Dietary supplements in the management of hypertension and diabetes - a review

Angiotensin-Converting Enzyme and Hypertension: A Systemic Analysis of Various ACE Inhibitors, Their Side Effects, and Bioactive Peptides as a Putative Therapy for Hypertension

Hypertension is a major risk factor for heart attack, produce atherosclerosis (hardening of the arteries), congestive heart failure, stroke, kidney infection, blindness, end-stage renal infection, and cardiovascular diseases. Many mechanisms are involved in causing hypertension, i.e., via calcium channels, alpha and beta receptors, and the renin-angiotensin system (RAS). RAS has an important role in blood pressure control and is also involved in the metabolism of glucose, homeostasis, and balance of electrolytes in the body. The components of RAS that are involved in the regulation of blood pressure are angiotensinogen, Ang I (angiotensin I), Ang II (angiotensin II), ACE (angiotensin-converting enzyme), and ACE 2 (angiotensin-converting enzyme 2). These components provide for relevant therapeutic targets for the treatment of hypertension, and various drugs are commercially available that target individual components of RAS. Angiotensin receptor blockers (ARBs) and ACE inhibitors are the most popular among these drugs. ACE is chosen in this review as it makes an important target for blood pressure control because it converts Ang I into Ang II and also acts on the vasodilator, bradykinin, to degrade it into inactive peptides. This review highlights various aspects of blood pressure regulation in the body with a focus on ACE, drugs targeting the components involved in regulation, their associated side effects, and a need to shift to alternative therapy for putative hypertension treatment in the form of bioactive peptides from food.

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

Potential benefits of garlic and other dietary supplements for the management of hypertension

Elevated blood pressure is a major risk factor for cardiovascular diseases. Although some effective drug treatments are available, a relatively large proportion of patients have uncontrolled blood pressure. Dietary supplements are used for the prevention and treatment of hypertension as complementary and alternative medicines. Of the various dietary supplements, antioxidants, fish oil and diverse herbal products are commonly used. Within this context, it is important to determine the actual effectiveness and possible side-effects of these supplements; however, some of the products have been poorly investigated for their effects and safety. In the current review, we focus on garlic and several other dietary supplements, such as coenzyme Q10, fish oil and probiotics, that have exhibited significant beneficial effects on blood pressure in clinical trials. In addition, we discuss the possible mechanisms of action responsible for their anti-hypertensive effects, as well as the safety, active ingredients and their potential use as adjunct therapies for uncontrolled hypertension.

Antihypertensive and antioxidant effects of protocatechuic acid in deoxycorticosterone acetate-salt hypertensive rats

Protocatechuic acid (PCA) is a natural antioxidant with beneficial cardiovascular properties. In this study, the effect of supplementation with PCA was investigated in deoxycorticosterone acetate (DOCA)-salt hypertension. Male Wistar rats received DOCA (25 mg/kg, s.c.) twice weekly and 1% NaCl in drinking water and simultaneously treated with PCA (50, 100 and 200 mg/kg, p.o.) for 4 weeks. Systolic blood pressure (SBP) was detected using tail-cuff method. Electrolytes including Na⁺, K⁺ and chloride, catalase activity, glutathione, total antioxidant capacity, malondialdehyde (MDA) and hydroperoxides concentration were measured in serum samples. Body and organs weight, water intake and, kidney and heart histopathology were also evaluated. Administration of PCA reversed the changes caused by DOCA-salt approximately at all doses. At the lowest dose, PCA significantly decreased SBP (132.5 ± 4.0 vs 152.3 ± 4.5 mmHg, P < .05), serum sodium (138.5  ± 1.52 vs 141 ± 1.50, P < .05) and chloride level (101.6 ± 1.47 vs 110 ± 1.39, P < .01) and raised serum potassium level (3.8 ± 0.09 vs 3.1 ± 0.17, P < .05) compared with DOCA-salt hypertensive rats. PCA increased serum catalase activity, total antioxidant capacity and glutathione concentration and reduced MDA and hydroperoxides levels. PCA also improved organ weight changes, reduced water intake and moderately prevented histopathological changes of kidney and heart upon DOCA-salt administration. The present study indicates the antihypertensive and antioxidant effects of PCA against DOCA-salt hypertension.

Anti-diabetic effect of Alpinia oxyphylla extract on 57BL/KsJ db-/db- mice

Diabetes mellitus is characterized by high blood glucose levels. Increased levels of reactive oxygen species (ROS) may disrupt insulin signaling and result in insulin resistance. The Alpinia oxyphylla extract (AOE) possesses powerful antioxidant activity and may therefore inhibit the development of insulin resistance. The objective of the present study was to determine the effects of AOE on blood glucose, insulin and lipid levels in a type II diabetic nephropathy animal model (C57BIKsj db-/db-). All experiments were performed on male C57BL/Ks DB/DB and db-/db- mice that were left to acclimatize for 1 week prior to the experimental period. AOE was administered to these mice at different dosages (100, 300 and 500 mg/kg) for 8 weeks. The results demonstrated that AOE did not affect mouse weight, while blood glucose concentrations were found to significantly decrease in a dose-dependent manner (P<0.05). The effect of administering 500 mg/kg AOE (AOE500) to db-/db- mice was tested further. Treatment with AOE500 for 8 weeks led to improved glucose tolerance and reduced plasma insulin concentrations (P<0.05), as well as a significant decrease in triglyceride concentrations (P<0.05) and levels of total cholesterol (P<0.05) in db-/db- mice. Furthermore, treatment with AOE500 decreased the concentration of malondialdehyde, elevated the concentration of glutathione and increased the activities of the antioxidant enzymes superoxide dismutase and peroxidase (P<0.05) in the livers of db-/db- mice. Meanwhile, AOE-treated mice exhibited significantly reduced urine albumin, creatinine and blood urea nitrogen excretion (P<0.05). In parallel, the upregulated expression of phosphatase and tensin homolog (PTEN) in the liver and kidneys of db-/db- mice was impaired following AOE500 treatment. The results of the present study suggest that AOE regulates blood glucose and lipid levels and improves renal function by mediating oxidative stress and PTEN expression at the onset of type II diabetes mellitus.