The effect of nutrition on blood pressure

Effect modification of diet and vitamins on the association between air pollution particles of different diameters and hypertension: A 12-year longitudinal cohort study in densely populated areas of China

INTRODUCTION

Particulate matter (PM) is identified as one of the exacerbating and triggering factors for hypertension. Diet intake and the consumption of vitamins may potentially moderate the impact of PM on hypertension.

METHODS

A 12-year longitudinal cohort study was conducted on a population in densely populated areas of China. Residual balancing with weighted methods was employed to control for time-varying and no time-varying confounding factors. Stratified Cox proportional hazards models were conducted to examine the moderating effects of diet and vitamins on the risk of hypertension with PM.

RESULTS

There was a significant positive association between long-term exposure to different diameter PM and the risk of developing hypertension. The hazard ratios (HRs) for hypertension were 1.0200 (95 % CIs: 1.0147, 1.0253) for PM1, 1.0120 (95 % CIs: 1.0085, 1.0155) for PM2.5, and 1.0074 (95 % CIs, 1.0056, 1.0092) for PM10. The diet and vitamins moderated these associations, the intake of healthy foods and vitamins exhibited a significant positive moderating effect on the relationship between PM exposure and hypertension risk. Among all participants, the high intake of fruit (PM1 (HRs: 1.0102, 95 % CIs: 1.0024, 1.0179), PM2.5 (HRs: 1.0060, 95 % CIs: 1.0011, 1.0109), and PM10 (HRs: 1.0044, 95 % CIs: 1.0018, 1.0070)) and vitamin E (PM1 (HRs: 1.0143, 95 % CIs: 1.0063, 1.0223), PM2.5 (HRs:1.0179, 95 % CIs: 1.0003, 1.0166), and PM10 (HRs: 1.0042, 95 % CIs: 1.0008, 1.0075)) with lower risk of hypertension than the overall level and low intake of related foods and vitamins, exhibited a strong positive moderating effect on the relationship between PM and hypertension. Similar trends were observed for the intake of fish, root food, whole grains, eggs, fungus food, vitamin B2, B3. However, Na, meat, sugary and alcoholic exhibited opposite trends. The moderating effect of vitamin E intake was stronger than vitamin B and C.

CONCLUSIONS

Diet and vitamins intake may moderate the association between PM exposure and the risk of hypertension in adults.

Associations between whole grains intake and new-onset hypertension: a prospective cohort study

IMPORTANCE

Epidemiological evidences regarding the association between whole grain intake and the risk of new-onset hypertension are still controversial.

OBJECTIVE

We aimed to investigate the relationship between whole grain intake and new-onset hypertension and examine possible effect modifiers in the general population.

METHODS

A total of 10,973 participants without hypertension from the China Health and Nutrition Survey were enrolled, with follow-up beginning in 1997 and ending in 2015. Whole grain intake was assessed by 3 consecutive 24-h dietary recalls combined with a household food inventory. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression model after adjusting for potential risk factors.

RESULTS

During a median follow-up of 7.0 years, 3,733 participants developed new-onset hypertension. The adjusted HRs (95% CIs) were as follows: for quartile 2 (HR: 0.52; 95% CI: 0.47-0.57), quartile 3 (HR: 0.46; 95% CI: 0.42-0.51), and quartile 4 (HR: 0.35; 95% CI: 0.31-0.38), compared with quartile 1. Different types of whole grain types, including wheat (adjusted HR, 0.35; 95% CI, 0.32-0.39), maize (adjusted HR, 0.50; 95% CI, 0.42-0.59), and millet (adjusted HR, 0.38; 95% CI, 0.30-0.48), showed significant associations with a reduced risk of hypertension. The association between whole grain intake and new-onset hypertension was stronger in individuals with older age (P for interaction < 0.001) and higher BMI (P for interaction < 0.001).

CONCLUSION

Higher consumption of whole grains was significantly associated with a lower risk of new-onset hypertension. This study provides further evidence supporting the importance of increasing whole grain intake for hypertension prevention among Chinese adults.

Inverse Association between the Global Diet Quality Score and New-Onset Hypertension in Adults: A Nationwide Cohort Study

BACKGROUND

The Global Diet Quality Score (GDQS) is a simple and practical dietary metric associated with a number of chronic diseases. The GDQS included various foods related to blood pressure, especially diverse plant-based foods that have shown to lower blood pressure. However, studies on the role of the GDQS in reducing the risk of new-onset hypertension and whether its performance differs from that of other dietary metrics are lacking.

OBJECTIVE

We aimed to examine the association between the GDQS and new-onset hypertension and to compare its performance with that of other dietary patterns, including the Plant-based Diet Index (PDI), alternate Mediterranean diet (aMED) score, Alternative Healthy Eating Index-2010, and Dietary Approaches to Stop Hypertension (DASH) score in Chinese adults.

METHODS

We included a total of 12,002 participants (5644 males and 6358 females) aged >18 y from the China Health and Nutrition Survey (1997-2015). Dietary intake was estimated using average food intakes from 3 consecutive 24-h dietary recalls. Multivariable relative risks (RRs) were computed for hypertension using modified Poisson regression models.

RESULTS

With ≤18 y of follow-up (mean 8.7± 5.4 y), we ascertained 4232 incident cases of hypertension. Compared with participants with a low GDQS score (<15), the multivariable-adjusted RR of hypertension was 0.72 [95% confidence interval (CI): 0.62, 0.83] among participants with a high score (≥23). A 25% increment in the GDQS was associated with a 30% (RR, 0.70; 95% CI: 0.64, 0.76) lower risk of new-onset hypertension, which was comparable with the RRs of new-onset hypertension associated with every 25% increment in the PDI (RR, 0.84; 95% CI: 0.76, 0.93), DASH score (RR, 0.84; 95% CI: 0.78, 0.91), and aMED score (RR, 0.89; 95% CI: 0.84, 0.93).

CONCLUSION

A higher GDQS was associated with a lower risk of new-onset hypertension, with comparable associations of new-onset hypertension with PDI, DASH, and aMED scores in Chinese adults.

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.

National Initiatives on Salt Substitutes: Scoping Review

BACKGROUND

Salt substitutes are edible salts that contain less sodium chloride owing to its partial substitution with other minerals, which serve as an important and effective intervention and public health strategy targeting hypertension and its secondary diseases, despite a small degree of controversy.

OBJECTIVE

This study aimed to identify the current salt substitute initiatives in various nations and intergovernmental organizations (IGOs) worldwide and summarize their types and characteristics.

METHODS

A scoping review was performed based on Arksey and O'Malley's framework and the latest guidance from the Joanna Briggs Institute. Searches were conducted on Google; government websites on food, health, and other related topics; PubMed; Web of Science; and Google Scholar from January 2022 to May 2022. Initiatives related to salt substitutes that were included in the study focused on the involvement of governments or IGOs through the publication of standards, actions, collaborations, funding, and so on. Data were extracted into Microsoft Excel (version 2019; Microsoft Corp) based on predefined items and analyzed using narrative synthesis and frequency count methods.

RESULTS

A total of 35 initiatives from 11 countries (of which 9 are high-income countries) and 3 IGOs were identified. We classified all salt substitute initiatives into 5 types, namely benefit-risk assessments and cautions; plans and actions; regulations and standards; labels; and food reformulation, cooperation with the food industry, and media. More than half (18/35, 51%) of the salt substitute initiatives were launched within the past 5 years. Except for regulations and standards, salt substitute initiatives are, in general, part of the salt reduction framework. No nation or IGO has yet reported on the monitoring and implications of the use of salt substitutes.

CONCLUSIONS

Despite the limited number of salt substitute initiatives worldwide at present, a review on the different types and characteristics of such initiatives could be helpful in providing a reference for policy makers and stakeholders. Given the great potential of salt substitutes in improving hypertension and stroke, we call on more nations to pay attention to these substitutes and propose salt substitute initiatives in line with their national conditions.

Interaction of Dietary Sodium-to-potassium Ratio and Dinner Energy Ratio on Prevalence of Hypertension in Inner Mongolia, China

BACKGROUND

Hypertension is one of the most common chronic diseases, and dietary factors play an important role in hypertension. We examined the interaction of dietary sodium-to-potassium (Na/K) ratio and dinner energy ratio on hypertension.

METHODS

We conducted this study using data from the cross-sectional National Survey for Nutrition and Adult Chronic Disease in 2015 in Inner Mongolia, China. Dietary data were collected using 24-hour diet records with food weights across 3 consecutive days. Logistic regression was used to determine the interaction of dinner energy ratio and dietary Na/K ratio on hypertension.

RESULTS

A total of 1,861 participants were included in this study, and 914 individuals were hypertensive (49.1%). Dinner energy ratio and high dietary Na/K ratio were independently related to high prevalence of hypertension. A formal test showed that dinner energy ratio interacted significantly with dietary Na/K ratio on hypertension (P < 0.001), with an adjusted odds ratio (OR) of 1.119 (95% confidence interval [CI], 1.040-1.203). Participants whose dinner energy ratio greater than 39.1% and dietary Na/K ratio of 3.625-6.053 had the highest OR of hypertension prevalence, with an adjusted OR of 2.984 (95% CI, 1.758-5.066), compared with participants with dinner energy ratio of 30.2-39.1%, and dietary Na/K ratio less than 2.348.

CONCLUSION

Our study highlighted the interactive effect of dinner energy ratio and dietary Na/K ratio on hypertension among adults in Inner Mongolia. We advocated a balanced diet (dinner energy ratio not small or large) and a low dietary Na/K ratio for reducing the prevalence of 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.

Association of dietary fatty acid intake with hypertension in children and adolescents: evidence from the NHANES 2005-2018

Aim

This study aims to evaluate the association between dietary fatty acid intake and hypertension in children and adolescents.

Methods

This cross-sectional study used data of children and adolescents aged 8-17 years from the National Health and Nutrition Examination Survey (NHANES) 2005-2018. Dietary intake of total fat and fatty acid was evaluated via two 24-h dietary recall interviews. Multivariate logistic regression models were used to assess the association between fatty acid intake and hypertension, with odds ratios (ORs) and 95% confidence intervals (CIs) calculated. A subgroup analysis was conducted according to gender, age, and body mass index Z-score.

Results

This study included 13,330 subjects, of which 11,614 were non-hypertensive and 1,716 were hypertensive. Higher intake of total polyunsaturated fatty acids (PUFAs) was associated with significantly lower odds of hypertension (OR = 0.85, 95% CI: 0.74-0.97, P = 0.018). No significant associations were found between the density of total saturated fatty acid, monounsaturated fatty acids, and PUFAs and the odds of hypertension (all P > 0.05). Increased intake of omega-3 (OR = 0.82, 95% CI: 0.72-0.93, P = 0.002) and omega-6 (OR = 0.86, 95% CI: 0.75-0.98, P = 0.025) PUFAs, octadecatrienoic acid (OR = 0.82, 95% CI: 0.72-0.93, P = 0.003), and octadecadienoic acid (OR = 0.86, 95% CI: 0.75-0.98, P = 0.025) was associated with significantly lower odds of hypertension, and individuals with higher omega-6/omega-3 ratio had significantly higher odds of hypertension (OR = 1.09, 95% CI: 1.02-1.17, P = 0.025). The density of omega-3 PUFAs (OR = 0.86, 95% CI: 0.78-0.95, P = 0.004) and octadecatrienoic acid (OR = 0.87, 95% CI: 0.78-0.96, P = 0.006) was inversely associated with the odds of hypertension, and the omega-6/omega-3 ratio was positively associated with the odds of hypertension (OR = 1.09, 95% CI: 1.02-1.17, P = 0.012).

Conclusion

Total PUFA intake was negatively associated with the odds of hypertension in children and adolescents. Higher intake of omega-3 and omega-6 PUFAs, octadecatrienoic acid, and octadecadienoic acid, as well as density of omega-3 PUFAs and octadecatrienoic acid, was associated with lower odds of hypertension.

Intermittent fasting for the prevention of cardiovascular disease: implications for clinical practice

Cardiovascular disease remains one of the most prevalent and preventable chronic conditions worldwide. Nutrition plays an important role in reducing several risk factors associated with cardiovascular disease. Intermittent fasting has been rapidly gaining interest among patients with cardiometabolic disease as a nutritional strategy for improving cardiovascular outcomes. However, research had yet to determine whether intermittent fasting provides greater cardiometabolic benefits compared to continuous daily caloric restriction. A recent Cochrane review has synthesised the benefits of intermittent fasting for the prevention of cardiovascular disease but is limited by its interpretation of the findings for clinical practice. This commentary aims to critically appraise the methods used within the review by Allaf et al, 2021 and expand upon the findings to determine its implications for clinical practice.

Association of fine particulate matter and its constituents with hypertension: the modifying effect of dietary patterns

BACKGROUND

Studies have shown that nutritional supplements could reduce the adverse effects induced by air pollution. However, whether dietary patterns can modify the association of long-term exposure to fine particulate matter (PM2.5) and its constituents with hypertension defined by the 2017 ACC/AHA guideline has not been evaluated.

METHODS

We included 47,501 Chinese adults from a nationwide cross-sectional study. PM2.5 and five constituents were estimated by satellite-based random forest models. Dietary approaches to stop hypertension (DASH) and alternative Mediterranean diet (AMED) scores were calculated for each participant. Interactions between dietary patterns and air pollution were examined by adding a multiplicative interaction term to logistic models.

RESULTS

Long-term exposure to PM2.5 and its constituents was associated with an increased risk of hypertension and stage 1-2 hypertension. The DASH and AMED scores significantly modified these associations, as individuals with higher scores had a significantly lower risk of air pollution-related hypertension and stage 1-2 hypertension (P-interaction < 0.05), except for interaction between PM2.5, sulfate, nitrate, ammonium, and AMED score on stage 1 hypertension. For each IQR increase in PM2.5, participants with the lowest DASH and AMED quintiles had hypertension risk with ORs (95%CI) of 1.20 (1.10, 1.30) and 1.19 (1.09, 1.29), whereas those with the highest DASH and AMED quintiles had lower risks with 0.98 (0.91, 1.05) and 1.04 (0.97, 1.11). The stratified analysis found modification effect was more prominent in the < 65 years age group. Consuming more fresh vegetables, fruits, whole grains, and dairy would reduce the risk of hypertension caused by PM2.5 and its constituents.

CONCLUSIONS

Dietary patterns rich in antioxidants can reduce long-term exposure to PM2.5 and its constituents-induced hypertension defined by the 2017 ACC/AHA guideline, especially in young and middle-aged individuals. Compared to the Mediterranean diet, the DASH diet offers superior dietary guidance to prevent stage 1 hypertension caused by air pollution.

Identification of the Most Suitable Mobile Apps to Support Dietary Approaches to Stop Hypertension (DASH) Diet Self-Management: Systematic Search of App Stores and Content Analysis

Smartphone apps might provide an opportunity to support the Dietary Approaches to Stop Hypertension (DASH) diet, a healthy diet designed to help lower blood pressure. This study evaluated DASH diet self-management apps based on their quality, likely effectiveness, and data privacy/security to identify the most suitable app(s). A systematic search and content analysis were conducted of all DASH diet apps available in Google Play and the Apple App Store in the UK in November 2022. Apps were included if they provided DASH diet tracking. A previous systematic literature review found some commercial apps not found in the app store search, and these were also included in this review. Three reviewers used the App Quality Evaluation Tool (AQEL) to assess each app's quality across seven domains: knowledge acquisition, skill development, behaviour change, purpose, functionality, and appropriateness for adults with hypertension. Domains with a score of 8 or higher were considered high-quality. Two reviewers assessed the apps' data privacy and security and then coded Behaviour change techniques (BCTs) linked to the Theoretical Domain Framework (TDF) underpinning the likely effectiveness of the apps. Seven DASH diet apps were assessed, showing the limited availability of apps supporting DASH diet self-management. The AQEL assessment showed that three apps scored higher than eight in most of the AQEL domains. Nineteen BCTs were used across the apps, linked to nine TDF action mechanisms that may support DASH diet self-management behaviours. Four apps met standards for privacy and security. All seven apps with self-monitoring functionality had sufficient theoretical basis to demonstrate likely effectiveness. However, most had significant quality and data security shortcomings. Only two apps, NOOM and DASH To TEN, were found to have both adequate quality and security and were thus deemed suitable to support DASH diet self-management.

The role of sex and gender in hypertension

Hypertension (HTN) is a critical primary modifiable risk factor for the development of cardiovascular diseases, with recognized sex-based differences. While sex refers to one's biological genetic makeup and attributes, gender encompasses the individual's psycho-socio-cultural characteristics, including their environment and living conditions. The impact of each gendered variable may differ amongst men and women with respect to HTN. Applying a sex and gender-based lenses to inform our understanding of HTN has the potential to unveil important contributors of HTN-related cardiovascular outcomes. For instance, increased life stressors, work related anxiety and depression, typically have more pronounced effect on women than men with HTN. The impact of social surrounding including marital status and social support on HTN also differs amongst men and women. While married men are less likely to have higher blood pressure, single women, and those who never married are less likely to have HTN. Additionally, the beneficial role of social support is more pronounced in more historically marginalized cultural groups compared to majority. Finally, socioeconomic status, including education level and income have a linear and inverse relationship in blood pressure control in more resource-rich countries. The aim of this review is to summarize how sex and gender interact in shaping the clinical course of HTN demonstrating the importance of both sex and gender in HTN risk and its treatment. Hence, when investigating the role of gendered factors in HTN it is imperative to consider cultural, and social settings. In this narrative we found that employment and education play a significant role in manifestation and control of HTN particularly in women.

Sestrin2 as a Potential Target in Hypertension

Hypertension is a highly complex, intricate condition affecting millions of individuals across the globe. Nearly half of adults in the United States are diagnosed with hypertension, with incident rates projected to rise over the next decade. Hypertension is a precursor to many cardiovascular diseases including atherosclerosis, stroke, myocardial infarction, heart failure, and peripheral artery disease. This review describes the major processes contributing to the development of hypertension and how Sestrin2 (Sesn2), an antioxidative protein, could be a potential target in the treatment of hypertension. In hypertension, increased reactive oxygen species (ROS) production is a critical component in the etiology of the condition. The increased ROS in hypertension is derived from a variety of sources, all of which are covered in depth in this review. Increased ROS is generated from mitochondrial stress, endoplasmic reticulum (ER) stress, NADPH oxidase (NOX) overactivity, and the uncoupling of endothelial nitric oxidase synthase (eNOS). Sesn2, a highly conserved, stress-inducible protein, has the structural and functional characteristics to be a potential therapeutic target to alleviate the progression of hypertension. The structure, function, genetics, and characteristics of Sesn2 are presented in the review. The Nrf2/Sesn2, Sesn2/AMPK/mTOR, and Sesn2/Angiotensin II signaling pathways are described in detail in this review. Sesn2 can be utilized in a multitude of ways as a therapeutic modality in hypertension. This review explores potential Sesn2 inducers and activators and how Sesn2 can be incorporated into gene therapy for the treatment of hypertension.

Determinants of hypertension among diabetic patients in southern Ethiopia: a case-control study

BACKGROUND

Hypertension, among diabetic patients, is a worldwide public-health challenge and a number one modifiable risk factor for other cardiovascular diseases and death. The prevalence of hypertension among the diabetic population is nearly twice of nondiabetic patients. Screening and prevention of risk factors for hypertension based on evidence from local studies is required to minimize the burden of hypertension among diabetic patients. This study is aimed at assessing the determinants of hypertension among diabetic patients in Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia, 2022.

METHODS

Facility-based unmatched case-control study design was conducted from March 15 to April 15, 2022, at the outpatient diabetic clinic, Wolaita Sodo University Comprehensive Specialized Hospital. A total of 345 diabetic patients were selected using systematic random sampling techniques. Data were collected using a structured questionnaire by interviewing and extracting from the medical chart of patients. Bivariate logistic regression followed by multiple logistic analysis was used to identify the determinants of hypertension among diabetic patients. A p-value less than 0.05 is considered to be statistically significant.

RESULTS

The significant determinants of hypertension among diabetes patients were being overweight [AOR = 2.06, 95% CI (1.1, 3.89), P = 0.025], being obese [AOR = 2.64, 95% CI (1.22, 5.70), P = 0.013], lack of Moderate intensity exercise [AOR = 2.41, 95% CI (1.36,4.24), P = 0.002], age [AOR = 1.03, 95% CI (1.01, 1.06), P = 0.011], Type 2 diabetes mellitus [AOR = 5.05, 95% CI (1.28, 19.88), P = 0.021], duration of diabetes mellitus ≥ 6 years [AOR = 7.47, 95% CI (2.02, 27.57), P = 0.003], diabetic nephropathy [AOR = 3.87, 95% CI (1.13, 13.29), P = 0.032], and urban residence [AOR = 2.11, 95% CI (1.04,4.29), P = 0.04].

CONCLUSION

Being overweight and obese, lack of moderate-intensity exercise, age, type 2 diabetes mellitus, duration of Diabetes ≥ 6 years, presence of diabetic nephropathy, and being urban residents were significant determinants of hypertension among diabetic patients. These risk factors can be targeted by health professionals for prevention and earlier detection of hypertension among diabetic patients.

A U-shaped association between dietary phosphorus intake and new-onset hypertension: a nationwide cohort study in China

BACKGROUND

The association between dietary phosphorus intake and the risk of hypertension remains uncertain. We aimed to investigate the relation of dietary phosphorus intake with new-onset hypertension among Chinese adults.

METHODS

A total of 12,177 participants who were free of hypertension at baseline from the China Health and Nutrition Survey (CHNS) were included. Dietary intake was measured by 3 consecutive 24-hour dietary recalls combined with a household food inventory. New-onset hypertension was defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or diagnosed by a physician or under antihypertensive treatment during the follow-up.

RESULTS

During a median follow-up of 6.1 years, 4,269 participants developed new-onset hypertension. Overall, the association between dietary phosphorus intake and new-onset hypertension followed a U-shape (P for nonlinearity<.001). Consistently, when dietary phosphorus intake was assessed as quintiles, compared with those in the 3rd to 4th quintiles (912.0-<1089.5 mg/d), a significantly higher risk of new-onset hypertension was found in participants in the 1st to 2nd quintiles (<912.0 mg/d: HR, 1.23; 95% CI, 1.14-1.33), and the fifth quintile (≥1089.5 mg/d: HR, 1.21; 95% CI, 1.10-1.33).

CONCLUSION

There was a U-shaped association between dietary phosphorus intake and new-onset hypertension in general Chinese adults.

Channeling of Brain Towards Engaging Sensorimotor Tasks for Inducing Hedonic Pleasure to Alleviate Blood Pressure in Hypertension

Background

Hypertension is a modifiable risk factor for cardiovascular disease and is responsible for major deaths due to stroke and coronary heart disease. Several pharmacological and non-pharmacological interventions for reducing blood pressure have been tried earlier. Modulating brain regions such as prefrontal cortex (PFC) to channelize activities is an effective tool to target blood pressure.

Purpose

Prefrontal cortex (PFC) exerts inhibitory control over sympathoexcitatory circuits, which was explored using a novel reaction time paradigm.

Methods

Thirty participants of both genders in the age group 40-70 years with established hypertension were included. A structured reaction time paradigm was designed to include psychomotor and visuomotor elements with integrated sensory attention and motor performance tasks. Blood pressure, Lead II ECG, and EEG from F3 and F4 were recorded. A paired t-test was used to examine the variations in these parameters across tasks.

Results

A significant reduction in mean arterial pressure by 4.04 mmHg (p = .0232) during the visuomotor task and a reduction of 3.38 mmHg during the auditory cue task (p = .0446) were observed. Analysis of the difference in heart rate has shown a profound decrease after passive listening tasks by 3.7 beats (p < .0001*). Spectral analysis from F3 and F4 shows high power in low-frequency zone of EEG indicating a relaxed state during auditory cues and passive listening.

Conclusion

The reaction time paradigm, when applied to hypertensives, helped decrease blood pressure and heart rate and improved the high frequency (HF) component of heart rate variability, indicating parasympathetic dominance. Such reward-oriented paradigms may act as biofeedback modules that cause hyperactivity of the PFC to suppress the sympathoexcitatory circuit with increased parasympathetic activity beneficial to hypertensive individuals.

Supermarket Proximity and Risk of Hypertension, Diabetes, and CKD: A Retrospective Cohort Study

RATIONALE & OBJECTIVE

Living in environments with low access to food may increase the risk of chronic diseases. We investigated the association of household distance to the nearest supermarket (as a measure of food access) with the incidence of hypertension, diabetes, and chronic kidney disease (CKD) in a metropolitan area of the United States.

STUDY DESIGN

Retrospective cohort study.

SETTING & PARTICIPANTS

777,994 individuals without hypertension, diabetes, or CKD at baseline within the HealthLNK Data Repository, which contains electronic health records from 7 health care institutions in Chicago, Illinois.

EXPOSURE

Zip code-level average distance between households and nearest supermarket.

OUTCOME

Incidence of hypertension, diabetes, and CKD based on presence of ICD-9 code and/or blood pressure≥140/90mm Hg, hemoglobin A1c≥6.5%, and eGFR<60mL/min/1.73m², respectively.

ANALYTICAL APPROACH

Average distance to nearest supermarket was aggregated from street-level metrics for 56 Chicagoland zip codes. The cumulative incidence of hypertension, diabetes, and CKD from 2007-2012 was calculated for each zip code in patients free of these diseases in 2006. Spatial analysis of food access and disease incidence was performed using bivariate local indicator of spatial association (BiLISA) maps and bivariate local Moran I statistics. The relationship between supermarket access and outcomes was analyzed using logistic regression.

RESULTS

Of 777,994 participants, 408,608 developed hypertension, 51,380 developed diabetes, and 56,365 developed CKD. There was significant spatial overlap between average distance to supermarket and incidence of hypertension and diabetes but not CKD. Zip codes with large average supermarket distances and high incidence of hypertension and diabetes were clustered in southern and western neighborhoods. Models adjusted only for neighborhood factors (zip code-level racial composition, access to vehicles, median income) revealed significant associations between zip code-level average distance to supermarket and chronic disease incidence. Relative to tertile 1 (shortest distance), ORs in tertiles 2 and 3, respectively, were 1.27 (95% CI, 1.23-1.30) and 1.38 (95% CI, 1.33-1.43) for diabetes, 1.03 (95% CI, 1.02-1.05) and 1.04 (95% CI, 1.02-1.06) for hypertension, and 1.18 (95% CI, 1.15-1.21) and 1.33 (95% CI, 1.29-1.37) for CKD. Models adjusted for demographic factors and health insurance showed significant and positive association with greater odds of incident diabetes (tertile 2: 1.29 [95% CI, 1.26-1.33]; tertile 3: 1.35 [95% CI, 1.31-1.39]) but lesser odds of hypertension (tertile 2: 0.95 [95% CI, 0.94-0.97]; tertile 3: 0.91 [95% CI, 0.89-0.92]) and CKD (tertile 2: 0.80 [95% CI, 0.78-0.82]; tertile 3: 0.73 [95% CI, 0.72-0.76]). After adjusting for both neighborhood and individual covariates, supermarket distance remained significantly associated with greater odds of diabetes and lesser odds of hypertension, but there was no significant association with CKD.

LIMITATIONS

Unmeasured neighborhood and social confounding variables, zip code-level analysis, and limited individual-level information.

CONCLUSIONS

There are significant disparities in supermarket proximity and incidence of hypertension, diabetes, and CKD in Chicago, Illinois. The relationship between supermarket access and chronic disease is largely explained by individual- and neighborhood-level factors.

The effect of almond intake on cardiometabolic risk factors, inflammatory markers, and liver enzymes: A systematic review and meta-analysis

Almond intake may be correlated with improvements in several cardiometabolic parameters, but its effects are controversial in the published literature, and it needs to be comprehensively summarized. We conducted a systematic search in several international electronic databases, including MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until April 2021 to identify randomized controlled trials that examined the effects of almond consumption on cardiometabolic risk factors, inflammatory markers, and liver enzymes. Data were pooled using the random-effects model method and presented as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Twenty-six eligible trials were analyzed (n = 1750 participants). Almond intake significantly decreased diastolic blood pressure, total cholesterol, triglyceride, low-density lipoprotein (LDL), non-high-density lipoprotein (HDL), and very LDL (p < 0.05). The effects of almond intake on systolic blood pressure, fasting blood glucose, insulin, hemoglobin A1c, homeostatic model assessment of insulin resistance, C-peptide, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, C-reactive protein (CRP), hs-CRP (high sensitivity C-reactive protein), interleukin 6, tumor necrosis factor-α, ICAM (Intercellular Adhesion Molecule), VCAM (Vascular Cell Adhesion Molecule), homocysteine, HDL, ox-LDL, ApoA1, ApoB, and lipoprotien-a were not statistically significant (p > .05). The current body of evidence supports the ingestion of almonds for their beneficial lipid-lowering and antihypertensive effects. However, the effects of almonds on antiinflammatory markers, glycemic control, and hepatic enzymes should be further evaluated via performing more extensive randomized trials.

J-Shaped Association of Tomato Intake with New-Onset Hypertension in General Adults: A Nationwide Prospective Cohort Study

We aim to examine the prospective association between the intake of dietary tomatoes and the risk of new-onset hypertension and its modifiable factors in general adults. A total of 11,460 adults without hypertension from the China Health and Nutrition Survey (CHNS) were enrolled, with follow-up beginning in 1997 and ending in 2015. Dietary tomato intake was measured by three consecutive 24-h dietary recalls combined with a household food inventory. The study outcome was new-onset hypertension, defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or diagnosed by physicians or under anti-hypertensive treatment during the follow-up. Finally, 4015 subjects developed new-onset hypertension during 92,335.5 person-years of follow-up. After multivariate adjustment for dietary and non-dietary risk factors, hazard ratios for increased consumption of dietary tomatoes were 0.42 (95% confidence interval, 0.37−0.47), 0.51 (0.46−0.57), and 0.82 (0.74−0.92) compared with non-consumers. Overall, cubic spline regression suggested a novel J-shaped association between dietary tomato intake and new-onset hypertension, with the lowest risk observed at approximately 10 to 13 g/day (p < 0.001 for curvature). Moreover, the association between dietary tomato intake and risk of new-onset hypertension was stronger in females or individuals who refrained from smoking or drinking (p = 0.024, p = 0.043, and p = 0.044 for interaction, respectively).

The advanced lung cancer inflammation index predicts long-term outcomes in patients with hypertension: National health and nutrition examination study, 1999–2014

Background

Malnutrition and systemic inflammation are associated with poor outcomes in patients with hypertension, and the two often coexist. However, few studies have combined nutritional and inflammatory status to assess the prognosis of patients with hypertension. The present study aimed to investigate the association between advanced lung cancer inflammation index (ALI), as a factor assessment the nutritional and inflammatory status, and long-term all-cause mortality of patients with hypertension.

Materials and methods

Data from the National Health and Nutrition Examination Survey (NHANES) 1999–2014 with mortality follow-up through December 31, 2015, were analyzed. A total of 15,681 participants were evaluated. The patients were grouped based on the ALI tertiles as follows: T1 (ALI ≤ 49.41, n = 5,222), T2 (ALI &gt; 49.41 and ≤ 76.29, n = 5,221), and T3 (ALI &gt; 76.29, n = 5,237) groups. Survival curves and Cox regression analysis based on the NHANES recommended weights were used to assess the relationship between nutritional and inflammatory status and long-term all-cause mortality.

Results

Advanced lung cancer inflammation index was significantly associated with long-term all-cause mortality in patients with hypertension. After adjustment for related factors, the T2 [hazard ratio (HR): 0.69, 95% confidence interval (CI): 0.58–0.83; P &lt; 0.001) and T3 (HR: 0.59, 95% CI: 0.47–0.74; P &lt; 0.001) groups were significantly associated with a decreased risk of all-cause mortality compared to the lower ALI level group (T1).

Conclusion

Advanced lung cancer inflammation index was a comprehensive index of nutrition and inflammation and an independent significant prognostic factor in hypertension patients in the American community. Systemic inflammatory and nutritional status assessment and monitoring are essential for the health of hypertensive patients.

Dietary Patterns in Association With Hypertension: A Community-Based Study in Eastern China

Objective

This study aimed to explore the association between dietary patterns and hypertension based on a community–based survey in Suzhou, Eastern China.

Methods

This cross–sectional analysis was undertaken from the subset of the Suzhou Food Consumption and Health State Survey in 2018–2019. Adults aged ≥ 18 years were invited to participate in this survey. Dietary intake was collected by a 24–h dietary recall and a weighing method over three consecutive days (including two weekdays and one weekend day). Dietary patterns were defined using factor analysis. Association between the dietary patterns and hypertension was examined by multivariable logistic regression models with adjustment for covariates. Moreover, sensitivity analysis was used to reinforce our findings.

Results

A total of 2,718 participants were included in the final analysis. Rice-vegetable pattern, fast food pattern, fruit-dairy pattern, and wheat-meat pattern were identified. We observed that the fruit-dairy pattern was inversely associated with hypertension after adjustment for all the covariates (OR = 0.55; 95% CI: 0.40, 0.75; P = 0.002). The association between the wheat-meat pattern and hypertension was attenuated and became statistically nonsignificant in sensitivity analyses. The other two patterns were not significantly associated with hypertension (P &gt; 0.05).

Conclusion

The fruit-dairy pattern was inversely associated with the risk of hypertension among Chinese adults. Our findings further emphasize the important role of optimal diet combination in the prevention of hypertension.

The Role of Berry Consumption on Blood Pressure Regulation and Hypertension: An Overview of the Clinical Evidence

The existence of a relationship between the consumption of dietary berries and blood pressure reduction in humans has been repeatedly hypothesized and documented by an increasing body of epidemiological and clinical evidence that has accumulated in recent years. However, results are mixed and complicated by a number of potentially confounding factors. The objective of this article is to review and summarize the available clinical evidence examining the effects of berry consumption on blood pressure regulation as well as the prevention or treatment of hypertension in humans, providing an overview of the potential contribution of distinctive berry polyphenols (anthocyanins, condensed tannins and ellagic acid), and results of dietary interventions with blueberries, bilberries, cranberries, raspberries, strawberries, chokeberries, cherries, blackcurrants and açai berries. We conclude that, while there is insufficient evidence supporting the existence of a direct blood pressure lowering effect, there is stronger evidence for specific types of berries acting indirectly to normalize blood pressure in subjects that are already hypertensive.

Inverse Association Between Variety of Proteins With Appropriate Quantity From Different Food Sources and New-Onset Hypertension

The relationships of the variety and quantity of different sources of dietary proteins with hypertension remain uncertain. We aimed to investigate associations between the variety and quantity of proteins intake from 8 major food sources and new-onset hypertension among 12 177 participants from the China Health and Nutrition Survey. Dietary intake was measured by 3 consecutive 24-hour dietary recalls combined with a household food inventory. The variety score of protein sources was defined as the number of protein sources consumed at the appropriate level, accounting for types and quantity of proteins. New-onset hypertension was defined as systolic blood pressure ≥140 mm Hg and diastolic blood pressure ≥90 mm Hg, or physician-diagnosed hypertension or receiving antihypertensive treatment, during the follow-up. During a median follow-up of 6.1 years, there were U-shaped associations of percentages energy from total, unprocessed or processed red meat-derived, whole grain-derived, and poultry-derived proteins with new-onset hypertension; an reverse J-shaped association of fish-derived protein with new-onset hypertension; L-shaped associations of eggs-derived and legumes-derived proteins with new-onset hypertension; and an reverse L-shaped association of refined grain-derived protein with new-onset hypertension (all P values for nonlinearity <0.001). That is, for each protein, there is a window of consumption (appropriate level) where the risk of hypertension is lower. Moreover, a significantly lower risk of new-onset hypertension was found in those with higher variety score of protein sources (per score increment, hazard ratio, 0.74 [95% CI, 0.72-0.76]). In summary, there was an inverse association between the variety of proteins with appropriate quantity from different food sources and new-onset hypertension.

Olympic Cycle Comparison of the Nutritional and Cardiovascular Health Status of an Elite-Level Female Swimmer: Case Study Report from Slovenia

Monitoring the many aspects that are crucial to an athlete’s performance progress is vital for further training planning and for the development of performance and the sport. We evaluated a four-year change (2018 vs. 2022) in the current nutritional and cardiovascular health status of the most successful elite-level female swimmer in Slovenia. Body composition and dietary intake were assessed using dual-energy X-ray absorptiometry and a standardized food questionnaire. The concentration of blood lipids, blood pressure, and serum micronutrients (B₁₂, 25(OH)D), potassium, calcium, phosphorus, magnesium, and iron) were measured. The four-year comparison showed an improved body composition status (i.e., increased body mass and decreased body fat (percentage and mass), increased lean soft tissue and total bone mineral density (BMD) (i.e., significantly decreased BMD of a left femoral neck and increased BMD of a spine and head)). We also measured an improvement in the cardiovascular health status of some markers (i.e., decreased total cholesterol, triglycerides, and blood pressure but increased low-density lipoprotein cholesterol), most likely due to the differences in assessed dietary intake (i.e., lower carbohydrate intake, higher total and saturated fat intake, and lower sodium intake). Notably, nutrient intakes that are generally of concern (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), vitamin B₁₂ and D, calcium, iron, and zinc (except for fiber intake)) were all within recommended ranges. However, the athlete’s vitamin K and potassium intake were not adequate. Furthermore, in 2018, the athlete did not consume dietary supplements, while she now regularly uses several dietary supplements, including EPA and DHA omega-3, vitamin D, multivitamins, carbohydrate powder, and sports drink. Moreover, from the micronutrient serum, only iron levels deviated from the reference values (37 μmol/L vs. 10.7–28.6 μmol/L). The presented screening example using valid, sensitive, and affordable methods and with rapid organizational implementation may be a viable format for regular monitoring.

Prevalence and Prognostic Significance of Malnutrition in Hypertensive Patients in a Community Setting

BACKGROUND

Malnutrition is a significantly poor prognostic factor for a variety of cardiovascular diseases. However, its prevalence and prognostic value in hypertensive patients is still unclear. The present study sought to determine the prevalence and prognostic value of malnutrition in hypertensive patients in a community setting.

METHODS

We included 9,949 hypertensive patients from the National Health and Nutrition Examination Survey (NHANES) (2005-2014). The Controlling Nutritional Status (CONUT) score, the Nutritional Risk Index (NRI), and the Naples Prognostic Score (NPS) were applied to assess the nutritional status of participants. A Cox regression model was established to examine the association between malnutrition and cardiovascular and all-cause mortality.

RESULTS

In all, 19.9, 3.9, and 82.9% hypertensive patients were considered to have malnutrition as evaluated by the CONUT, NRI, and NPS, respectively. Malnutrition assessed by CONUT and NRI was independently associated with cardiovascular mortality (HR [95% CI]) for mild and moderate-to-severe degree of malnutrition, respectively: 1.41 (1.04-1.91) and 5.79 (2.34-14.29) for CONUT; 2.60 (1.34-5.07) and 3.30 (1.66-6.56) for NRI (all P < 0.05), and for all-cause mortality (HR [95% CI]) for mild and moderate-to-severe degree of malnutrition, respectively: 1.48 (1.30-1.70) and 4.87 (3.40-6.98) for CONUT; 1.72 (1.24-2.39) and 2.60 (1.96-3.44) for NRI (all P < 0.01). Naples Prognostic Score could only independently predict all-cause mortality.

CONCLUSIONS

Malnutrition was common among hypertensive patients and was closely associated with both long-term cardiovascular and all-cause mortality.

A systematic review and meta-analysis of the effects of Hibiscus sabdariffa on blood pressure and cardiometabolic markers

Context

Hibiscus sabdariffa (hibiscus) has been proposed to affect cardiovascular risk factors.

Objective

To review the evidence for the effectiveness of hibiscus in modulating cardiovascular disease risk markers, compared with pharmacologic, nutritional, or placebo treatments.

Data Sources

A systematic search of the Web of Science, Cochrane, Ovid (MEDLINE, Embase, AMED), and Scopus databases identified reports published up to June 2021 on randomized controlled trials using hibiscus as an intervention for lipid profiles, blood pressure (BP), and fasting plasma glucose levels in adult populations.

Data Extraction

Seventeen chronic trials were included. Quantitative data were examined using a random effects meta-analysis and meta-regression with trial sequential analysis to account for type I and type II errors.

Data Analysis

Hibiscus exerted stronger effects on systolic BP (−7.10 mmHg [95%CI, −13.00, −1.20]; I² = 95%; P = 0.02) than placebo, with the magnitude of reduction greatest in those with elevated BP at baseline. Hibiscus induced reductions to BP similar to that resulting from medication (systolic BP reduction, 2.13 mmHg [95%CI, −2.81, 7.06], I² = 91%, P = 0.40; diastolic BP reduction, 1.10 mmHg [95%CI, −1.55, 3.74], I² = 91%, P = 0.42). Hibiscus also significantly lowered levels of low-density lipoprotein compared with other teas and placebo (−6.76 mg/dL [95%CI, −13.45, −0.07]; I² = 64%; P = 0.05).

Conclusions

Regular consumption of hibiscus could confer reduced cardiovascular disease risk. More studies are warranted to establish an effective dose response and treatment duration.

Systematic Review Registration

PROSPERO registration no. CRD42020167295

The influence of NaCl on the dynamic perception of the pungency sensation elicited by Sichuan pepper oleoresins

A cross-modal interaction may exist between the perception of saltiness and the pungency elicited by Sichuan pepper oleoresin (Spo). Thirty-one hypersensitive panelists were selected to participate in this study. Spo solutions dissolved in different NaCl concentrations, ranging from 1.25 g/L to 167.9 g/L, were used as the test samples. The rated difference from control, the generalized labeled magnitude scale (gLMS), and the time-intensity (TI) method were used to determine the detection threshold (DT), the recognition threshold (RT), the intensity, and the dynamic perception of pungent sensation. The results revealed that the pungency thresholds increased significantly (p < 0.01) in the solution with a high NaCl (167.9 g/L) concentration. Furthermore, high NaCl solutions suppressed the pungency intensity at all Spo concentrations except for 0.02 g Spo/L in water (p < 0.05). The TI and principal component analysis (PCA) results showed that an increase in the Spo concentration prolonged the duration of the pungency sensation. However, the maximum intensity, the time to reach maximum intensity, the decay time of perception, and the end time of perception of the Spo solutions ranging from 2.13 g/L to 4.69 g/L were significantly reduced at medium (42.95 g/L) and high NaCl concentrations. Since the salty and pungency sensations exhibited by NaCl and Spo are common flavor combinations in food products and dishes, studying the influence of saltiness on the dynamic perception of pungent sensation not only aids the development of oral cleaners during pungency evaluation but also presents significant theoretical and practical value in creating pungent food and cuisine based on consumer preferences.

Dairy Product Consumption and Cardiovascular Health: a Systematic Review and Meta-Analysis of Prospective Cohort Studies

The association between dairy product consumption and cardiovascular health remains highly debated. We quantitatively synthesized prospective cohort evidence on the associations between dairy consumption and risk of hypertension (HTN), coronary heart disease (CHD) and stroke. We systematically searched PubMed, Embase, and Web of Science through August 1st, 2020 to retrieve prospective cohort studies that reported on dairy consumption and risk of HTN, CHD or stroke. We used random-effects models to calculate the pooled relative risk (RR) and 95% confidence interval (CI) for the highest vs the lowest category of intake and for 1 serving/day increase in consumption. We rated the quality of evidence using NutriGrade. Fifty-five studies were included. Total dairy consumption was associated with a lower risk of HTN (RR for highest vs lowest level of intake: 0.91, 95% CI: 0.86-0.95, I2 = 73.5%; RR for 1 serving/day increase: 0.96, 95% CI: 0.94-0.97, I2 = 66.5%), CHD (highest vs lowest level of intake: 0.96, 95% CI: 0.92-1.00, I2 = 46.6%; 1 serving/day increase: 0.98, 95% CI: 0.95-1.00, I2 = 56.7%), and stroke (highest vs lowest level of intake: 0.90, 95% CI: 0.85-0.96, I2 = 60.8%; 1 serving/day increase: 0.96, 95% CI: 0.93-0.99, I2 = 74.7%). Despite moderate to considerable heterogeneity, these associations remained consistent across multiple subgroups. Evidence on the relationship between total dairy and risk of HTN and CHD were of moderate quality and of low quality for stroke. Low-fat dairy consumption was associated with lower risk of HTN and stroke, and high-fat dairy with a lower risk of stroke. Milk, cheese, or yogurt consumption showed inconsistent associations with the cardiovascular outcomes in high vs. low intake and dose-response meta-analyses. Total dairy consumption was associated with a modestly lower risk of hypertension, CHD and stroke. Moderate to considerable heterogeneity was observed in the estimates and the overall quality of the evidence was low to moderate.

Higher habitual dietary flavonoid intake associates with lower central blood pressure and arterial stiffness in healthy older adults

Flavonoids have shown anti-hypertensive and anti-atherosclerotic properties: the impact of habitual flavonoid intake on vascular function, central haemodynamics and arterial stiffness may be important. We investigated the relationship between habitual flavonoid consumption and measures of central blood pressure and arterial stiffness. We performed cross-sectional analysis of 381 non-smoking healthy older adults (mean age 66·0 (sd 4·1) years; BMI, 26·4 (sd 4·41) kg/m2; 41 % male) recruited as part of the Australian Research Council Longevity Intervention study. Flavonoid intake (i.e. flavonols, flavones, flavanones, anthocyanins, isoflavones, flavan-3-ol monomers, proanthocyanidins, theaflavins/thearubigins and total consumption) was estimated from FFQ using the US Department of Agriculture food composition databases. Measures of central haemodynamics and arterial stiffness included systolic blood pressure (cSBP), diastolic blood pressure (cDBP), mean arterial pressure (cMAP) and augmentation index (cAIx). After adjusting for demographic and lifestyle confounders, each sd/d higher intake of anthocyanins ((sd 44·3) mg/d) was associated with significantly lower cDBP (-1·56 mmHg, 95 % CI -2·65, -0·48) and cMAP (-1·62 mmHg, 95 % CI -2·82, -0·41). Similarly, each sd/d higher intake of flavanones ((sd 19·5) mg/d) was associated with ~1 % lower cAIx (-0·93 %, 95 % CI -1·77, -0·09). These associations remained significant after additional adjustment for (1) a dietary quality score and (2) other major nutrients that may affect blood pressure or arterial stiffness (i.e. Na, K, Ca, Mg, n-3, total protein and fibre). This study suggests a possible benefit of dietary anthocyanin and flavanone intake on central haemodynamics and arterial stiffness; these findings require corroboration in further research.

Autonomic nervous system activity changes in patients with hypertension and overweight: role and therapeutic implications

The incidence and prevalence of hypertension is increasing worldwide, with approximately 1.13 billion of people currently affected by the disease, often in association with other diseases such as diabetes mellitus, chronic kidney disease, dyslipidemia/hypercholesterolemia, and obesity. The autonomic nervous system has been implicated in the pathophysiology of hypertension, and treatments targeting the sympathetic nervous system (SNS), a key component of the autonomic nervous system, have been developed; however, current recommendations provide little guidance on their use. This review discusses the etiology of hypertension, and more specifically the role of the SNS in the pathophysiology of hypertension and its associated disorders. In addition, the effects of current antihypertensive management strategies, including pharmacotherapies, on the SNS are examined, with a focus on imidazoline receptor agonists.

Uncovering the relationship between food-related discussion on Twitter and neighborhood characteristics

Objective

Initiatives to reduce neighborhood-based health disparities require access to meaningful, timely, and local information regarding health behavior and its determinants. We examined the validity of Twitter as a source of information for neighborhood-level analysis of dietary choices and attitudes.

Materials and Methods

We analyzed the “healthiness” quotient and sentiment in food-related tweets at the census tract level, and associated them with neighborhood characteristics and health outcomes. We analyzed keywords driving the differences in food healthiness between the most and least-affluent tracts, and qualitatively analyzed contents of a random sample of tweets.

Results

Significant, albeit weak, correlations existed between healthiness and sentiment in food-related tweets and tract-level measures of affluence, disadvantage, race, age, U.S. density, and mortality from conditions associated with obesity. Analyses of keywords driving the differences in food healthiness revealed foods high in saturated fat (eg, pizza, bacon, fries) were mentioned more frequently in less-affluent tracts. Food-related discussion referred to activities (eating, drinking, cooking), locations where food was consumed, and positive (affection, cravings, enjoyment) and negative attitudes (dislike, personal struggles, complaints).

Discussion

Tweet-based healthiness scores largely correlated with offline phenomena in the expected directions. Social media offer less resource-intensive data collection methods than traditional surveys do. Twitter may assist in informing local health programs that focus on drivers of food consumption and could inform interventions focused on attitudes and the food environment.

Conclusions

Twitter provided weak but significant signals concerning food-related behavior and attitudes at the neighborhood level, suggesting its potential usefulness for informing local health disparity reduction efforts.

Ultra-processed foods, changes in blood pressure and incidence of hypertension: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Objective:

To estimate changes in blood pressure and the incidence of hypertension associated with consumption of ultra-processed foods (UPF) by Brazilian civil servants at a 4-year follow-up.

Design:

Longitudinal analysis of the ELSA-Brasil with non-hypertensive individuals at baseline. We applied the FFQ at the baseline and categorised energy intake by degree of processing, using the NOVA classification. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at baseline (2008–2010) and again at first follow-up (2012–2014). Incidence of arterial hypertension was defined as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or antihypertensive medication during the previous 2 weeks. A mixed-effect linear regression model and mixed-effect logistic regression model were used to estimate associations between UPF consumption and, respectively, changes in blood pressure and incidence of hypertension.

Setting:

Brazil.

Participants:

Civil servants of Brazilian public academic institutions in six cities (n 8754), aged 35–74 years at baseline (2008–2010).

Results:

UPF consumption contributed 25·2 % (sd = 9·6) of total energies consumed. After adjustment, participants with high UPF consumption presented a 23 % greater risk of developing hypertension (OR = 1·23, 95 % CI 1·06, 1·44) than those with low UPF consumption. We did not find association between UPF consumption and changes in blood pressure over time.

Conclusions:

The higher the UPF consumption, the higher the risk of hypertension in adults. Reducing UPF consumption is thus important to promote health and prevent hypertension.

Reasons for poor blood pressure control in Eastern Sub-Saharan Africa: looking into 4P's (primary care, professional, patient, and public health policy) for improving blood pressure control: a scoping review

AIM

Hypertension control in Sub-Saharan Africa (SSA) is the worst (less than one out of ten) when compared to the rest of the world. Therefore, this scoping review was conducted to identify and describe the possible reasons for poor blood pressure (BP) control based on 4Ps' (patient, professional, primary healthcare system, and public health policy) factors.

METHODS

PRISMA extension for scoping review protocol was used. We systematically searched articles written in the English language from January 2000 to May 2020 from the following databases: PubMed/Medline, Embase, Scopus, Web of Science, and Google scholar.

RESULTS

Sixty-eight articles were included in this scoping review. The mean prevalence of hypertension, BP control, and patient adherence to prescribed medicines were 20.95%, 11.5%, and 60%, respectively. Only Kenya, Malawi, and Zambia out of ten countries started annual screening of the high-risk population for hypertension. Reasons for nonadherence to prescribed medicines were lack of awareness, lack of access to medicines and health services, professional inertia to intensify drugs, lack of knowledge on evidence-based guidelines, insufficient government commitment, and specific health behaviors related laws. Lack of screening for high-risk patients, non-treatment adherence, weak political commitment, poverty, maternal and child malnutrition were reasons for the worst BP control.

CONCLUSION

In conclusion, the rate of BP treatment, control, and medication adherence was low in Eastern SSA. Screening for high-risk populations was inadequate. Therefore, it is crucial to improve government commitment, patient awareness, and access to medicines, design country-specific annual screening programs, and empower clinicians to follow individualized treatment and conduct medication adherence research using more robust tools.

Incentives to Reduce Salt Intake Resulting From Women's Experiences: A Qualitative Study

INTRODUCTION

Over consumption of salt adversely affects health and is associated with some diseases. Salt over consumption has been reported to be higher in Asian countries including Iran. This research aimed to identify the facilitative factors of reduced salt consumption among 20-65 year-old women to develop effective educational interventions. Methods: This research used qualitative content analysis. We included 42 (31 women aged 20-65 years residing in Hamidia, Yazd and 11 healthcare providers) using Purposeful sampling method. Data were collected through focal group discussions (three groups of 6) and in-depth semi-structured individual interviews with 24 Participants. Data analysis was done using Graneheim and Lundman's approach. Results: Motivators and facilitators were extracted. The former consisted of sub-categories: physical fitness and healthcare, obtaining others' approval, family cooperation and support, internal motivators, contextual motivators and healthcare staff support. Sub-categories of the latter were gaining more information from different instructions, willingness to acquire self-protection skills and nutritional advice. These factors affected to reduce the salt intake among women. Conclusion: In the light of the qualitative results of motivating and facilitating factors, it is essential to enhance internal motivators and increase access to information via different communicative channels in community including schools, medical care providers and public associations. It is also necessary to pave the way for more family and medical staff support, provide appropriate educational and advertising programs, raise women's awareness and change their attitude and behavior with this concern.

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.

Fruit and Vegetable Consumption Behavior Among Asian Americans: A Thematic Analysis

Consuming 5 or more cups of fruits and vegetables (F & V) per day or 400 g/day for adults is advocated by most health authorities and has short-term and long-term health benefits. There have been numerous studies examining dietary behaviors among different US populations; however, the literature on F & V consumption behavior among Asian Americans (AAs) is sparse. AAs constitute a diverse group and as their population continues to grow in the US; there is a greater need to examine the health practices of AAs and their constituent subgroups. The study aimed to conduct a thematic analysis based on a scoping review of the peer-reviewed published literature over the past 15 years targeting F & V consumption among AAs. The thematic analysis was organized around the prevalence, consequences, determinants, and interventions (n = 33). AAs consuming recommended servings of F & V ranged from 0.5% to 20%. Correlations between the consumption of F & V and Body Mass Index (BMI) and other chronic diseases were reported as negative and significant associations were noted between F & V intake and self-reported health. There was only 1 intervention that was conducted with this behavior in only 1 small subgroup of this target population. There is an urgent need to study F & V consumption behavior among different AA subgroups as well as to design culturally appropriate theory-based efficacious F & V promotion interventions for them.

Association of dietary patterns and practices on metabolic syndrome in adults with central obesity attending a mission hospital in Kenya: a cross-sectional study

OBJECTIVE

Dietary patterns and practices can predispose or protect against metabolic syndrome (MetS) in humans. Despite the growing problem of MetS in adults, the underpinning dietary behaviour is poorly understood. We determined the dietary patterns and practices relevant to MetS in adults with central obesity attending a mission hospital in Kenya.

STUDY DESIGN

Descriptive, cross-sectional.

SETTING

Outpatient clinic of a mission-based hospital in Nairobi.

PARTICIPANTS

Adults (N=404) aged 18-64 years diagnosed with central obesity as per the International Diabetes Federation definition for MetS.

PRIMARY OUTCOMES

Anthropometric measurements, clinical-biochemical markers and dietary components, quantity and frequency of food intake, as well as time-lapse between consumption of dinner and sleeping.

RESULTS

A high (87.2%) prevalence of MetS was observed for respondents who reported consumption of large amount of carbohydrates (p<0.001), proteins (p<0.001), processed/fast foods (p<0.001) and sugar (p=0.009). Frequent consumption of legumes (p<0.001), nuts (p<0.001), fruits (p<0.001) and vegetables (p=0.021) was linked to reduced MetS. Additionally, longer interval between eating dinner and going to bed was associated with reduced MetS.

CONCLUSION

Regular consumption of fruits, vegetables, legumes and nuts, as well as observing sometime after eating dinner before sleeping, was the dietary pattern significantly associated with a lower risk of MetS. Whereas, consumption of a large quantity of carbohydrates, proteins, processed/fast foods and sugar is likely to predispose to MetS. The findings underscore the need to focus on specific dietary intake patterns including frequency, quantity, quality and variety for MetS prevention and management. The MetS-related interventions could be implemented during individual consultation, group and community health messaging sessions.

Brain and muscle adaptation to high-fat diets and exercise: Metabolic transporters, enzymes and substrates in the rat cortex and muscle

There is evidence suggesting that the effects of diet and physical activity on physical and mental well-being are the result of altered metabolic profiles. Though the central and peripheral systems work in tandem, the interactions between peripheral and central changes that lead to these altered states of well-being remains elusive. We measured changes in the metabolic profile of brain (cortex) and muscle (soleus and plantaris) tissue in rats following 5-weeks of treadmill exercise and/or a high-fat diet to evaluate peripheral and central interactions as well as identify any common adaptive mechanisms. To characterize changes in metabolic profiles, we measured relative changes in key metabolic enzymes (COX IV, hexokinase, LDHB, PFK), substrates (BHB, FFA, glucose, lactate, insulin, glycogen, BDNF) and transporters (MCT1, MCT2, MCT4, GLUT1, GLUT3). In the cortex, there was an increase in MCT1 and a decrease in glycogen following the high-fat diet, suggesting an increased reliance on monocarboxylates. Muscle changes were dependent muscle type. Within the plantaris, a high-fat diet increased the oxidative capacity of the muscle likely supported by increased glycolysis, whereas exercise increased the oxidative capacity of the muscle likely supported via increased glycogen synthesis. There was no effect of diet on soleus measurements, but exercise increased its oxidative capacity likely fueled by endogenous and exogenous monocarboxylates. For both the plantaris and soleus, combining exercise training and high-fat diet mediated results, resulting in a middling effect. Together, these results indicate the variable adaptions of two main metabolic pathways: glycolysis and oxidative phosphorylation. The results also suggest a dynamic relationship between the brain and body.

Dietary Approaches to Stop Hypertension (DASH) Diet and Blood Pressure Reduction in Adults with and without Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The Dietary Approaches to Stop Hypertension (DASH) diet is recognized as an effective dietary intervention to reduce blood pressure (BP). However, among randomized controlled trials (RCTs) investigating the DASH diet-mediated BP reduction, there are significant methodological and clinical differences. The purpose of this study was to comprehensively assess the DASH diet effect on BP in adults with and without hypertension, accounting for underlying methodological and clinical confounders. We systematically searched Medline and the Cochrane Collaboration Library databases and identified 30 RCTs (n = 5545 participants) that investigated the BP effects of the DASH diet compared with a control diet in hypertensive and nonhypertensive adults. Both random-effects and fixed-effect models were used to calculate the mean attained systolic BP (SBP) and diastolic BP (DBP) differences during follow-up. Subgroup and meta-regression analyses were also conducted. Compared with a control diet, the DASH diet reduced both SBP and DBP (difference in means: -3.2 mm Hg; 95% CI: -4.2, -2.3 mm Hg; P < 0.001, and -2.5 mm Hg; 95% CI: -3.5, -1.5 mm Hg; P < 0.001, respectively). Hypertension status did not modify the effect on BP reduction. The DASH diet compared with a control diet reduced SBP levels to a higher extent in trials with sodium intake >2400 mg/d than in trials with sodium intake ≤2400 mg/d, whereas both SBP and DBP were reduced more in trials with mean age <50 y than in trials of older participants. The quality of evidence was rated as moderate for both outcomes according to the Grading of Recommendations, Assessment, Development, and Evaluation approach. The adoption of the DASH diet was accompanied by significant BP reduction in adults with and without hypertension, although higher daily sodium intake and younger age enhanced the BP-lowering effect of the intervention. This meta-analysis was registered at www.crd.york.ac.uk/prospero as CRD42019128120.

Obesity ‑ a risk factor for increased COVID‑19 prevalence, severity and lethality (Review)

Coronaviruses (CoVs), enveloped positive-sense RNA viruses, are a group of viruses that cause infections in the human respiratory tract, which can be characterized clinically from mild to fatal. The severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) is the virus responsible. The global spread of COVID‑19 can be described as the worst pandemic in humanity in the last century. To date, COVID‑19 has infected more than 3,000,000 people worldwide and killed more than 200,000 people. All age groups can be infected from the virus, but more serious symptoms that can possibly result in death are observed in older people and those with underlying medical conditions such as cardiovascular and pulmonary disease. Novel data report more severe symptoms and even a negative prognosis for the obese patients. A growing body of evidence connects obesity with COVID‑19 and a number of mechanisms from immune system activity attenuation to chronic inflammation are implicated. Lipid peroxidation creates reactive lipid aldehydes which in a patient with metabolic disorder and COVID‑19 will affect its prognosis. Finally, pregnancy‑associated obesity needs to be studied further in connection to COVID‑19 as this infection could pose high risk both to pregnant women and the fetus.

Association of cardiovascular risk factor clustering and prehypertension among adults：Results from the China health and retirement longitudinal study baseline

Background: Prehypertension is common in China, but its causes and associated factors have not been well studied. This study aimed to examine the age and gender-specific associations between CVD risk factor clustering and prehypertension among adults in China.Methods: This cross-sectional study used data from participants (n = 8735) aged over 45 in the China Health and Retirement Longitudinal Study (CHARLS) Baseline conducted from 2011-2012. The participants' data were collected using standard questionnaires, anthropometric, and biochemical tests. Logistic regression analyses were used to examine the associations between cardiovascular risk factors, their clustering and prehypertension.Results: Overall, 21.1%, 39.5%, 27.6% and 11.8% participants had 0, 1, 2, ≥ 3 CVD risk factors in prehypertension group, respectively. Diabetes and overweight/obesity were significantly associated with prehypertension (OR, 1.24; 95% confidence interval [CI], 1.06-1.44; OR, 1.55; 95% CI, 1.38-1.75) in the overall population, and diabetes was associated with prehypertension only in men (OR, 1.26; 95% CI, 1.00-1.58) and older adults (OR, 1.32; 95% CI, 1.03-1.69). Moreover, participants with 1, 2 and ≥3 risk factors had increased odds of having prehypertension (OR, 1.29; 95% CI, 1.12-1.49; OR, 1.59; 95% CI, 1.31-1.78; OR, 2.05; 95% CI, 1.66-2.53, respectively) and existed dose-response relationship, regardless of age and gender.Conclusions: This study indicated that CVD risk factor clustering was significantly associated with prehypertension and hypertension. These results provide valuable information for health professionals to better understand the impact of CVD risk factor clustering on prehypertension and hypertension.

The effect of zinc supplementation on blood pressure: a systematic review and dose-response meta-analysis of randomized-controlled trials

PURPOSE

Despite previous investigations on the effects of zinc supplementation on blood pressure, inconsistent findings are available in this regard. Therefore, we conducted a systematic review and meta-analysis of randomized clinical trials on the effects of zinc supplementation on blood pressure (BP) in adults.

METHODS

Relevant studies published up to September 2019 were searched through PubMed/Medline, Scopus, ISI Web of Science, and Google Scholar using suitable keywords. All randomized clinical trials (RCTs) that examined the effect of oral zinc supplementation on systolic blood pressure (SBP) or diastolic blood pressure (DBP) in adults were included.

RESULTS

Overall, nine trials were included in our study. Zinc supplementation significantly reduced SBP compared to the control [weighted mean differences (WMD) - 1.49 mmHg; 95% CI - 2.85 to - 0.13; P = 0.03]. However, zinc supplementation had no significant effects on DBP (WMD - 0.88 mmHg; 95% CI - 2.04 to 0.29; P = 0.14). Nonlinear analysis failed to indicate a significant influence of supplementation dosage or duration on both SBP and DBP. Sensitivity analysis showed that no individual study had a significant impact on our final results. In addition, we found no evidence for the presence of small-study effects among studies for both SBP and DBP.

CONCLUSION

We found a significant reduction in SBP following zinc supplementation. However, zinc supplementation had no significant effect on DBP. In addition, no nonlinear association was found between supplementation dosage and duration with changes in both SBP and DBP. Further RCTs using different dosages of zinc in various durations are required to confirm our conclusion.

Prevalence and determinants of hypertension among students of the University of Kinshasa, Democratic Republic of Congo: a cross-sectional study

BACKGROUND

The 2017 ACC/AHA Guideline categorized blood pressure into 4 levels:normal (SBP<120 and DBP <80mm Hg), elevated (SBP of 120-129 or DBP< 80 mmHg) and stage 1 (SBP of 130-139 or DBP of 80-89 mm Hg) or 2 (SBP≥140 orDBP≥90mmHg). Compared with the JNC7 guideline, the 2017 ACC/AHA guideline recommends using lower SBP and DBP levels to define hypertension.

OBJECTIVE

To determine the prevalence of hypertension as well as associated factors among students of the University of Kinshasa.

METHODS

This was a cross-sectional study conducted at the University of Kinshasa and including 1 281 students aged between 18 and 30. Blood pressure was assessed according to the WHO STEPwise approach, which is a standardized method of data collection, analysis and dissemination for the surveillance of non-communicable diseases in WHO member countries. The Chi-square and Student's t-tests and a multivariate logistic regression analysis have been used to evaluate the results. Statistical analyses were done using IBM SPSS version 21.

RESULTS

The prevalence of hypertension according to the guidelines from the 2017 ACC/AHA and the JNC 7 was 26.4 % (CI 95%; 23.9 - 28.9) and 7.3 % (CI 95%; 5.8 - 8.8), respectively. The results of multivariate logistic regression analysis showed that smoking, alcohol abuse, overweight, male sex, age ≥ 24 years old and low physical activity were associated with hypertension (p < 0.0001).

CONCLUSION

At least one out of four students had hypertension. These data should encourage public health authorities to develop strategies for screening of BP and topromote the adoption of healthy lifestyle in young adults.