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Behers BJ, Melchor J, Behers BM, Meng Z, Swanson PJ, Paterson HI, Mendez Araque SJ, Davis JL, Gerhold CJ, Shah RS, Thompson AJ, Patel BS, Mouratidis RW, Sweeney MJ. Vitamins and Minerals for Blood Pressure Reduction in the General, Normotensive Population: A Systematic Review and Meta-Analysis of Six Supplements. Nutrients 2023; 15:4223. [PMID: 37836507 PMCID: PMC10574336 DOI: 10.3390/nu15194223] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Hypertension is the leading preventable risk factor for cardiovascular disease and all-cause mortality worldwide. However, studies have shown increased risk of mortality from heart disease and stroke even within the normal blood pressure (BP) range, starting at BPs above 110-115/70-75 mm Hg. Nutraceuticals, such as vitamins and minerals, have been studied extensively for their efficacy in lowering BP and may be of benefit to the general, normotensive population in achieving optimal BP. Our study investigated the effects of six nutraceuticals (Vitamins: C, D, E; Minerals: Calcium, Magnesium, Potassium) on both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in this population. We performed a systematic review and pairwise meta-analysis for all six supplements versus placebo. Calcium and magnesium achieved significant reductions in both SBP and DBP of -1.37/-1.63 mm Hg and -2.79/-1.56 mm Hg, respectively. Vitamin E and potassium only yielded significant reductions in SBP with values of -1.76 mm Hg and -2.10 mm Hg, respectively. Vitamins C and D were not found to significantly lower either SBP or DBP. Future studies should determine optimal dosage and treatment length for these supplements in the general, normotensive population.
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Affiliation(s)
- Benjamin J. Behers
- College of Medicine, Florida State University, 1115 W Call Street, Tallahassee, FL 32304, USA; (J.M.); (H.I.P.); (J.L.D.); (C.J.G.); (R.S.S.); (A.J.T.); (R.W.M.); (M.J.S.)
| | - Julian Melchor
- College of Medicine, Florida State University, 1115 W Call Street, Tallahassee, FL 32304, USA; (J.M.); (H.I.P.); (J.L.D.); (C.J.G.); (R.S.S.); (A.J.T.); (R.W.M.); (M.J.S.)
| | - Brett M. Behers
- College of Medicine, University of South Florida, 560 Channel Side Drive MDD 54, Tampa, FL 33602, USA; (B.M.B.); (S.J.M.A.)
| | - Zhuo Meng
- Department of Statistics, Florida State University, 117 N Woodward Ave., Tallahassee, FL 32306, USA; (Z.M.); (P.J.S.)
| | - Palmer J. Swanson
- Department of Statistics, Florida State University, 117 N Woodward Ave., Tallahassee, FL 32306, USA; (Z.M.); (P.J.S.)
| | - Hunter I. Paterson
- College of Medicine, Florida State University, 1115 W Call Street, Tallahassee, FL 32304, USA; (J.M.); (H.I.P.); (J.L.D.); (C.J.G.); (R.S.S.); (A.J.T.); (R.W.M.); (M.J.S.)
| | - Samuel J. Mendez Araque
- College of Medicine, University of South Florida, 560 Channel Side Drive MDD 54, Tampa, FL 33602, USA; (B.M.B.); (S.J.M.A.)
| | - Joshua L. Davis
- College of Medicine, Florida State University, 1115 W Call Street, Tallahassee, FL 32304, USA; (J.M.); (H.I.P.); (J.L.D.); (C.J.G.); (R.S.S.); (A.J.T.); (R.W.M.); (M.J.S.)
| | - Cameron J. Gerhold
- College of Medicine, Florida State University, 1115 W Call Street, Tallahassee, FL 32304, USA; (J.M.); (H.I.P.); (J.L.D.); (C.J.G.); (R.S.S.); (A.J.T.); (R.W.M.); (M.J.S.)
| | - Rushabh S. Shah
- College of Medicine, Florida State University, 1115 W Call Street, Tallahassee, FL 32304, USA; (J.M.); (H.I.P.); (J.L.D.); (C.J.G.); (R.S.S.); (A.J.T.); (R.W.M.); (M.J.S.)
| | - Anthony J. Thompson
- College of Medicine, Florida State University, 1115 W Call Street, Tallahassee, FL 32304, USA; (J.M.); (H.I.P.); (J.L.D.); (C.J.G.); (R.S.S.); (A.J.T.); (R.W.M.); (M.J.S.)
| | - Binit S. Patel
- Internal Medicine Residency, Florida State University, 1700 South Tamiami Trail, Sarasota, FL 34239, USA;
| | - Roxann W. Mouratidis
- College of Medicine, Florida State University, 1115 W Call Street, Tallahassee, FL 32304, USA; (J.M.); (H.I.P.); (J.L.D.); (C.J.G.); (R.S.S.); (A.J.T.); (R.W.M.); (M.J.S.)
| | - Michael J. Sweeney
- College of Medicine, Florida State University, 1115 W Call Street, Tallahassee, FL 32304, USA; (J.M.); (H.I.P.); (J.L.D.); (C.J.G.); (R.S.S.); (A.J.T.); (R.W.M.); (M.J.S.)
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Dreier R, Andersen UB, Forman JL, Sheykhzade M, Egfjord M, Jeppesen JL. Effect of Increased Potassium Intake on Adrenal Cortical and Cardiovascular Responses to Angiotensin II: A Randomized Crossover Study. J Am Heart Assoc 2021; 10:e018716. [PMID: 33870711 PMCID: PMC8200735 DOI: 10.1161/jaha.120.018716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Increased potassium intake lowers blood pressure in patients with hypertension, but increased potassium intake also elevates plasma concentrations of the blood pressure-raising hormone aldosterone. Besides its well-described renal effects, aldosterone is also believed to have vascular effects, acting through mineralocorticoid receptors present in endothelial and vascular smooth muscle cells, although mineralocorticoid receptors-independent actions are also thought to be involved. Methods and Results To gain further insight into the effect of increased potassium intake and potassium-stimulated hyperaldosteronism on the human cardiovascular system, we conducted a randomized placebo-controlled double-blind crossover study in 25 healthy normotensive men, where 4 weeks treatment with a potassium supplement (90 mmol/day) was compared with 4 weeks on placebo. At the end of each treatment period, we measured potassium and aldosterone in plasma and performed an angiotensin II (AngII) infusion experiment, during which we assessed the aldosterone response in plasma. Hemodynamics were also monitored during the AngII infusion using ECG, impedance cardiography, finger plethysmography (blood pressure-monitoring), and Doppler ultrasound. The study showed that higher potassium intake increased plasma potassium (mean±SD, 4.3±0.2 versus 4.0±0.2 mmol/L; P=0.0002) and aldosterone (median [interquartile range], 440 [336-521] versus 237 [173-386] pmol/L; P<0.0001), and based on a linear mixed model for repeated measurements, increased potassium intake potentiated AngII-stimulated aldosterone secretion (P=0.0020). In contrast, the hemodynamic responses (blood pressure, total peripheral resistance, cardiac output, and renal artery blood flow) to AngII were similar after potassium and placebo. Conclusions Increased potassium intake potentiates AngII-stimulated aldosterone secretion without affecting systemic cardiovascular hemodynamics in healthy normotensive men. Registration EudraCT Number: 2013-004460-66; URL: https://www.ClinicalTrials.gov; Unique identifier: NCT02380157.
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Affiliation(s)
- Rasmus Dreier
- Department of Medicine Amager Hvidovre Hospital in Glostrup University of Copenhagen Glostrup Denmark.,Department of Clinical Physiology, Nuclear Medicine, and PET Rigshospitalet Glostrup University of Copenhagen Glostrup Denmark
| | - Ulrik B Andersen
- Department of Clinical Physiology, Nuclear Medicine, and PET Rigshospitalet Glostrup University of Copenhagen Glostrup Denmark
| | - Julie L Forman
- Section of Biostatistics Department of Public Health Faculty of Health and Medical Sciences University of Copenhagen Denmark
| | - Majid Sheykhzade
- Department of Drug Design and Pharmacology Faculty of Health and Medical Sciences University of Copenhagen Denmark
| | - Martin Egfjord
- Department of Nephrology P Rigshospitalet Blegdamsvej University of Copenhagen Denmark.,Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Denmark
| | - Jørgen L Jeppesen
- Department of Medicine Amager Hvidovre Hospital in Glostrup University of Copenhagen Glostrup Denmark.,Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Denmark
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Vaidya A, Carey RM. Evolution of the Primary Aldosteronism Syndrome: Updating the Approach. J Clin Endocrinol Metab 2020; 105:5899581. [PMID: 32865201 PMCID: PMC7899564 DOI: 10.1210/clinem/dgaa606] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/26/2020] [Indexed: 12/19/2022]
Abstract
CONTEXT New approaches are needed to address the evolution of the primary aldosteronism syndrome and to increase its recognition. Herein, we review evidence indicating that primary aldosteronism is a prevalent syndrome that is mostly unrecognized, and present a pragmatic and pathophysiology-based approach to improve diagnosis and treatment. METHODS Evidence was gathered from published guidelines and studies identified from PubMed by searching for primary aldosteronism, aldosterone, renin, and hypertension. This evidence was supplemented by the authors' personal knowledge, research experience, and clinical encounters in primary aldosteronism. INTERPRETATION OF EVIDENCE Renin-independent aldosterone production is a prevalent phenotype that is diagnosed as primary aldosteronism when severe in magnitude, but is largely unrecognized when milder in severity. Renin-independent aldosterone production can be detected in normotensive and hypertensive individuals, and the magnitude of this biochemical phenotype parallels the magnitude of blood pressure elevation, the risk for incident hypertension and cardiovascular disease, and the likelihood and magnitude of blood pressure reduction with mineralocorticoid receptor antagonist therapy. Expansion of the indications to screen for primary aldosteronism, combined with the use of a pathophysiology-based approach that emphasizes inappropriate aldosterone production in the context of renin suppression, will substantially increase the diagnostic and therapeutic yields for primary aldosteronism. CONCLUSIONS The landscape of primary aldosteronism has evolved to recognize that it is a prevalent syndrome of renin-independent aldosterone production that contributes to the pathogenesis of hypertension and cardiovascular disease. Expanding screening indications and simplifying the diagnostic approach will enable implementation of targeted treatment for primary aldosteronism.
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Affiliation(s)
- Anand Vaidya
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, & Hypertension, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Correspondence and Reprint Requests: Anand Vaidya, MD, MMSc, Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Ave, RFB, Boston, MA 02115, USA. E-mail:
| | - Robert M Carey
- Division of Endocrinology and Metabolism, University of Virginia Health System, Charlottesville, Virginia
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