Previous studies evaluating the antihypertensive efficacy of Mg(2+) supplementation gave contradictory results. This study aimed to investigate the effect of oral Mg(2+) supplementation on 24-h blood pressure (BP) and intracellular ion status in patients with mild hypertension. METHODS A total of 48 patients with mild uncomplicated hypertension participated in the study. Among them, 24 subjects were assigned to 600 mg of pidolate Mg(2+) daily in addition to lifestyle recommendations for a 12-week period and another 24 age- and sex-matched controls were only given lifestyle recommendations. At baseline and study-end (12 weeks) ambulatory BP monitoring, determination of serum and intracellular ion levels, and 24-h urinary collections for determination of urinary Mg(2+) were performed in all study subjects. RESULTS In the Mg(2+) supplementation group, small but significant reductions in mean 24-h systolic and diastolic BP levels were observed, in contrast to control group (-5.6 +/- 2.7 vs. -1.3 +/- 2.4 mm Hg, P < 0.001 and -2.8 +/- 1.8 vs. -1 +/- 1.2 mm Hg, P = 0.002, respectively). These effects of Mg(2+) supplementation were consistent in both daytime and night-time periods. Serum Mg(2+) levels and urinary Mg(2+) excretion were significantly increased in the intervention group. Intracellular Mg(2+) and K(+) levels were also increased, while intracellular Ca(2+) and Na(+) levels were decreased in the intervention group. None of the intracellular ions were significantly changed in the control group. CONCLUSION This study suggests that oral Mg(2+) supplementation is associated with small but consistent ambulatory BP reduction in patients with mild hypertension.
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Bayir A, Kara H, Ak A, Cander B, Kara F. Magnesium sulfate in emergency department patients with hypertension. Biol Trace Elem Res 2009; 128:38-44. [PMID: 18953498 DOI: 10.1007/s12011-008-8256-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 09/30/2008] [Indexed: 02/05/2023]
Abstract
To compare the effect of IV magnesium with other antihypertensives in emergency department (ED) patients with hypertension. ED patients with a systolic BP > 135 mmHg or diastolic BP > 85 were approached for entry into the study. Those granting consent were randomly placed into one of three treatment groups: (1) 1.5 gm IV MgSO(4) (n = 42), (2) a parenteral or oral antihypertensive agent (n = 41), (3) both IV MgSO(4) and an antihypertensive agent (n = 44). Systolic and diastolic blood pressures were measured at entry into the study and at 15, 30, 45, and 60 min after magnesium or other antihypertensive medications were given. The main outcome measure was blood pressure at 60 min, and results were compared using one-way analysis of variance with the post hoc Tukey HSD test. Compared to systolic and diastolic blood pressures at time 0, both were lower at 15, 30, 45, and 60 min in all groups (p < 0.05). No significant difference in systolic or diastolic BP at any time point was observed when response to treatment was compared between the three groups. Intravenous MgSO(4) is as effective as antihypertensives at lowering BP in emergency department patients.
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Affiliation(s)
- Ayşegül Bayir
- Department of Emergency Medicine, Meram Faculty of Medicine, Selçuk University, Meram, Konya, Turkey.
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22
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Dairy product enriched with milk peptide and magnesium and help to moderate signs of anxiety in mildly stress-sensitive adult - Scientific Opinion of the Panel on Dietetic Products, Nutrition and Allergies. EFSA J 2008. [DOI: 10.2903/j.efsa.2008.905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Knox J, Gaster B. Dietary Supplements for The Prevention and Treatment of Coronary Artery Disease. J Altern Complement Med 2007; 13:83-95. [PMID: 17309382 DOI: 10.1089/acm.2006.6206] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE With the recent growth in the use of dietary supplements, it is increasingly important for clinicians to be familiar with the evidence for and against their efficacy. We set out to systematically review the dietary supplements available for the prevention and treatment of coronary artery disease. METHODS Between May 2004 and May 2006, we searched MEDLINE, the Cochrane Library, and Pro-Quest using the MeSH terms hypertension, hypercholesterolemia, myocardial infarction, dietary supplements, and herb-drug interactions. The MeSH terms of individual supplements identified were then added to the search. Reference lists of pertinent papers were also searched to find appropriate papers for inclusion. We included randomized controlled trials published in English of at least 1 week's duration that studied the efficacy of supplements in the treatment of hypercholesterolemia, or hypertension, or in the prevention of cardiac events. Qualifying papers were identified and assigned a Jadad quality score. In areas of uncertainty, a second investigator independently scored the trial. RESULTS Fifteen (15) supplements were identified. Of these, most had little data available and most of the data were of poor quality. The supplements with the most supporting data were policosanol and garlic, both for hyperlipidemia. CONCLUSIONS A growing body of literature exists for numerous supplements in the prevention of coronary artery disease, but much of these data are inconclusive. Clinicians should become familiar with the extent and limitations of this literature so that they may counsel their patients better.
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Affiliation(s)
- Jeffrey Knox
- Department of Medicine, University of Washington, Seattle, WA, USA
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Dickinson HO, Nicolson DJ, Campbell F, Cook JV, Beyer FR, Ford GA, Mason J. Magnesium supplementation for the management of essential hypertension in adults. Cochrane Database Syst Rev 2006:CD004640. [PMID: 16856052 DOI: 10.1002/14651858.cd004640.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
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.
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Affiliation(s)
- H O Dickinson
- University of Newcastle, National Guideline Research & Development Unit, 21 Claremont Place, Newcastle upon Tyne, Tyne & Wear, UK NE2 4AA.
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Yokota K, Kato M, Lister F, Ii H, Hayakawa T, Kikuta T, Kageyama S, Tajima N. Clinical Efficacy of Magnesium Supplementation in Patients with Type 2 Diabetes. J Am Coll Nutr 2004; 23:506S-509S. [PMID: 15466952 DOI: 10.1080/07315724.2004.10719390] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Effects of magnesium (Mg) supplementation on nine mild type 2 diabetic patients with stable glycemic control were investigated. Water from a salt lake with a high natural Mg content (7.1%) (MAG21) was used for supplementation after dilution with distilled water to 100mg/100mL; 300mL/day was given for 30 days. Fasting serum immunoreactive insulin level decreased significantly, as did HOMA squareR (both p < 0.05). There was also a marked decrease of the mean triglyceride level after supplementation. The patients with hypertension showed significant reduction of systolic (p < 0.01), diastolic (p = 0.0038), and mean (p < 0.01) blood pressure. The salt lake water supplement, MAG21, exerted clinical benefit as a Mg supplement in patients with mild type 2 diabetes mellitus.
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Affiliation(s)
- Kuninobu Yokota
- Department of Internal Medicine, Jikei University School of Medicine, 3-15-8 Nishi-shinbashi, Minato-ku 105-0003, Japan.
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Jee SH, Miller ER, Guallar E, Singh VK, Appel LJ, Klag MJ. The effect of magnesium supplementation on blood pressure: a meta-analysis of randomized clinical trials. Am J Hypertens 2002; 15:691-6. [PMID: 12160191 DOI: 10.1016/s0895-7061(02)02964-3] [Citation(s) in RCA: 197] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND An increased intake of magnesium might lower blood pressure (BP), yet evidence from clinical trials is inconsistent, perhaps as a result of small sample size or heterogeneity in study design. METHODS We performed a meta-analysis of randomized trials that tested the effects of magnesium supplementation on BP. Twenty trials meeting the inclusion criteria were identified. Random effects models and meta-regression methods were used to pool study results and to determine the dose-response relationship of magnesium to BP. RESULTS The 20 studies included 14 of hypertensive and 6 of normotensive persons totaling 1220 participants. The doses of magnesium ranged from 10 to 40 mmol/day (median, 15.4 mmol/day). Magnesium supplementation resulted in only a small overall reduction in BP. The pooled net estimates of BP change (95% confidence interval [CI]) were -0.6 (-2.2 to 1.0) mm Hg for systolic BP and -0.8 (-1.9 to 0.4) mm Hg for diastolic BP. However, there was an apparent dose-dependent effect of magnesium, with reductions of 4.3 mm Hg systolic BP (95% CI 6.3 to 2.2; P < .001) and of 2.3 mm Hg diastolic BP (95% CI 4.9 to 0.0; P = .09) for each 10 mmol/day increase in magnesium dose. CONCLUSIONS Our meta-analysis detected dose-dependent BP reductions from magnesium supplementation. However, adequately powered trials with sufficiently high doses of magnesium supplements need to be performed to confirm this relationship.
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Affiliation(s)
- Sun Ha Jee
- Department of Epidemiology and Disease Control, Yonsei University Graduate School of Health Science and Management, Seoul, Korea
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27
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Laurant P, Touyz RM. Physiological and pathophysiological role of magnesium in the cardiovascular system: implications in hypertension. J Hypertens 2000; 18:1177-91. [PMID: 10994748 DOI: 10.1097/00004872-200018090-00003] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Attention is growing for a potential role of magnesium in the pathoetiology of cardiovascular disease. Magnesium modulates mechanical, electrical and structural functions of cardiac and vascular cells, and small changes in extracellular magnesium levels and/or intracellular free magnesium concentration may have significant effects on cardiac excitability and on vascular tone, contractility and reactivity. Thus, magnesium may be important in the physiological regulation of blood pressure whereas alterations in cellular magnesium metabolism could contribute to the pathogenesis of blood pressure elevation. Although most epidemiological and experimental studies support a pathological role for magnesium in the etiology and development of hypertension, data from clinical studies have been less convincing. Furthermore, the therapeutic value of magnesium in the management of essential hypertension is unclear. The present review discusses the molecular, biochemical, physiological and pharmacological roles of magnesium in the regulation of vascular function and blood pressure and introduces novel concepts relating to magnesium as a second messenger in intracellular signaling in cardiovascular cells. In addition, alterations in magnesium regulation in experimental and clinical hypertension and the potential antihypertensive therapeutic effects of magnesium are addressed.
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Affiliation(s)
- P Laurant
- Laboratoire Physiologie, Pharmacologie et Nutrition Prèventive Expérimentale, UFR Médecine et Pharmacie, Université de Franche-Comté, Besancon, France
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Vogt TM, Appel LJ, Obarzanek E, Moore TJ, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Cutler JA, Windhauser MM, Lin PH, Karanja NM. Dietary Approaches to Stop Hypertension: rationale, design, and methods. DASH Collaborative Research Group. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1999; 99:S12-8. [PMID: 10450289 DOI: 10.1016/s0002-8223(99)00411-3] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Epidemiologic studies across societies have shown consistent differences in blood pressure that appear to be related to diet. Vegetarian diets are consistently associated with reduced blood pressure in observational and interventional studies, but clinical trials of individual nutrient supplements have had an inconsistent pattern of results. Dietary Approaches to Stop Hypertension (DASH) was a multicenter, randomized feeding study, designed to compare the impact on blood pressure of 3 dietary patterns. DASH was designed as a test of eating patterns rather than of individual nutrients in an effort to identify practical, palatable dietary approaches that might have a meaningful impact on reducing morbidity and mortality related to blood pressure in the general population. The objectives of this article are to present the scientific rationale for this trial, review the methods used, and discuss important design considerations and implications.
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Affiliation(s)
- T M Vogt
- Kaiser Permanente Center for Health Research, Honolulu, Hawaii 96813, USA
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