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Better Blood Pressure

January 28, 2015 Written by JP       [Font too small?]

Unless you have very high or low blood pressure, you probably don’t think a lot about the the blood pressure spectrum. As an example, a significant number of people have higher-than-normal blood pressure, but not high enough to treat with medication. This is typically defined as “prehypertension” and is marked by blood pressure ranging from 120-139 systolic and 80-89 diastolic. If you consistently have blood pressure in this range, you may well be a candidate for using a variety of natural options to drop your readings into the “normal” category of 120/80 mmHg or less. However, I want to point out that in some instances having higher than normal blood pressure may actually be advantageous. For instance, some research has found that higher blood pressure may actually reduce the risk of balance issues, dementia and all-cause mortality in seniors. So, when in doubt, consult with a cardiologist to determine what’s right for your unique circumstance.

A good starting point for naturally lowering blood pressure is to lose excess weight. Even modest weight loss can help. But, even if you don’t have much success dropping pounds, the diet you choose can still be of assistance. Two recent studies inform that a higher fat Mediterranean diet and a Paleolithic-style diet are good options. In the modified Mediterranean diet, added extra virgin olive oil or nuts were supplemented in order to increase the polyphenol content of the meal plan. Polyphenols are naturally occurring chemicals found in fruits, herbs, nuts, olive oil, seeds, spices and vegetables, which have been shown to support healthier vascular function. Whole food based Paleolithic diets are also chock full of health promoting phytochemicals and nutrients. A study appearing in the October 2014 issue of Lipids in Health and Disease found that adherence to a two week Paleo diet resulted in a 9.1 mmHg drop in systolic and a 5.2 mmHg in diastolic blood pressure. As a bonus, other cardiovascular risk factors such as cholesterol and triglycerides also improved.

In addition to diet and weight loss, the medical literature points to several foods with the potential to lower hypertension: beetroots, blueberries, dark chocolate, flax seeds and strawberries. A just-published study in the Journal of the Academy of Nutrition and Dietetics reports that about 1 cup/day of blueberries or 22 grams of freeze-dried blueberry powder effectively lowers arterial stiffness and blood pressure in pre- and stage-1 hypertensives. A previous blueberry trial bolsters this finding and goes on to document immune enhancing activity as well – an increase in natural kill cells. 30 grams daily of ground flax seeds not only reduces blood pressure and various cardiovascular dangers, but also assists with weight loss. As little as 10 grams/day of non-alkalized dark chocolate (75% or higher cocoa content) improves endothelial function and flow-mediated dilation, both of which help to decrease blood pressure. About 8 ounces a day of red beetroot juice increases bodily production of nitric oxide, a substance which enhances blood flow, exercise capacity and lowers blood pressure. In addition, a current study reveals a complementary interaction between beetroot juice and dark chocolate.

I have a few suggestions for putting this all together. You can easily make a blended shake containing a cup of frozen blueberries, some strawberries and three tablespoons of flaxseeds. As a liquid base, I recommend purified water and/or unsweetened almond, cashew or coconut milk. This can be a meal replacement or snack. It may not be practical to make beetroot juice at home, and store bought, fresh beetroot juice tends to be quite expensive. But, you can find reasonably priced, powdered forms of organic beetroot juice online and in some health food stores. When it comes to dark chocolate, I now recommend a specific product. Last year, a consumer group tested a variety of cocoa powders and chocolate bars. Most of the pure cocoa powders tested high in certain heavy metals, including cadmium and lead. However, one dark chocolate bar, Endangered Species Chocolate: Natural Dark Chocolate with 88% Cocoa, impressed me because of its potent antioxidant (flavanol) content and purity. You can use these natural remedies in any combination that suits your lifestyle and taste. You might have a shake on some days, half a chocolate bar on others and beetroot juice prior to your workouts. Mixing and matching isn’t a bad thing, provided that you find positive results. But, keep in mind that the studies I referenced demanded daily consumption of the remedies in question. So, test and verify.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 - Effects of Total Dietary Polyphenols on Plasma Nitric Oxide & Blood (link)

Study 2 - Favourable Effects of Consuming a Palaeolithic-Type Diet on … (link)

Study 3 - Daily Blueberry Consumption Improves Blood Pressure and Arterial(link)

Study 4 - Six Weeks Daily Ingestion of Whole Blueberry Powder Increases Natural (link)

Study 5 – Evaluation of Flaxseed Formulation as a Potential Therapeutic Agent (link)

Study 6 - Flaxseed Consumption Reduces Blood Pressure in Patients with (link)

Study 7 - Cocoa Consumption Dose-Dependently Improves Flow-Mediated Dilation (link)

Study 8 – Central Arterial Hemodynamic Effects of Dark Chocolate Ingestion (link)

Study 9 - Dietary Nitrate Provides Sustained Blood Pressure Lowering in … (link)

Study 10 - Interactions Between Cocoa Flavanols & Inorganic Nitrate: Additive (link)

Strawberries Lower Blood Pressure and Improve Lipid Profile

Source: World J Diabetes. 2014 Dec 15;5(6):962-8. (link)

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44 Comments & Updates to “Better Blood Pressure”

  1. JP Says:

    Update: Recently, a client asked me about the relatively high sugar content of beets. She wondered if it might be cause enough to avoid them – despite their other healthful properties. A just published study puts this concern to rest …

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153083/

    J Nutr Sci. 2014 Apr 30;3:e9. doi: 10.1017/jns.2014.7. eCollection 2014.

    Effects of a beetroot juice with high neobetanin content on the early-phase insulin response in healthy volunteers.

    Produce rich in phytochemicals may alter postprandial glucose and insulin responses by interacting with the pathways that regulate glucose uptake and insulin secretion in humans. The aims of the present study were to assess the phytochemical constituents of red beetroot juice and to measure the postprandial glucose and insulin responses elicited by either 225 ml beetroot juice (BEET), a control beverage matched for macronutrient content (MCON) or a glucose beverage in healthy adults. Beetroot juice was a particularly rich source of betalain degradation compounds. The orange/yellow pigment neobetanin was measured in particularly high quantities (providing 1·3 g in the 225 ml). A total of sixteen healthy individuals were recruited, and consumed the test meals in a controlled single-blind cross-over design. Results revealed a significant lowering of the postprandial insulin response in the early phase (0-60 min) (P < 0·05) and a significantly lower glucose response in the 0-30 min phase (P < 0·05) in the BEET treatment compared with MCON. Betalains, polyphenols and dietary nitrate found in the beetroot juice may each contribute to the observed differences in the postprandial insulin concentration.

    Be well!

    JP

  2. JP Says:

    Update: Mind the magnesium!

    http://ajh.oxfordjournals.org/content/early/2015/01/23/ajh.hpu293.abstract

    Prevalence of Prehypertension in Mexico and Its Association With Hypomagnesemia

    BACKGROUND: Prehypertension (preHTN) increases the risk of developing hypertension. The objectives of this study were to estimate the prevalence of preHTN in the Mexican adult population and evaluate the association between hypomagnesemia and preHTN.

    METHODS: This study was a 2-phase, population-based study. In the first phase, 4,272 Mexican adults (aged 20–65 years) were enrolled to determine the prevalence of preHTN. In the second phase, a cross-sectional analysis was performed to evaluate the association between hypomagnesemia and preHTN. The exclusion criteria were chronic diarrhea, malignancy, hepatic and renal diseases, chronic inflammatory disease, and the intake of magnesium supplements. PreHTN was defined as a systolic blood pressure (BP) of 120–139mm Hg and/or diastolic BP of 80–89mm Hg, and hypomagnesemia was defined as a serum magnesium concentration <1.8mg/dl.

    RESULTS: The prevalence of preHTN was 37.5% (95% confidence interval (CI): 36.0–39.0): 46.7% were men (95% CI: 44.1–49.4) and 33.2% (95% CI: 31.5–5.0) were women. The serum magnesium data were available for 921 participants. Hypomagnesemia was identified in 276 (30.0%; 95% CI: 27.1–33.0) subjects; of them, 176 (63.8%; 95% CI: 58.3–69.6) had preHTN. Individuals with preHTN exhibited lower magnesium levels than individuals without preHTN (1.78±0.36 vs. 1.95±0.37, P < 0.0005). A multiple logistic regression analysis (adjusted for age, sex, smoking, body mass index, waist circumference, fasting glucose, total cholesterol, high-density lipoprotein cholesterol, and triglycerides levels) indicated a significant association between hypomagnesemia and preHTN (odds ratio = 1.78; 95% CI: 1.5–4.0, P < 0.0005).

    CONCLUSIONS: The prevalence of preHTN in the Mexican population is 37.5%, and hypomagnesemia is strongly associated with preHTN.

    Be well!

    JP

  3. JP Says:

    Update: Exercising first thing in the morning may help manage overnight blood pressure and improve sleep quality …

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270305/

    Effects of exercise timing on sleep architecture and nocturnal blood pressure in prehypertensives

    “The present study indicates that partaking in a bout of moderate-intensity aerobic exercise in the early morning (7A) evokes optimal BP changes and results in an improvement in overall sleep architecture. Research demonstrates decreases in the deep stages of sleep, with concomitant increases in the lighter stages and a longer SOL correlated with an individual’s approach to middle age.35 To date, there have been no well-accepted nonpharmacological or pharmacological interventions to increase the amount of deep sleep. Therefore, utilizing aerobic exercise may be a nonpharmacological treatment to attenuate these alterations and improve sleep quality as one ages. The present investigation reports that the timing of exercise is an important aspect to maximize these effects. It seems that the effect of exercise on the various components of sleep architecture is a complicated phenomenon involving several physiological aspects that require further investigation. In conclusion, the early morning (at 7A) may be the most beneficial time of day to engage in aerobic exercise for the improvement of BP and sleep architecture.”

    Be well!

    JP

  4. Pat Says:

    Is there any way to get the benefits of beets for blood pressure without the iron? My iron levels are high the way it is.

  5. Rob Says:

    Good stuff, more examples that achieving good health is much more effective by using a multi pronged approach, ie:via diet, sleep and exercise. Thanks

  6. JP Says:

    Hi, Pat. Despite a few contrary accounts on the ‘net, beets are a poor source of iron. What’s more, iron from plant-based sources usually isn’t very well absorbed. I haven’t found any scientific evidence demonstrating that beets affect iron levels in humans.

    http://nutritiondata.self.com/facts/vegetables-and-vegetable-products/2348/2

    Be well!

    JP

  7. JP Says:

    Agreed, Rob. Thank you!

    Be well!

    JP

  8. JP Says:

    Update: More support for supplemental omega-3 fatty acids …

    http://informahealthcare.com/doi/abs/10.3109/13697137.2014.981521

    Climacteric. 2014 Dec 26:1-9.

    Effects of omega-3 on metabolic markers in postmenopausal women with metabolic syndrome.

    Objective: The aim of this study was to evaluate the effect of diet alone or combined with omega-3 supplementation on metabolic and inflammatory markers in postmenopausal women with metabolic syndrome.

    Methods: This randomized, controlled trial included 87 Brazilian women (age ≥ 45 years and with amenorrhea ≥ 12 months). Exclusion criteria were: cardiovascular disease, insulin-dependent diabetes, cancer, autoimmune diseases and use of either statins or hormone therapy. Participants were randomized to diet alone (n = 43, control) or diet plus omega-3 supplementation, 900 mg/day orally (n = 44). All women were provided with an individualized dietary prescription. Clinical, anthropometrical (body mass index and waist circumference) and biochemical variables were measured. The inflammatory profile included C-reactive protein, tumor necrosis factor α and interleukins (IL-1β and IL-6). The intervention time was 6 months, with assessments at initiation and completion. Data were analyzed according to intention-to-treat, using the independent t-test and ANOVA.

    Results: There were significant reductions in body mass index and waist circumference in both groups (p < 0.05) without significant changes in body fat or muscle mass. Intervention with diet plus omega-3 was associated with significant reduction in systolic (< 12.2%) and diastolic (< 8.2%) blood pressure, serum triglyceride concentration (< 21.4%), and insulin resistance (< 13.1%) (p < 0.05), as well as a reduction in serum IL-6 concentration (< 28.5%) (p = 0.034).

    Conclusion: In postmenopausal women with metabolic syndrome, dietary intervention plus supplementation of omega-3 resulted in a further decrease in triglycerides and blood pressure and also in an improvement in insulin resistance and inflammatory markers, important components of metabolic syndrome.

    Be well!

    JP

  9. Elisabethpac Says:

    Thank you for your informative site. Over the years I have been referring my patients to it.

  10. JP Says:

    Thank you for helping to spread the word, Elizabeth!

    Be well!

    JP

  11. JP Says:

    Update: Flax seeds lower LDL (“bad”) cholesterol too …

    http://jn.nutrition.org/content/early/2015/02/18/jn.114.204594.abstract

    J Nutr. 2015 Feb 18. pii: jn.114.204594.

    Dietary Flaxseed Independently Lowers Circulating Cholesterol and Lowers It beyond the Effects of Cholesterol-Lowering Medications Alone in Patients with Peripheral Artery Disease.

    BACKGROUND: Dietary flaxseed lowers cholesterol in healthy subjects with mild biomarkers of cardiovascular disease (CVD).

    OBJECTIVE: The aim was to investigate the effects of dietary flaxseed on plasma cholesterol in a patient population with clinically significant CVD and in those administered cholesterol-lowering medications (CLMs), primarily statins.

    METHODS: This double-blinded, randomized, placebo-controlled trial examined the effects of a diet supplemented for 12 mo with foods that contained either 30 g of milled flaxseed [milled flaxseed treatment (FX) group; n = 58] or 30 g of whole wheat [placebo (PL) group; n = 52] in a patient population with peripheral artery disease (PAD). Plasma lipids were measured at 0, 1, 6, and 12 mo.

    RESULTS: Dietary flaxseed in PAD patients resulted in a 15% reduction in circulating LDL cholesterol as early as 1 mo into the trial (P = 0.05). The concentration in the FX group (2.1 ± 0.10 mmol/L) tended to be less than in the PL group (2.5 ± 0.2 mmol/L) at 6 mo (P = 0.12), but not at 12 mo (P = 0.33). Total cholesterol also tended to be lower in the FX group than in the PL group at 1 mo (11%, P = 0.05) and 6 mo (11%, P = 0.07), but not at 12 mo (P = 0.24). In a subgroup of patients taking flaxseed and CLM (n = 36), LDL-cholesterol concentrations were lowered by 8.5% ± 3.0% compared with baseline after 12 mo. This differed from the PL + CLM subgroup (n = 26), which increased by 3.0% ± 4.4% (P = 0.030) to a final concentration of 2.2 ± 0.1 mmol/L.Conclusions: Milled flaxseed lowers total and LDL cholesterol in patients with PAD and has additional LDL-cholesterol-lowering capabilities when used in conjunction with CLMs.

    Be well!

    JP

  12. JP Says:

    Update 04/15/15:

    http://hyper.ahajournals.org/content/early/2015/04/13/HYPERTENSIONAHA.115.05315.abstract

    Hypertension. 2015 Apr 13.

    Gut Dysbiosis Is Linked to Hypertension.

    Emerging evidence suggests that gut microbiota is critical in the maintenance of physiological homeostasis. This study was designed to test the hypothesis that dysbiosis in gut microbiota is associated with hypertension because genetic, environmental, and dietary factors profoundly influence both gut microbiota and blood pressure. Bacterial DNA from fecal samples of 2 rat models of hypertension and a small cohort of patients was used for bacterial genomic analysis. We observed a significant decrease in microbial richness, diversity, and evenness in the spontaneously hypertensive rat, in addition to an increased Firmicutes/Bacteroidetes ratio. These changes were accompanied by decreases in acetate- and butyrate-producing bacteria. In addition, the microbiota of a small cohort of human hypertensive patients was found to follow a similar dysbiotic pattern, as it was less rich and diverse than that of control subjects. Similar changes in gut microbiota were observed in the chronic angiotensin II infusion rat model, most notably decreased microbial richness and an increased Firmicutes/Bacteroidetes ratio. In this model, we evaluated the efficacy of oral minocycline in restoring gut microbiota. In addition to attenuating high blood pressure, minocycline was able to rebalance the dysbiotic hypertension gut microbiota by reducing the Firmicutes/Bacteroidetes ratio. These observations demonstrate that high blood pressure is associated with gut microbiota dysbiosis, both in animal and human hypertension. They suggest that dietary intervention to correct gut microbiota could be an innovative nutritional therapeutic strategy for hypertension.

    Be well!

    JP

  13. JP Says:

    Update 05/06/15:

    http://www.mdpi.com/2072-6643/7/5/3138/htm

    Nutrients. 2015 Apr 30;7(5):3138-3153.

    Consumption of a Polyphenol-Rich Grape-Wine Extract Lowers Ambulatory Blood Pressure in Mildly Hypertensive Subjects.

    Polyphenols in grape and wine have been suggested to contribute to the cardiovascular health benefits of the Mediterranean lifestyle. The reported effects of grape products on blood pressure (BP) remain, however, equivocal. In a double-blind placebo controlled crossover study, the effect of two grape extracts on BP and vascular function was assessed in 60 untreated, mildly hypertensive subjects after four weeks intervention. Both extracts (grape-red wine and grape alone) had high concentrations of anthocyanins and flavonols, but the grape alone was relatively poor in catechins and procyanidins. Parameters measured included ambulatory and office BP, flow-mediated vasodilation, arterial distensibility, platelet function and plasma lipoproteins. Results showed that 24-hour ambulatory systolic/diastolic BPs were significantly lower in the grape-wine extract intervention (135.9 ± 1.3/84.7 ± 0.8 mmHg; mean ± SEM) compared to placebo (138.9 ± 1.3/86.6 ± 1.2 mmHg), predominantly during daytime. Plasma concentrations of the vasoconstrictor endothelin-1 decreased by 10%, but other measures of vascular function were not affected. Grape juice extract alone had no effect on BP or any measures of vascular function. Polyphenol-rich food products, and may be specifically catechins and procyanidins, may thus help sustain a healthy BP and contribute to the healthy Mediterranean lifestyle.

    Be well!

    JP

  14. JP Says:

    Update 06/15/15:

    http://www.ncbi.nlm.nih.gov/pubmed/26071633?dopt=Abstract

    Clin Nutr. 2015 May 29. pii: S0261-5614(15)00144-2.

    Effects of flaxseed supplements on blood pressure: A systematic review and meta-analysis of controlled clinical trial.

    BACKGROUND & AIMS: Many experimental and clinical trials suggested that flaxseed might be a potent antihypertensive, but the evidences concerning the effects of flaxseed supplements on blood pressure (BP) has not been fully conclusive. We aimed to assess the impact of the effects of flaxseed supplements on blood pressure through systematic review of literature and meta-analysis of available randomized controlled trials (RCTs).

    METHODS: The literature search included PUBMED, Cochrane Library, Scopus, and EMBASE up to February 2015 to identify RCTs investigating the effect of flaxseed supplements on plasma blood pressure. Effect size was expressed as weighed mean difference (WMD) and 95% confidence interval (CI).

    RESULTS: 15 trials (comprising 19 treatment arms) with 1302 participants were included in this meta-analysis. Random-effects meta-analysis suggested significant reductions in both systolic BP (SBP) (WMD: -2.85 mmHg, 95%CI: -5.37 to -0.33, p = 0.027) and diastolic BP (DBP) (WMD: -2.39 mmHg, 95%CI: -3.78 to -0.99, p = 0.001) following supplementation with flaxseed products. When the studies were stratified according to their duration, there was a greater effect on both SBP and DBP in the subset of trials with ≥12 weeks of duration (WMD: -3.10 mmHg, 95%CI: -6.46 to 0.27, p = 0.072 and -2.62 mmHg, 95%CI: -4.39 to -0.86, p = 0.003, respectively) vs the subset lasting <12 weeks (WMD: -1.60 mmHg, 95%CI: -5.44 to 2.24, p = 0.413, and -1.74 mmHg, 95%CI: -4.41 to 0.93, p = 0.202, respectively). Another subgroup analysis was performed to assess the impact of flaxseed supplement type on BP. Reduction of SBP was significant with flaxseed powder (WMD: -1.81 mmHg, 95% CI: -2.03 to -1.59, p < 0.001) but not oil (WMD: -4.62 mmHg, 95%CI: -11.86 to 2.62, p = 0.211) and lignan extract (WMD: 0.28 mmHg, 95% CI: -3.49 to 4.04, p = 0.885). However, DBP was significantly reduced with powder and oil preparations (WMD: -1.28 mmHg, 95% CI: -2.44 to -0.11, p = 0.031, and -4.10 mmHg, 95%CI: -6.81 to -1.39, p = 0.003, respectively), but not with lignan extract (WMD: -1.78 mmHg, 95% CI: -4.28 to 0.72, p = 0.162).

    CONCLUSIONS: This meta-analysis of RCTs showed significant reductions in both SBP and DBP following supplementation with various flaxseed products.

    Be well!

    JP

  15. JP Says:

    Update 06/24/15:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4460349/

    ARYA Atheroscler. 2015 Jan;11(1):21-9.

    High-cocoa polyphenol-rich chocolate improves blood pressure in patients with diabetes and hypertension.

    BACKGROUND: The aim was to examine the effects of high-cocoa polyphenol-rich chocolate on lipid profiles, weight, blood pressure, glycemic control, and inflammation in individuals with Type 2 diabetes and hypertension.

    METHODS: Sixty individuals [32 in dark chocolate group (DCG) and 28 in white chocolate group (WCG)] with Type 2 diabetes on stable medication were enrolled in a randomized, placebo-controlled double-blind study. Subjects were randomized to consume 25 g DCG or WCG for 8 weeks. Changes in weight, blood pressure, glycemic control, lipid profile, and high sensitive C-reactive protein (hsCRP) were measured at the beginning and end of the intervention. This clinical trial was registered at the Iranian registry of clinical trials.

    RESULTS: In DCC group, compared with baseline, serum levels of Apo A-1 (P = 0.045) was increased and fasting blood sugar (FBS) (P = 0.027), hemoglobin A1c (HbA1c) (P = 0.025), Apo B (P = 0.012) and Log of hsCRP (P = 0.043) levels were decreased at the end of study. No changes were seen within the WCG in studied parameters. High polyphenol chocolate consumption compared to white chocolate resulted in significant decrease in of systolic (-5.93 ± 6.25 vs. -1.07 ± 7.97 mmHg, P = 0.004) and diastolic blood pressure (-6.4 ± 6.25 vs. 0.17 ± 7.9 mmHg, P = 0.002), FBS (-7.84 ± 19.15 vs. 4.00 ± 20.58 mg/dl, P = 0.019) over the course of 8 weeks of daily chocolate consumption neither weight nor body mass index and TG levels altered from baseline.

    CONCLUSION: High polyphenol chocolate is effective in improving TG levels in hypertensive patients with diabetes and decreasing blood pressure and FBS without affecting weight, inflammatory markers, insulin resistance or glycemic control.

    Be well!

    JP

  16. JP Says:

    Updated 07/20/15:

    http://www.complementarytherapiesinmedicine.com/article/S0965-2299%2815%2900105-3/pdf

    Complementary Therapies in Medicine – June 19, 2015

    Acupuncture lowers blood pressure in mild hypertension patients: A randomized, controlled, assessor-blinded pilot trial

    Objectives: To preliminarily assess the effects of acupuncture on prehypertension and stage I hypertension, and to provide data for further research.

    Design: A randomized, controlled, assessor-blinded study with an 8-week intervention period and a 4-week follow-up.

    Interventions: Participants were patients with systolic blood pressure (SBP) of 120–159 mmHg or diastolic blood pressure (DBP) of 80–99 mmHg.Thirty participants were allocated to acupuncture group or untreated control group at a 1:1 ratio. The acupuncture group received standard acupuncture twice weekly for 8 weeks, and was followed-up for 4 weeks after treatment; the control group did not receive any type of anti-hypertensive treatment for 12 weeks.

    Main outcome measures: Primary outcome measure was SBP and DBP at post-treatment. The secondary outcomes were SBP and DBP at follow-up; Euro Quality of life (EQ-5D), heart rate variability (HRV), body mass index (BMI), and blood lipid profile.

    Results: DBP (-5.7 mmHg;P=0.025), but not SBP (-6.0 mmHg;P=0.123), was significantly different between groups at post-treatment. Both DBP (-7.8 mmHg;P=0.004) and SBP (-8.6 mmHg;P=0.031) were significantly different at follow-up. Among the HRV indices, only high frequency power was significantly different between groups at weeks 4 and 8 (P=0.047 andP=0.030, respectively). There were no differences between groups in EQ-5D, BMI or lipid profile.

    Conclusion: The results of this study show that acupuncture might lower blood pressure in prehypertension and stage I hypertension, and further RCT need 97 participants in each group. The effect of acupuncture on prehypertension and mild hypertension should be confirmed in larger studies.

    Be well!

    JP

  17. JP Says:

    Updated 07/26/15:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4492638/

    Drug Des Devel Ther. 2015 Jul 1;9:3405-12.

    Effect of vitamin C on inflammation and metabolic markers in hypertensive and/or diabetic obese adults: a randomized controlled trial.

    BACKGROUND: Obesity is well associated as being an interfering factor in metabolic diseases such as hypertension and diabetes by increasing the secretion of proinflammatory markers from adipose tissue. Having healthy effects, vitamin C could work as an anti-inflammatory agent through its antioxidant capacity.

    REGISTRATION NUMBER: FPSK_Mac [13]04.

    OBJECTIVE: The aim of the study reported here was to identify the effect of vitamin C on reducing the levels of inflammatory markers in hypertensive and/or diabetic obese adults.

    SUBJECTS AND METHODS: Sixty-four obese patients, who were hypertensive and/or diabetic and had high levels of inflammatory markers, from primary health care centers in Gaza City, Palestine, were enrolled into one of two groups in an open-label, parallel, randomized controlled trial. A total of 33 patients were randomized into a control group and 31 patients were randomized into an experimental group. The experimental group was treated with 500 mg vitamin C twice a day.

    RESULTS: In the experimental group, vitamin C significantly reduced the levels of high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), fasting blood glucose (FBG), and triglyceride (TG) after 8 weeks of treatment (overall: P<0.001); no changes appeared in total cholesterol (TC). In the control group, there were significant reductions in FBG and TG (P=0.001 and P=0.026, respectively), and no changes in hs-CRP, IL-6, or TC. On comparing the changes in the experimental group with those in the control group at the endpoint, vitamin C was found to have achieved clinical significance in treating effectiveness for reducing hs-CRP, IL-6, and FBG levels (P=0.01, P=0.001, and P<0.001, respectively), but no significant changes in TC or TG were found.

    CONCLUSION: Vitamin C (500 mg twice daily) has potential effects in alleviating inflammatory status by reducing hs-CRP, IL-6, and FBG in hypertensive and/or diabetic obese patients.

    Be well!

    JP

  18. JP Says:

    Updated 08/28/15:

    http://www.njcponline.com/article.asp?issn=1119-3077;year=2015;volume=18;issue=6;spage=762;epage=770;aulast=Nwachukwu

    Niger J Clin Pract. 2015 Nov-Dec;18(6):762-70.

    Effect of Hibiscus sabdariffaon blood pressure and electrolyte profile of mild to moderate hypertensive Nigerians: A comparative study with hydrochlorothiazide.

    BACKGROUND: Hibiscus sabdariffa (HS) is widely consumed in Nigeria as a refreshing beverage and also as an antihypertensive agent. Since three decades ago when its antihypertensive activities were reported in several animal experiments, its consumption has greatly increased.

    AIM: The aim of this study is to investigate the effect of HS consumption on blood pressure (BP) and electrolytes of mild to moderate hypertensive Nigerians and compare it with that of hydrochlorothiazide (HCTZ), a diuretic widely used asfirst-line antihypertensive drug.

    SUBJECTS AND METHODS: Eighty newly diagnosed, but untreated mild to moderate hypertensive subjects attending Medical Out-Patients clinic of Enugu State University Teaching Hospital, Enugu, were recruited for the study. They were randomly divided into three groups: A, B and C. Those in Groups A were given placebo; those in Group B took HCTZ while those in Group C were given HS. Treatment lasted for 4 weeks. BP, serum, and urine electrolytes were measured at baseline, weekly during treatment and 1 week after withdrawal of treatment.

    RESULTS: At the end of treatment, both HCTZ and HS significantly (P < 0.001) reduced systolic BP, diastolic BP, mean arterial pressure and serum Na+ compared to placebo. When compared to each other, HCTZ significantly (P < 0.001) reduced serum Na+ and Cl- compared to HS and significantly (P < 0.001) increased K+ and Cl- output in urine. After withdrawal of treatment, the fall in BP and serum Na+ in HS group were significant compared to HCTZ where they returned to baseline values. No side effect was reported during the study.

    CONCLUSION: HS was a more effective antihypertensive agent than HCTZ in mild to moderate hypertensive Nigerians and did not cause electrolyte imbalance. HS showed longer duration of action compared to HCTZ and reduction in serum Na+ may be another antihypertensive mechanism of action of HS.

    Be well!

    JP

  19. JP Says:

    Updated 09/24/15:

    http://www.ncbi.nlm.nih.gov/pubmed/26392838

    Med Acupunct. 2015 Aug 1;27(4):253-266.

    Long-Lasting Reduction of Blood Pressure by Electroacupuncture in Patients with Hypertension: Randomized Controlled Trial.

    Background: Acupuncture at specific acupoints has experimentally been found to reduce chronically elevated blood pressure.

    Objective: To examine effectiveness of electroacupuncture (EA) at select acupoints to reduce systolic blood pressure (SBP) and diastolic blood pressures (DBP) in hypertensive patients.

    Design: Two-arm parallel study.

    Patients: Sixty-five hypertensive patients not receiving medication were assigned randomly to one of the two acupuncture intervention (33 versus 32 patients).

    Intervention: Patients were assessed with 24-hour ambulatory blood pressure monitoring. They were treated with 30-minutes of EA at PC 5-6+ST 36-37 or LI 6-7+GB 37-39 once weekly for 8 weeks. Four acupuncturists provided single-blinded treatment.

    Main outcome measures: Primary outcomes measuring effectiveness of EA were peak and average SBP and DBP. Secondary outcomes examined underlying mechanisms of acupuncture with plasma norepinephrine, renin, and aldosterone before and after 8 weeks of treatment. Outcomes were obtained by double-blinded evaluation.

    Results: After 8 weeks, 33 patients treated with EA at PC 5-6+ST 36-37 had decreased peak and average SBP and DBP, compared with 32 patients treated with EA at LI 6-7+GB 37-39 control acupoints. Changes in blood pressures significantly differed between the two patient groups. In 14 patients, a long-lasting blood pressure-lowering acupuncture effect was observed for an additional 4 weeks of EA at PC 5-6+ST 36-37. After treatment, the plasma concentration of norepinephrine, which was initially elevated, was decreased by 41%; likewise, renin was decreased by 67% and aldosterone by 22%.

    Conclusions: EA at select acupoints reduces blood pressure. Sympathetic and renin-aldosterone systems were likely related to the long-lasting EA actions.

    Be well!

    JP

  20. Vincent Says:

    I would like to point out that when you referred to “Endangered Species Chocolate: Natural Dark Chocolate” with high a cocoa count, it should be “cacao” which is the unprocessed bean. Very important distinction. Thanks!

  21. JP Says:

    Thank you, Vincent. I understand what you’re saying. For what it’s worth, the manufacturer uses “cocoa” in their description.

    http://www.chocolatebar.com/?portfolio=dark-chocolate-with-88-cocoa

    Be well!

    JP

  22. JP Says:

    Updated 12/10/15:

    http://www.atherosclerosis-journal.com/article/S0021-9150%2815%2930216-1/abstract

    Atherosclerosis. 2015 Nov 23;244:165-171.

    Contribution of vitamin D deficiency to the risk of coronary heart disease in subjects with essential hypertension.

    BACKGROUND: Vitamin D deficiency is proposed as a risk factor for coronary heart disease (CHD). An inverse relation was observed between serum 25-Hydroxy-Vitamin-D level and incidence of hypertension. This study aimed to evaluate the predictive value of serum 25-Hydroxy-Vitamin-D in improvement of CHD risk-stratification in patients with hypertension.

    METHODS: In this cohort, we followed 1586 patients with essential hypertension (1078 diabetic and 508 non-diabetic) for 8.5 years. Physician-adjudicated first hard CHD event was the primary outcome. Cox regression analysis was used to investigate the association between 25-Hydroxy-Vitamin-D quartiles and incident CHD. 25-Hydroxy-Vitamin-D was also added to the Framingham Risk Score (FRS) and Net-Reclassification-Improvement (NRI) and Integrated-Discriminant-Improvement (IDI) were used to examine improved reclassification.

    RESULTS: During follow-up, 176 events were recorded. Patients in the lowest quartile of 25-Hydroxy-Vitamin-D experienced the most number of hard CHD events. A significant linear trend was observed in hazard ratios (HR) of incident hard CHD events in 25-Hydroxy-Vitamin-D quartiles which remained significant after multiple adjustments for conventional CHD risk-factors (HRs in full-adjusted model: 2.87 [1.76-4.70] for 1st quartile, 2.31 [1.39-3.83] for 2nd quartile and 1.87 [1.15-3.03] for 3rd quartile, compared with the highest quartile; p-for-trend<0.001). Addition of 25-Hydroxy-Vitamin-D to FRS could improve CHD risk-estimation (relative-IDI = 15%, p-value<0.001). Addition of 25-Hydroxy-Vitamin-D to FRS successfully reclassified 33% [18-49] of patients with hypertension among CHD risk groups (p-value<0.001).

    CONCLUSION: We observed that serum 25-Hydroxy-Vitamin-D is independently associated with future hard CHD events and improves its prediction in patients with essential hypertension. Addition of serum 25-Hydroxy-Vitamin-D to CHD risk-estimation models may have additive values.

    Be well!

    JP

  23. JP Says:

    Updated 12/20/15:

    http://journals.lww.com/jhypertension/pages/articleviewer.aspx?year=9000&issue=00000&article=98149&type=abstract

    J Hypertens. 2015 Dec 16.

    Soft drink consumption, mainly diet ones, is associated with increased blood pressure in adolescents.

    OBJECTIVE: The aim of this cross-sectional study was to investigate the association between consumption of sugar-sweetened and diet soft drinks with blood pressure (BP) in adolescents.

    METHODS: Fifth graders of 20 public schools were invited to participate in an intervention aimed at behavioral dietary changes and had their BP, weight, and height measured at baseline. Type and frequency of soft drink consumption were assessed using a food and beverages frequency questionnaire, and students were classified as nonconsumers, sugar-sweetened soft drink consumers, and diet soft drink consumers.

    RESULTS: Of the 574 students invited, 512 were examined and 488 had their BP measured. Of these, 25 (5.1%) reported to be nonconsumers, 419 (85.9%) were sugar-sweetened soft drink consumers, and 44 (9%) were diet soft drink consumers. Mean SBP and DBP were 101.3/57.8, 102.6/58.8, and 106.0/61.3 mmHg for these three groups of consumption, respectively. After adjustment for sex, age, BMI, physical activity, addition of salt to food, and education of the head of the family, SBP was 5.4 mmHg higher in the diet soft drink consumers group compared with the nonconsumers group and 3.3 mmHg higher compared with the sugar-sweetened consumers group (P value of trend = 0.01). Moreover, DBP was also higher among diet soft drink consumers compared with nonconsumers, with a difference of 3.3 mmHg, and compared with sugar-sweetened consumers, with a difference of 2.3 mmHg (P value of trend = 0.04).

    CONCLUSION: The results indicate that the consumption of soft drink is associated with increased BP, which is further increased by drinking diet type sodas.

    Be well!

    JP

  24. JP Says:

    Updated 12/23/15:

    http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0144920

    PLoS One. 2015 Dec 18;10(12):e0144920.

    Plasma Ascorbic Acid, A Priori Diet Quality Score, and Incident Hypertension: A Prospective Cohort Study.

    Vitamin C may reduce risk of hypertension, either in itself or by marking a healthy diet pattern. We assessed whether plasma ascorbic acid and the a priori diet quality score relate to incident hypertension and whether they explain each other’s predictive abilities. Data were from 2884 black and white adults (43% black, mean age 35 years) initially hypertension-free in the Coronary Artery Risk Development in Young Adults Study (study year 10, 1995-1996). Plasma ascorbic acid was assessed at year 10 and the diet quality score at year 7. Eight-hundred-and-forty cases of hypertension were documented between years 10 and 25. After multiple adjustments, each 12-point (1 SD) higher diet quality score at year 7 related to mean 3.7 μmol/L (95% CI 2.9 to 4.6) higher plasma ascorbic acid at year 10. In separate multiple-adjusted Cox regression models, the hazard ratio of hypertension per 19.6-μmol/L (1 SD) higher ascorbic acid was 0.85 (95% CI 0.79-0.92) and per 12-points higher diet score 0.86 (95% CI 0.79-0.94). These hazard ratios changed little with mutual adjustment of ascorbic acid and diet quality score for each other, or when adjusted for anthropometric variables, diabetes, and systolic blood pressure at year 10. Intake of dietary vitamin C and several food groups high in vitamin C content were inversely related to hypertension, whereas supplemental vitamin C was not. In conclusion, plasma ascorbic acid and the a priori diet quality score independently predict hypertension. This suggests that hypertension risk is reduced by improving overall diet quality and/or vitamin C status. The inverse association seen for dietary but not for supplemental vitamin C suggests that vitamin C status is preferably improved by eating foods rich in vitamin C, in addition to not smoking and other dietary habits that prevent ascorbic acid from depletion.

    Be well!

    JP

  25. JP Says:

    Updated 1/8/16:

    http://www.ncbi.nlm.nih.gov/pubmed/26740254

    Nutrition. 2015 Nov 6.

    Effects of Rubus occidentalis extract on blood pressure in patients with prehypertension: Randomized, double-blinded, placebo-controlled clinical trial.

    OBJECTIVE: Black raspberry (Rubus occidentalis) is known for improving vascular function. However, there has been no study evaluating its effects on 24-h systolic and diastolic blood pressure in prehypertensive patients. The aim of this study was to examine those effects.

    METHODS: Patients with prehypertension (N = 45) were prospectively randomized into a moderate-dose black raspberry group (n = 15, 1500 mg/d), a high-dose black raspberry group (n = 15, 2500 mg/d), or a placebo group (n = 15) during an 8-wk follow-up period. Raspberries were consumed in the form of a dried powder extract that was fashioned into capsules. The capsules contained 187.5 and 312.5 mg of raspberry powder, which was equivalent to 1500 and 2500 mg raspberries. Ambulatory 24-h blood pressure (BP); central BP; pulse-wave velocity; abdominal visceral fat; serum renin; angiotensin-converting enzyme; and inflammatory cytokines such as interleukin-6, tumor necrosis factor-α, C-reactive protein, soluble intercellular adhesion molecule-1, soluble vascular cell adhesion molecule-1, and plasminogen activator inhibitor-1 were measured at baseline and at 8-wk follow-up.

    RESULTS: High-dose black raspberry significantly reduced 24-h systolic blood pressure (SBP; 3.3 ± 10 mm Hg versus -6.7 ± 11.8 mm Hg; P < 0.05) and nighttime SBP (5.4 ± 10.6 mm Hg versus -4.5 ± 11.3 mm Hg; P < 0.05) compared with controls during the 8-wk follow-up. Black raspberry powder did not produce any significant changes in most of the parameters other than BP.

    CONCLUSION: The use of black raspberry significantly lowered 24-h BP in prehypertensive patients during the 8-wk follow-up. Black raspberry used as a dietary supplement could be beneficial in reducing SBP in prehypertensive patients.

    Be well!

    JP

  26. JP Says:

    Updated 1/26/16:

    http://link.springer.com/article/10.1007%2Fs10661-015-5078-1

    Environ Monit Assess. 2016 Feb;188(2):86.

    Heavy metal content in various types of candies and their daily dietary intake by children.

    Children are vulnerable to heavy metal contamination through consumption of candies and chocolates. Considering this representative samples (69) of candies and chocolates based on cocoa, milk and sugar were analyzed for selected heavy metals by means of flame atomic absorption spectrometry. The average concentration of Zn, Pb, Ni, and Cd was found to be 2.52 ± 2.49, 2.0 ± 1.20, 0.84 ± 1.35, and 0.17 ± 0.22 μg/g respectively. Results indicate that cocoa-based candies have higher metal content than milk- or sugar-based candies. The daily dietary intake of metals for children eating candies and chocolates was also calculated, and results indicated highest intake of Pb and Zn followed by Ni, Cd, and Cu. Comparison of the current study results with other studies around the globe shows that the heavy metal content in candies and chocolates is lower in India than reported elsewhere. However, to reduce the further dietary exposure of heavy metals through candies and chocolates, their content should be monitored regularly and particularly for Pb as children are highly susceptible to its toxicity.

    Be well!

    JP

  27. JP Says:

    Updated 1/30/16:

    http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10071082&fileId=S0007114515004328

    Br J Nutr. 2016 Jan;115(2):226-38.

    Effects of grape seed extract beverage on blood pressure and metabolic indices in individuals with pre-hypertension: a randomised, double-blinded, two-arm, parallel, placebo-controlled trial.

    The aim of the present study was to test grape seed extract (GSE) as a functional ingredient to lower blood pressure (BP) in individuals with pre-hypertension. A single-centre, randomised, two-arm, double-blinded, placebo-controlled, 12-week, parallel study was conducted in middle-aged adults with pre-hypertension. A total of thirty-six subjects were randomised (1:1) to Placebo (n 18) or GSE (n 18) groups; twenty-nine of them completed all the protocol-specified procedures (Placebo, n 17; GSE, n 12). Subjects consumed a juice (167 kJ (40 kcal)) containing 0 mg (Placebo) or 300 mg/d GSE (150 mg) twice daily for 6 weeks preceded by a 2-week Placebo run-in and followed by 4-week no-beverage follow-up. Compliance was monitored. BP was measured at screening, 0, 6 and 10 weeks of intervention and blood samples were collected at 0, 3, 6 and 10 weeks of intervention. GSE significantly reduced systolic BP (SBP) by 5·6 % (P=0·012) and diastolic BP (DBP) by 4·7 % (P=0·049) after 6 weeks of intervention period, which was significantly different (SBP; P=0·03) or tended to be different (DBP; P=0·08) from Placebo. BP returned to baseline after the 4-week discontinuation period of GSE beverage. Subjects with higher initial BP experienced greater BP reduction; nearly double the effect size. Fasting insulin and insulin sensitivity tended to improve after 6 weeks of GSE beverage supplementation (P=0·09 and 0·07, respectively); no significant changes were observed with fasting plasma lipids, glucose, oxidised LDL, flow-mediated dilation or vascular adhesion molecules. Total plasma phenolic acid concentrations were 1·6 times higher after 6 weeks of GSE v. Placebo. GSE was found to be safe and to improve BP in people with pre-hypertension, supporting the use of GSE as a functional ingredient in a low-energy beverage for BP control.

    Be well!

    JP

  28. JP Says:

    Updated 03/10/16:

    http://link.springer.com/article/10.1007/s00394-016-1188-y/fulltext.html

    Eur J Nutr. 2016 Mar 7.

    Impact of phenolic-rich olive leaf extract on blood pressure, plasma lipids and inflammatory markers: a randomised controlled trial.

    PURPOSE: Dietary polyphenols have been demonstrated to favourably modify a number of cardiovascular risk markers such as blood pressure (BP), endothelial function and plasma lipids. We conducted a randomised, double-blind, controlled, crossover trial to investigate the effects of a phenolic-rich olive leaf extract (OLE) on BP and a number of associated vascular and metabolic measures.

    METHODS: A total of 60 pre-hypertensive [systolic blood pressure (SBP): 121-140 mmHg; diastolic blood pressure (DBP): 81-90 mmHg] males [mean age 45 (±SD 12.7 years, BMI 26.7 (±3.21) kg/m2] consumed either OLE (136 mg oleuropein; 6 mg hydroxytyrosol) or a polyphenol-free control daily for 6 weeks before switching to the alternate arm after a 4-week washout.

    RESULTS: Daytime [-3.95 (±SD 11.48) mmHg, p = 0.027] and 24-h SBP [-3.33 (±SD 10.81) mmHg, p = 0.045] and daytime and 24-h DBP [-3.00 (±SD 8.54) mmHg, p = 0.025; -2.42 (±SD 7.61) mmHg, p = 0.039] were all significantly lower following OLE intake, relative to the control. Reductions in plasma total cholesterol [-0.32 (±SD 0.70) mmol/L, p = 0.002], LDL cholesterol [-0.19 (±SD 0.56) mmol/L, p = 0.017] and triglycerides [-0.18 (±SD 0.48), p = 0.008] were also induced by OLE compared to control, whilst a reduction in interleukin-8 [-0.63 (±SD 1.13) pg/ml; p = 0.026] was also detected. Other markers of inflammation, vascular function and glucose metabolism were not affected.

    CONCLUSION: Our data support previous research, suggesting that OLE intake engenders hypotensive and lipid-lowering effects in vivo.

    Be well!

    JP

  29. JP Says:

    Updated 03/29/16:

    http://ajcn.nutrition.org/content/early/2016/03/02/ajcn.115.109249.abstract

    Am J Clin Nutr. 2016 Mar 2.

    Flavonoid intake and incident hypertension in women.

    BACKGROUND: Intake of flavonoid-containing food has been shown to have a beneficial effect on blood pressure in short-term randomized trials. There are limited data on total flavonoid and flavonoid-subclass consumption over a long period of time and the corresponding incidence of hypertension.

    OBJECTIVE: We aimed to evaluate the relation between flavonoid subclasses and total flavonoid intakes and incidence of hypertension.

    DESIGN: In a prospective cohort of 40,574 disease-free French women who responded to a validated dietary questionnaire, we observed 9350 incident cases of hypertension between 1993 and 2008. Cases were identified through self-reports of diagnosed or treated hypertension. Multivariate Cox regression models were adjusted for age, family history of hypertension, body mass index, physical activity, smoking, diabetes, hypercholesterolemia, hormone therapy, and alcohol, caffeine, magnesium, potassium, omega-3 (n-3), and processed meat intakes.

    RESULTS: Women in the highest quintile of flavonol intake had a 10% lower rate of hypertension than women in the lowest quintile (HR: 0.90; 95% CI: 0.84, 0.97; P-trend = 0.031). Similarly, there was a 9% lower rate for women in the highest category of intake than for women in the lowest category of intake for both anthocyanins and proanthocyanidin polymers [HRs: 0.91 (95% CI: 0.84, 0.97; P-trend = 0.0075) and 0.91 (95% CI: 0.85, 0.97; P-trend = 0.0051), respectively]. An inverse association for total flavonoid intake was observed with a similar magnitude.

    CONCLUSION: In this large prospective cohort of French middle-aged women, participants with greater flavonol, anthocyanin, and polymeric flavonoid intakes and greater total flavonoid intake were less likely to develop hypertension.

    Be well!

    JP

  30. JP Says:

    Updated 04/04/16:

    http://www.foodandnutritionresearch.net/index.php/fnr/article/view/30449

    Food Nutr Res. 2016 Mar 31;60:30449.

    Cocoa extract intake for 4 weeks reduces postprandial systolic blood pressure response of obese subjects, even after following an energy-restricted diet.

    BACKGROUND: Cardiometabolic profile is usually altered in obesity. Interestingly, the consumption of flavanol-rich foods might be protective against those metabolic alterations.

    OBJECTIVE: To evaluate the postprandial cardiometabolic effects after the acute consumption of cocoa extract before and after 4 weeks of its daily intake. Furthermore, the bioavailability of cocoa extract was investigated.

    DESIGN: Twenty-four overweight/obese middle-aged subjects participated in a 4-week intervention study. Half of the volunteers consumed a test meal enriched with 1.4 g of cocoa extract (415 mg flavanols), while the rest of the volunteers consumed the same meal without the cocoa extract (control group). Glucose and lipid profile, as well as blood pressure and cocoa metabolites in plasma, were assessed before and at 60, 120, and 180 min post-consumption, at the beginning of the study (Postprandial 1) and after following a 4-week 15% energy-restricted diet including meals containing or not containing the cocoa extract (Postprandial 2).

    RESULTS: In the Postprandial 1 test, the area under the curve (AUC) of systolic blood pressure (SBP) was significantly higher in the cocoa group compared with the control group (p=0.007), showing significant differences after 120 min of intake. However, no differences between groups were observed at Postprandial 2. Interestingly, the reduction of postprandial AUC of SBP (AUC_Postprandial 2-AUC_Postprandial 1) was higher in the cocoa group (p=0.016). Furthermore, cocoa-derived metabolites were detected in plasma of the cocoa group, while the absence or significantly lower amounts of metabolites were found in the control group.

    CONCLUSIONS: The daily consumption of cocoa extract within an energy-restricted diet for 4 weeks resulted in a greater reduction of postprandial AUC of SBP compared with the effect of energy-restricted diet alone and independently of body weight loss. These results suggest the role of cocoa flavanols on postprandial blood pressure homeostasis.

    Be well!

    JP

  31. JP Says:

    Updated 04/21/16:

    http://www.ncbi.nlm.nih.gov/pubmed/27096963

    Int J Cardiol. 2016 Apr 3;214:461-464.

    Effect of music therapy on blood pressure of individuals with
    hypertension: A systematic review and Meta-analysis.

    BACKGROUND: Studies have reported the benefits of music on blood
    pressure in hypertensive patients, however there is no meta-analysis.
    We performed a meta-analysis to investigate the effects of music in
    hypertensive patients.

    METHODS: Pubmed, Scopus, LILACS, IBECS, MEDLINE and SciELO via Virtual
    Health Library (Bireme) (from the earliest date available to February
    2016) for controlled trials that evaluated the effects of music on
    systolic and diastolic blood pressure in hypertensive patients.
    Weighted mean differences (WMD) and 95% confidence intervals (CIs)
    were calculated, and heterogeneity was assessed using the I2 test.

    RESULTS: Three studies met the eligibility criteria. Music resulted in
    improvement in systolic blood pressure WMD (-6.58 95% CI: -9.38 to
    -3.79), compared with control group. A nonsignificant difference in
    diastolic blood pressure was found for participants in the music group
    compared with control group.

    CONCLUSIONS: Music may improve systolic blood pressure and should be
    considered as a component of care of hypertensive patients.

    Be well!

    JP

  32. JP Says:

    Updated 05/16/16:

    http://www.sciencedirect.com/science/article/pii/S0026286216300486

    Microvasc Res. 2016 May 7.

    Assessing the effects of a short-term green tea intervention in skin microvascular and oxygen tension in older and younger adults.

    Green tea consumption has been associated with a reduction in cardiovascular disease risk factors. However, there is little evidence examining its potential differing effect between younger and older populations, whilst little is known on its effect on the circulatory system when oxygen demand is higher. Therefore the aim of this study was to evaluate the short-term effects of green tea consumption on microvascular functioning in both an older and younger population. Fifteen young [24 (4.0)] and fifteen older [61 (4.0)] participants, consumed two cups of green tea daily for 14days. We used Laser Doppler Flowmetry to assess cutaneous microvascular function and Transcutaneous Oxygen Pressure to assess skin oxygen tension. Systolic and diastolic blood pressure were also assessed on both visits. We observed significant improvements in axon-mediated microvascular vasodilation for the younger group [1.6 (0.59) vs 2.05 (0.72), p<0.05] and the older group [1.25 (0.58) vs 1.65 (0.5) p<0.05]. Improvements in skin oxygen tension were also noted for both groups in both noted TcPO2 measures (i.e. 1.25 (0.58) vs 1.65 (0.5) (p<0.05), for ΔTcPO2max for the older group, between visits) respectively. Improvements were also observed for systolic blood pressure in both the younger [120 (10) vs 112 (10), p<0.05] and older group [129 (12) v 124 (11), p<0.001]. In conclusion, we observed statistically-significant improvements in microvascular function and skin oxygen tension. Our results suggest that green tea may prove beneficial as a dietary element in lifestyle interventions aiming to lower cardiovascular disease risk, in both older and younger populations.

    Be well!

    JP

  33. JP Says:

    Updated 06/14/16:

    http://www.ncbi.nlm.nih.gov/pubmed/27294768

    J Racial Ethn Health Disparities. 2015 Dec 22.

    Cultural Dance Program Improves Hypertension Management for Native Hawaiians and Pacific Islanders: a Pilot Randomized Trial.

    OBJECTIVE: Native Hawaiians and Pacific Islanders (NHPI) bear an unequal burden of hypertension and cardiovascular disease. Hula, the traditional dance of Hawaii, has shown to be a culturally meaningful form of moderate-vigorous physical activity for NHPI. A pilot study was done in Honolulu, Hawaii, to test a 12-week hula-based intervention, coupled with self-care education, on blood pressure management in NHPI with hypertension in 2013.

    METHOD: NHPI with a systolic blood pressure (SBP) ≥140 mmHg were randomized to the intervention (n = 27) or a wait-list control (n = 28). Blood pressure, physical functioning, and eight aspects of health-related quality of life (HRQL) were assessed.

    RESULTS: The intervention resulted in a reduction in SBP compared to control (-18.3 vs. -7.6 mmHg, respectively, p ≤ 0.05) from baseline to 3-month post-intervention. Improvements in HRQL measures of bodily pain and social functioning were significantly associated with SBP improvements in both groups.

    CONCLUSION: Using hula as the physical activity component of a hypertension intervention can serve as a culturally congruent strategy to blood pressure management in NHPI with hypertension.

    Be well!

    JP

  34. JP Says:

    Updated 07/19/16:

    http://hyper.ahajournals.org/content/early/2016/07/11/HYPERTENSIONAHA.116.07664.full.pdf+html

    Hypertension. 2016 Jul 11.

    Effects of Magnesium Supplementation on Blood Pressure: A Meta-Analysis of Randomized Double-Blind Placebo-Controlled Trials.

    The antihypertensive effect of magnesium (Mg) supplementation remains controversial. We aimed to quantify the effect of oral Mg supplementation on blood pressure (BP) by synthesizing available evidence from randomized, double-blind, placebo-controlled trials. We searched trials of Mg supplementation on normotensive and hypertensive adults published up to February 1, 2016 from MEDLINE and EMBASE databases; 34 trials involving 2028 participants were eligible for this meta-analysis. Weighted mean differences of changes in BP and serum Mg were calculated by random-effects meta-analysis. Mg supplementation at a median dose of 368 mg/d for a median duration of 3 months significantly reduced systolic BP by 2.00 mm Hg (95% confidence interval, 0.43-3.58) and diastolic BP by 1.78 mm Hg (95% confidence interval, 0.73-2.82); these reductions were accompanied by 0.05 mmol/L (95% confidence interval, 0.03, 0.07) elevation of serum Mg compared with placebo. Using a restricted cubic spline curve, we found that Mg supplementation with a dose of 300 mg/d or duration of 1 month is sufficient to elevate serum Mg and reduce BP; and serum Mg was negatively associated with diastolic BP but not systolic BP (all P<0.05). In the stratified analyses, a greater reduction in BP tended to be found in trials with high quality or low dropout rate (all P values for interaction <0.05). However, residual heterogeneity may still exist after considering these possible factors. Our findings indicate a causal effect of Mg supplementation on lowering BPs in adults. Further well-designed trials are warranted to validate the BP-lowering efficacy of optimal Mg treatment.

    Be well!

    JP

  35. JP Says:

    Updated 09/01/16:

    http://ajcn.nutrition.org/content/103/6/1531.long

    Am J Clin Nutr. 2016 Jun;103(6):1531-9.

    Effects of Montmorency tart cherry (Prunus Cerasus L.) consumption on vascular function in men with early hypertension.

    BACKGROUND: Tart cherries contain numerous polyphenolic compounds that could potentially improve endothelial function and reduce cardiovascular disease risk.

    OBJECTIVE: We sought to examine the acute effects of Montmorency tart cherry (MC) juice on vascular function in subjects with early hypertension.

    DESIGN: A placebo-controlled, blinded, crossover, randomized Latin square design study with a washout period of ≥14 d was conducted. Fifteen men with early hypertension [systolic blood pressure (SBP) ≥130 mm Hg, diastolic blood pressure ≥80 mm Hg, or both] received either a 60-mL dose of MC concentrate or placebo. Microvascular reactivity (laser Doppler imaging with iontophoresis), arterial stiffness (pulse wave velocity and analysis), blood pressure, and phenolic acid absorption were assessed at baseline and at 1, 2, 3, 5, and 8 h postconsumption.

    RESULTS: MC consumption significantly lowered SBP (P < 0.05) over a period of 3 h, with peak reductions of mean ± SEM 7 ± 3 mm Hg 2 h after MC consumption relative to the placebo. Improvements in cardiovascular disease risk factors were closely linked to increases in circulating protocatechuic and vanillic acid at 1-2 h.

    CONCLUSIONS: MC intake acutely reduces SBP in men with early hypertension. These benefits may be mechanistically linked to the actions of circulating phenolic acids. This study provides information on a new application of MCs in health maintenance, particularly in positively modulating SBP.

    Be well!

    JP

  36. JP Says:

    Updated 09/13/16:

    http://www.ncbi.nlm.nih.gov/pubmed/27569177

    Med Clin (Barc). 2016 Aug 25.

    [Effects of a dance therapy programme on quality of life, sleep and blood pressure in middle-aged women: A randomised controlled trial].

    BACKGROUND AND OBJECTIVE: Evidence suggests that dance therapy may have positive effects in areas such as cardiovascular parameters and sleep. The aim of the present study is to explore whether a dance therapy programme improves sleep and blood pressure in a population of middle-aged pre-hypertensive and hypertensive women.

    METHODS: A randomised controlled trial was conducted, in which participants were assigned to one of 2 groups: standard care (with usual activities and medication) or dance therapy (in which the participants followed a dance therapy programme, in addition to their medication). The intervention was an 8-week, 3-times-per-week, progressive and specific group dance-training programme. The dance steps were specifically designed to improve balance by shifting the body and relocating the centre of gravity. The main measures obtained were blood pressure, sleep quality and quality of life, measured by the Pittsburgh Sleep Quality Index and the European Quality of Life Questionnaire.

    RESULTS: Sixty-seven pre-hypertensive and hypertensive middle-aged women were randomised to either an intervention group (n=35) or a control group (n=32) after baseline testing. The intervention group reported a significant improvement in blood pressure values (P<.01), as well as in sleep quality (P<.05) and quality of life (P<.001), compared to the control group.

    CONCLUSION: The dance therapy programme improved blood pressure, sleep and quality of life in pre-hypertensive and hypertensive middle-aged women, and constitutes an interesting basis for larger-scale research.

    Be well!

    JP

  37. JP Says:

    Updated 09/20/16:

    http://www.ashjournal.com/article/S1933-1711(16)30448-X/abstract

    J Am Soc Hypertens. 2016 Aug 4.

    The effects of mindfulness-based stress reduction on cardiac patients’ blood pressure, perceived stress, and anger: a single-blind randomized controlled trial.

    This study aimed at assessing the effects of mindfulness-based stress reduction (MBSR) on cardiac patients’ blood pressure (BP), perceived stress, and anger. In total, 60 cardiac patients were recruited between April and June 2015 from a specialized private cardiac clinic located in Kashan, Iran. Patients were allocated to the intervention and control groups. Patients in the experimental group received MBSR in eight 2.5-hour sessions, while patients in the control group received no psychological therapy. The main outcomes were BP, perceived stress, and anger. Analysis of covariance revealed a significant difference between the study groups regarding the posttest values of systolic BP, perceived stress, and anger (P < .001). However, the study groups did not differ significantly in terms of diastolic BP (P = .061; P = .17). This study reveals that MBSR is effective in reducing cardiac patients’ systolic BP, perceived stress, and anger.

    Be well!

    JP

  38. JP Says:

    Updated 11/03/16:

    https://www.ncbi.nlm.nih.gov/pubmed/27803727

    Evid Based Complement Alternat Med. 2016;2016:1549658.

    Effectiveness of Acupressure on the Taichong Acupoint in Lowering Blood Pressure in Patients with Hypertension: A Randomized Clinical Trial.

    Objectives. To evaluate the effectiveness of acupressure on the Taichong acupoint in lowering systolic and diastolic blood pressure (BP) in hypertensive patients. Methods. Eighty patients with hypertension attending a cardiology outpatient department in central Taiwan were included in this randomized clinical trial. Acupressure was applied to the Taichong acupoint in the experimental group (n = 40) and to the first metatarsal (sham acupoint) in the control group (n = 40). Blood pressure was measured by electronic monitoring before and immediately 15 min and 30 min after acupressure. Results. The average age of the experimental and control participants was 59.3 ± 9.2 years and 62.7 ± 8.4 years, respectively. The two groups were similar for demographics and antihypertensive drug use. Mean systolic and diastolic BP in the experimental group decreased at 0, 15, and 30 min after acupressure (165.0/96.3, 150.4/92.7, 145.7/90.8, and 142.9/88.6 mmHg); no significant changes occurred in the control group. There was a significant difference in systolic and diastolic BP between the experimental and control groups immediately and 15 and 30 min after acupressure (p < 0.05). Conclusion. Acupressure on the Taichong acupoint can lower BP in hypertensive patients and may be included in the nursing care plan for hypertension. However, additional studies are needed to determine the optimal dosage, frequency, and long-term effects of this therapy.

    Be well!

    JP

  39. JP Says:

    Updated 11/20/16:

    http://www.nature.com/jhh/journal/v30/n10/full/jhh201634a.html

    J Hum Hypertens. 2016 Oct;30(10):627-32.

    Improvement of hypertension, endothelial function and systemic inflammation following short-term supplementation with red beet (Beta vulgaris L.) juice: a randomized crossover pilot study.

    Hypertension is a major risk factor for cardiovascular disease and has a prevalence of about one billion people worldwide. It has been shown that adherence to a diet rich in fruits and vegetables helps in decreasing blood pressure (BP). This study aimed to investigate the effect of raw beet juice (RBJ) and cooked beet (CB) on BP of hypertensive subjects. In this randomized crossover study, 24 hypertensive subjects aged 25-68 years old were divided into two groups. One group took RBJ for 2 weeks and the other group took CB. After 2 weeks of treatment, both groups had a washout for 2 weeks then switched to the alternate treatment. Each participant consumed 250 ml day(-1) of RBJ or 250 g day(-1) of CB each for a period of 2 weeks. Body weight, BP, flow-mediated dilation (FMD), lipid profile and inflammatory parameters were measured at baseline and after each period. According to the results, high-sensitivity C-reactive protein (hs-CRP) and tumour necrosis factor alpha (TNF-α) were significantly lower and FMD was significantly higher after treatment with RBJ compared with CB (P<0.05). FMD was significantly (P<0.05) increased, but systolic and diastolic BP, intracellular adhesion molecule-1 (ICAM-1), vascular endothelial adhesion molecule-1 (VCAM-1), hs-CRP, interleukin-6, E-selectin and TNF-α were significantly (P<0.05) decreased with RBJ or CB. Total antioxidant capacity was increased and non-high-density lipoprotein (HDL), low-density lipoprotein (LDL) and total cholesterol (TC) were decreased with RBJ but not with CB. Although both forms of beetroot were effective in improving BP, endothelial function and systemic inflammation, the raw beetroot juice had greater antihypertensive effects. Also more improvement was observed in endothelial function and systemic inflammation with RBJ compared with CB.

    Be well!

    JP

  40. JP Says:

    Updated 12/27/16:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5066864/

    Integr Blood Press Control. 2016 Oct 13;9:95-104.

    Consumption of nattokinase is associated with reduced blood pressure and von Willebrand factor, a cardiovascular risk marker: results from a randomized, double-blind, placebo-controlled, multicenter North American clinical trial.

    OBJECTIVE: The objective of this study is to evaluate the effects of consumption of nattokinase on hypertension in a North American hypertensive population with associated genetic, dietary, and lifestyle factors. This is in extension of, and contrast to, previous studies on Asian populations.

    MATERIALS AND METHODS: A randomized, double-blind, placebo-controlled, parallel-arm clinical study was performed to evaluate nattokinase (NSK-SD), a fermented soy extract nattō from which vitamin K2 has been removed. Based on the results from previous studies on Asian populations, 79 subjects were enrolled upon screening for elevated blood pressure (BP; systolic BP ≥130 or diastolic BP ≥90 mmHg) who consumed placebo or 100 mg nattokinase/d for the 8-week study duration. Blood collections were performed at baseline and 8 weeks for testing plasma renin activity, von Willebrand factor (vWF), and platelet factor-4. Seventy-four people completed the study with good compliance.

    RESULTS: Consumption of nattokinase was associated with a reduction in both systolic and diastolic BP. The reduction in systolic BP was seen for both sexes but was more robust in males consuming nattokinase. The average reduction in diastolic BP in the nattokinase group from 87 mmHg to 84 mmHg was statistically significant when compared to that in the group consuming placebo, where the average diastolic BP remained constant at 87 mmHg (P<0.05), and reached a high level of significance for males consuming nattokinase, where the average diastolic BP dropped from 86 mmHg to 81 mmHg (P<0.006). A decrease in vWF was seen in the female population consuming nattokinase (P<0.1). In the subpopulation with low plasma renin activity levels at baseline (<0.29 ng/mL/h), an increase was seen for 66% of the people after 8-week consumption of nattokinase (P<0.1), in contrast to only 8% in the placebo group.

    CONCLUSION: The data suggest that nattokinase consumption in a North American population is associated with beneficial changes to BP in a hypertensive population, indicating sex-specific mechanisms of action of nattokinase’s effect on vWF and hypertension.

    Be well!

    JP

  41. JP Says:

    Updated 02/13/17:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5245087/

    Exp Ther Med. 2017 Jan;13(1):295-301.

    The effect of resveratrol on hypertension: A clinical trial.

    The aim of this clinical trial was to investigate the effects of Evelor, a micronized formulation of resveratrol (RESV; 3,5,4′-trihydroxy-trans-stilbene), in patients with primary hypertension. RESV is a stilbenoid and phytoalexin produced by several plants in response to injury or attack by pathogens, such as bacteria and fungi. Patients included in the clinical trial were split into the following two groups, based on the severity of their disease: Group A (n=46), stage I hypertension [systolic blood pressure (SBP), 140-159 mmHg; diastolic blood pressure (DBP), 90-99 mmHg] and Group B (n=51), stage II hypertension (SBP, 160-179 mmHg; DBP, 100-109 mmHg). Each group was divided into two subgroups: A1 and B1, patients treated with standard antihypertensive therapy (A1, 10 mg Dapril; B1, 20 mg Dapril), and A2 and B2, patients treated with antihypertensive therapy (Dapril) plus Evelor. The present study aimed to determine the effects of Evelor, in addition to the standard hypertension treatment, and its effect on the hepatic enzymes serum glutamate-pyruvate transaminase (SGPT) and gamma-glutamyl transferase (gamma-GT). Following the trial, which lasted two years (October 2010 to October 2012), the mean blood pressure of both groups lay within the normal range, indicating that blood pressure was efficiently controlled. The results of the present study demonstrate that the addition of RESV to standard antihypertensive therapy is sufficient to reduce blood pressure to normal levels, without the need for additional antihypertensive drugs. In addition, statistical analysis of the results identified a significant reduction in plasma concentration levels of SGPT (P<0.001) and gamma-GT (P<0.001) with the addition of RESV, indicating that RESV prevents liver damage.

    Be well!

    JP

  42. JP Says:

    Updated 05/29/17:

    https://www.ncbi.nlm.nih.gov/pubmed/28546682

    Int J Yoga. 2017 May-Aug;10(2):103-106.

    Yoga Practice Improves the Body Mass Index and Blood Pressure: A Randomized Controlled Trial.

    BACKGROUND: Yoga, an ancient Indian system of exercise and therapy is an art of good living or an integrated system for the benefit of the body, mind, and inner spirit. Regular practice of yoga can help to increase blood flow to the brain, reduce stress, have a calming effect on the nervous system, and greatly help in reducing hypertension.

    AIM: Aim of the present study is to evaluate the effect of 1-month yoga practice on body mass index (BMI), and blood pressure (BP).

    MATERIALS AND METHODS: The present study was conducted to determine the effect of yoga practice on 64 participants (age 53.6 ± 13.1 years) (experimental group) whereas the results were compared with 26 healthy volunteers (control group). We examined the effects of yoga on physiological parameters in a 1-month pilot study. Most of the participants were learner and practiced yoga for 1 h daily in the morning for 1 month. BMI and BP (systolic and diastolic) were studied before and after 1 month of yoga practice.

    RESULTS: Yoga practice causes decreased BMI (26.4 ± 2.5-25.22 ± 2.4), systolic BP (136.9 ± 22.18 mmHg to 133 ± 21.38 mmHg), and diastolic BP (84.7 ± 6.5 mmHg to 82.34 ± 7.6 mmHg). On the other hand, no significant changes were observed in BMI and BP of control group.

    Be well!

    JP

  43. JP Says:

    Updated 06/23/17:

    https://academic.oup.com/ajh/article-abstract/doi/10.1093/ajh/hpx102/3867393/Sauna-Bathing-and-Incident-Hypertension-A?redirectedFrom=fulltext

    Am J Hypertens. 2017 Jun 13.

    BACKGROUND: Sauna bathing is associated with reduced cardiovascular risk, but the mechanisms underlying this beneficial effect are not entirely understood. We aimed to assess the relationship between sauna bathing and risk of incident hypertension.

    METHODS: Frequency of sauna bathing was ascertained using questionnaires in the Kuopio Ischemic Heart Disease Study, a prospective cohort study conducted in Eastern Finland that comprised a population-based sample of 1,621 men aged 42 to 60 years without hypertension at baseline. The incidence of hypertension was defined as a physician diagnosis of hypertension, systolic blood pressure (SBP) >140 mm Hg, diastolic blood pressure >90 mm Hg, or use of antihypertensive medication.

    RESULTS: During a median follow-up of 24.7 years, 251 incident cases (15.5%) were recorded. In Cox regression analysis adjusted for baseline age, smoking, body mass index, and SBP; compared to participants reporting 1 sauna session per week, the hazard ratio for incident hypertension in participants reporting 2 to 3 sessions and 4 to 7 sessions was 0.76 (95% confidence interval: 0.57-1.02) and 0.54 (0.32-0.91), respectively. The corresponding hazard ratios were similar after further adjustment for glucose, creatinine, alcohol consumption, heart rate, family history of hypertension, socioeconomic status, and cardiorespiratory fitness: 0.83 (95% confidence interval: 0.59-1.18) and 0.53 (0.28-0.98), respectively.

    CONCLUSIONS: Regular sauna bathing is associated with reduced risk of hypertension, which may be a mechanism underlying the decreased cardiovascular risk associated with sauna use. Further epidemiological and experimental studies could help elucidate the effects of sauna bathing on cardiovascular function.

    Be well!

    JP

  44. JP Says:

    Updated 12/10/17:

    https://link.springer.com/article/10.1007%2Fs00394-017-1591-z

    Eur J Nutr. 2017 Dec 8.

    Coffee consumption and risk of hypertension: a dose-response meta-analysis of prospective studies.

    PURPOSE: Recently, a large prospective study provided additional information concerning the debated possible association between habitual coffee consumption and risk of hypertension (HPT). Therefore, we updated the state of knowledge on this issue by carrying out a comprehensive new systematic review of the literature and a meta-analysis of the available relevant studies.

    METHODS: We performed a systematic search for prospective studies on general population, published without language restrictions (1966-August 2017). A random-effects dose-response meta-analysis was conducted to combine study specific relative risks (RRs) and 95% confidence intervals. Potential non-linear relation was investigated using restricted cubic splines.

    RESULTS: Four studies (196,256 participants, 41,184 diagnosis of HPT) met the inclusion criteria. Coffee intake was assessed by dietary questionnaire. Dose-response meta-analysis showed a non-linear relationship between coffee consumption and risk of HPT (p for non-linearity < 0.001). Whereas the habitual drinking of one or two cups of coffee per day, compared with non-drinking, was not associated with risk of HPT, a significantly protective effect of coffee consumption was found starting from the consumption of three cups of coffee per day (RR = 0.97, 95% CI = 0.94 to 0.99), and was confirmed for greater consumption.

    CONCLUSIONS: The results of this analysis indicate that habitual moderate coffee intake is not associated with higher risk of HPT in the general population and that in fact a non-linear inverse dose-response relationship occurs between coffee consumption and risk of HPT.

    Be well!

    JP

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