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Buendia JR, Bradlee ML, Singer MR, Moore LL. Diets higher in protein predict lower high blood pressure risk in Framingham Offspring Study adults. Am J Hypertens. 2015;28(3):372-379. doi:10.1093/ajh/hpu157

There is a suggestion in short-term trials that dietary proteins are beneficial to lower blood pressure. For example, DASH diet studies reported that fruits and vegetable with low-fat dairy products (dietary protein) had the most effect to lower BP. This study is important because it expands the theory to long-term impact of proteins by animal, plant or both.

The method is monitoring 1361 samples from both sex, 30-54 years old with no history of HBP, CVD or diabetes for 11.3 years.
The effect of lowering SBP/DBP by proteins was recognized, and risks of HBP was significantly reduced by high consumption of proteins from both animal and plant: 40% less. Also, the study confirmed that dietary fiber is highly beneficial to lower BP with combination of high protein intake.

The clinical implication of this study is that risks of developing HBP are not related to dietary protein. Instead, people should increase intake of animal or plant proteins to prevent HBP for long-term.

It is interesting that this study tries to recommend animal proteins when most of recent studies conclude to shift to plant-based diets.

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Gorostegi-Anduaga, I., Corres, P., MartinezAguirre-Betolaza, A., Pérez-Asenjo, J., Aispuru, G. R., Fryer, S. M., & Maldonado-Martín, S. (2018). Effects of different aerobic exercise programmes with nutritional intervention in sedentary adults with overweight/obesity and hypertension: EXERDIET-HTA study. European journal of preventive cardiology, 25(4), 343–353. https://doi.org/10.1177/2047487317749956

This article is important because it looks at the role different aerobic exercise trainings play on blood pressure, cardiorespiratory function, body composition, and pharmacological treatment when combined with a low-calorie diet. The researchers looked at different 16-week exercise training programs for their study. Overweight or obese participants were assigned into one of four groups. The participants were assigned to a control group or one of three 16-week exercise training groups. The control group utilized physical activity recommendations while the exercise training groups had two days each week of high volume with 45 minutes of moderate intensity continuous training, high volume and high intensity interval training, alternating high and low intensities, or low volume high intensity interval training. All participants ate the same low-calorie diet.

One key finding in this study is that there was a significant decrease in blood pressure in all of the groups, however BMI decreased more in the exercise groups compared to the control group. Blood pressure medication was also reduced in about 37% among participants. High intensity interval training also seemed to be more effective at lowering body mass and increasing cardiorespiratory fitness.

This study is important clinically because it shows that a low-calorie diet combined with aerobic exercise can be an effective nutritional method to combat obesity and hypertension. Recommending exercise combined with diet management can be an effective tool for managing hypertension and even reducing negative side effects caused by medication. I think it is important to keep in mind that exercise and diet are equally as important to our quality of life.

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Barriers to Nutrition counseling

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Citation:

Berendsen AAM, Kang JH, van de Rest O, Feskens EJM, de Groot LCPGM, Grodstein F. The Dietary Approaches to Stop Hypertension Diet, Cognitive Function, and Cognitive Decline in American Older Women. J Am Med Dir Assoc. 2017

Study importance:

This study examined if there is an association between cognitive function and long-term adherence to the DASH diet, in older American women

Key finding:

Greater adherence to long-term DASH score was associated with better average cognitive function, irrespective of apolipoprotein E ε4 allele status. These differences were equivalent to being 1 year younger in age. Adherence to the DASH score was not associated with change in cognitive function over 6 years.

Clinical implication:

This study shows that long-term adherence to the DASH diet, may not only help with controlling hypertension but also help with keeping neurocognitive decline at bay. Given the benefits of the DASH diet on hypertension, it may be because of slowing down in the hypertension induced white matter disease process and consequent better cognition at an older age. Although we did not see any change in cognitive function over 6 years, this would significantly help in maintaining an independent lifestyle for longer.

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Citation: Atieh Mirzababaei, Faezeh Khorsha, Mansoureh Togha, Mir Saeed Yekaninejad, Ali Asghar Okhovat & Khadijeh Mirzaei (2020) Associations between adherence to dietary approaches to stop hypertension (DASH) diet and migraine headache severity and duration among women, Nutritional Neuroscience, 23:5, 335-342, DOI: 10.1080/1028415X.2018.1503848

Prevalence of migraine has been steadily high with the attacks causing neurological dysfunction and pain. Food has been associated with duration and severity of migraine attacks. This study evaluated the effects of adhering to dietary approaches to stop hypertension (DASH) diet had on headache severity and duration among women suffering from migraine. The study is conducted in 266 women between age 18-45 years who are being referred to headache clinic for the first time. The tools used include food frequency questionaire, anthropometric measurements, visual analog scale and migraine disability assessment questionaires.

The result showed that DASH diet is associated with lower headache severity and duration in migraine patients, specifically in women population being studied. Individuals with greatest adherence to DASH diet displayed 30% lower prevalence in severe headaches, compared to those with lowest adherence. After controlling for confounders, subjects in highest quartile of DASH diet adherence were 46% less likely to have severe headaches, and with 36% lower occurrence of moderate headaches, compared to those in the bottom quartile.

The result showed a significant positive correlation between adherence to DASH diets and lower rates of mean headache duration for each attack in the last month. Given the association, DASH diet might implicate in becoming potential core measures in the abortive and preventive treatments for migraine headaches. In addition to pharmacological therapy, it might be worthwhile to integrate the dietary approaches into clinical practice for treating migraine or other headaches.

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Citation: Ibsen H, Olsen MH, Wachtell K, Borch-Johnsen K, Lindholm LH, Mogensen CE, Dahlöf B, Devereux RB, de Faire U, Fyhrquist F, Julius S, Kjeldsen SE, Lederballe-Pedersen O, Nieminen MS, Omvik P, Oparil S, Wan Y. Reduction in albuminuria translates to reduction in cardiovascular events in hypertensive patients: losartan intervention for endpoint reduction in hypertension study. Hypertension. 2005 Feb;45(2):198-202. doi: 10.1161/01.HYP.0000154082.72286.2a. Epub 2005 Jan 17. PMID: 15655123.

Why is the study important?

The investigators from this study set out to analyze the correlation between albuminuria and the relative risk of cardiovascular events. Small amounts of urinary albumin can serve as a marker of cardiovascular risk in both diabetic and non-diabetic patients. A high urinary albumin excretion rate is correlated with left ventricular hypertrophy (LVH). This data suggests that quantifying the extent of albumin excretion from the body may serve as a clue to the severity of future cardiovascular events for patients with albuminuria, particularly hypertensive patients.

One key finding and relation to Nutrition

A key finding from this study was that decreases in albuminuria correlated with a decrease in the number of future cardiovascular events. Albuminuria is an integrated marker for the structural and functional abnormalities seen in hypertension. These included hypertensive vascular abnormalities, endothelial dysfunction, and impairment of renal function. Levels of albuminuria can be modulated by a number of different factors including through medications that lower blood pressure (ACE inhibitors) and dietary changes that result in weight loss. If the albuminuria is mainly caused because of renal dysfunction, then curing the condition may not be possible, but slowing the progression is achievable through a combination of the above methods.

Clinical implication

Monitoring albuminuria in hypertensive patients before and during treatment is very important in predicting the risk of future cardiovascular events. This means that testing for changes in albumin excretion should be closely examined throughout treatment. If a patient is successful in lowering the amount of albumin excretion from their body, then they effectively decrease the risk of cardiovascular events such as stroke and heart attack.

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 Hi Elizabeth, 

 

Thank you for sharing this study. I agree that it is very important to consider the complexities of disease progression. There is a lot of signaling events occurring within the body, and it is the summation of these events that lead to complex responses by the body. It is vital to target the root of the cause with any disease state and I could imagine that deciding exactly which condition that takes priority for treatment can often be a challenging situation. I wonder how often a patient’s symptoms are treated without impacting the root cause of the dysregulation. It was also interesting noting that abnormal lab values do not always result in the development of disease and that those values are not always indicative of a single disease state, in your study’s case, sodium intake was not always indicative to increased blood pressure. To provide patients with the best quality of medical service I think practitioners must balance a patient’s own unique homeostatic mechanisms when deciding an effective course of treatment. Any thoughts on that topic? Like you have mentioned, this will tie in nicely with the concept of precision medicine.  -James L. 

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Kazi, Raisa Nazir, et al. “Prevalence of Salt Rich Fast Food Consumption: A Focus on Physical Activity and Incidence of Hypertension among Female Students of Saudi Arabia.” Saudi Journal of Biological Sciences, vol. 27, no. 10, 2020, pp. 2669–2673., doi:10.1016/j.sjbs.2020.06.004.

Saudi Arabia is now experiencing a shift in nutrition from healthy foods to an increased consumption of fast food. Fast foods have such high levels of salt that eating it consistently will drastically increase risk for hypertension. This study is important because it looked at multiple different factors in hypertension, it looked at genetic influence, physical activity, and high salt. Something to point out in this study is that of the participants in this study (college aged females) 97% of them reported that they had fast food once per day. In addition to daily fast-food intake over half of the participants had family history of hypertension. To no surprise the findings of this study are as follows: increased high salt fast food diet, and physical inactivity increase risk of hypertension. When adding the genetic component as well (over 50% of participants) you increase the risk even further. An important part of this study focused of the education at the community level to families and children on the dangers of high salt fast food intake on a daily basis and they have taken swift action to stopping this “nutritional shift”. Nutritionally, of course eating fast food daily is not a healthy lifestyle decision. Life does get in the way sometimes and there are only 24 hours in a day so it is difficult to find the time for 3 healthy meals consistently but limiting high salt options on the run is a good way to help yourself down the road.

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Tain Y-L, Lee W-C, Wu KLH, Leu S, Chan JYH. Resveratrol Prevents the Development of Hypertension Programmed by Maternal Plus Post-Weaning High-Fructose Consumption through Modulation of Oxidative Stress, Nutrient-Sensing Signals, and Gut Microbiota. Molecular Nutrition & Food Research. 2018;62(15):1800066. doi:10.1002/mnfr.201800066

Since maternal diet high in fructose has been shown to cause hypertension in adult offspring, it is important to find ways to prevent this programmed hypertension. This study investigated whether resveratrol can prevent maternal diet induced tendency toward hypertension.

The study did confirm that male mice born exposed to high-fructose (HF) diet during gestation, lactation, and post-weaning period did develop hypertension. The mice that were also given resveratrol with their post-weaned diet, had less hypertension.  The gut microbiota was improved, renal oxidative stress was reduced, and severed nutrient-sensing signals were activated in the resveratrol group.

Several mechanisms are at play in preventing hypertension in offspring exposed to HF diet during gestation, lactation, and early life. Resveratrol’s effect on reduction of oxidative stress, restoring nutrient-sensing signals, and improving gut microbiota could be found to change HF diet induced hypertension. and this is clinically important.

Resveratrol is found in the skin of grapes, blueberries, mulberries, raspberries, and peanuts.

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Günther, A. L., Liese, A. D., Bell, R. A., Dabelea, D., Lawrence, J. M., Rodriguez, B. L., ... & Mayer-Davis, E. J. (2009). Association between the dietary approaches to hypertension diet and hypertension in youth with diabetes mellitus. Hypertension, 53(1), 6-12.

1. Importance
This study looks at the DASH diet (Dietary Approaches to Stop Hypertension) in adolescents with Type I and II Diabetes Mellitus (T1DM and T2DM). Hypertension research normally focuses on adult populations since half of adults in the US have hypertension and frequently look into obese adult populations. This article addresses a significant hole in research.

2. Key Finding
This study found that adolescents with T1DM who utilized the DASH diet significantly decreased their blood pressure and their likelihood of developing hypertension later in life. As diabetes mellitus (type I and II) has a high comorbidity rate with hypertension, the earlier the intervention, the better the lifelong outlook. The same findings were not found with adolescents with T2DM; however, this was thought to be because of statistical reasons rather than a lack of a relationship. T2DM adolescents were underrepresented in this study.

As this study focuses on nutrition's role in early hypertension intervention in adolescents with diabetes mellitus, it showcases the necessity of addressing nutrition's role in healthcare early in life.

3. Clinical Implications
This is extremely important clinically because it is widely known that early intervention has the best health outcomes. By addressing hypertension and diabetes mellitus in adolescents, we can showcase that early nutritional intervention shows significant improvements in blood pressure.

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Sahebkar, A., Ferri, C., Giorgini, P., Bo, S., Nachtigal, P., & Grassi, D. (2017). Effects of pomegranate juice on blood pressure: A systematic review and meta-analysis of randomized controlled trials. Pharmacological research, 115, 149–161. https://doi.org/10.1016/j.phrs.2016.11.018
Evidence had proven that consumption of flavonoid rich fruits and vegetables play a role in lowering blood pressure and conferring cardiovascular protection.

This is an important randomized controlled trail (RCT) because it aimed to investigate the effects of pomegranate juice consumption on blood pressure. Moreover, this RCT considered the participants’ ages, genders, BMI, circulating concentrations of total cholesterol, LDL-C, HDL-C, triglyceride levels, systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting glucose concentrations.

The key finding of this study is that eight RCTs showed that pomegranate juice is able to significantly decrease both SBP and DBP levels. Furthermore, pomegranate juice reduced SBP regardless of the duration of supplementation, and the administered dose, whereas doses > 240 cc of pomegranate juice provided a borderline significant effect in reducing DBP.

The most clinical implication of this RCT is that pomegranate juice might be considered as an effective tool to the anti-hypertensive medications and also as a constituent of a daily diet for patients who are at risk for hypertension and cardiovascular disease.

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Aljuraiban G, Chan Q, Gibson R for the INTERMAP Research Group, et al

Association between plant-based diets and blood pressure in the INTERMAP study. BMJ Nutrition, Prevention & Health 2020;3:doi: 10.1136/bmjnph-2020-000077

The use of “plant-based diet” terminology is becoming increasing popular in current public health messages to consumers.  It is important to note that there is not a standardized definition of plant-based diet established by USDA or by the Academy of Nutrition and Dietetics, the largest organization of food and nutrition professionals in the U.S.  PCRM has established a definition as have other entities and individual practitioners.  With that being said, it is important that consumers do understand that a plant-based diet is not necessarily synonymous with a high-quality diet.  When reviewing various definitions of a plant-based diet it is assumed that it is one of a high quality, nutrient dense eating pattern.  This study distinguishes the differences between a high-quality (healthy) plant-based diet, unhealthy plant-based diet and overall plant-based diet and their association on blood pressure.

I didn’t feel that the results were very surprising but am glad that this study addresses the quality of plant-based diets.  A high adherence to a high quality (healthy) plant-based diet was inversely associated with systolic and diastolic blood pressure.   A high adherence to an overall plant-based diet was not inversely associated with systolic and diastolic blood pressure.  Simply put: quality of the diet matters!  High adherence to an unhealthy plant-based diet was directly associated with higher systolic blood pressure.

I appreciated this study because it was a reminder that practitioners need to be aware that clients/patients may have misconceptions about plant-based diets and that education on what constitutes a high-quality plant-based diet (consisting of whole grains, fruits, vegetables, nuts, legumes, vegetable oils and tea/coffee but low in fruit juices, sugar-sweetened beverages, refined grains, processed potatoes, sweets and desserts) is important to address.

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Citation:  Pathak CM, Ix JH, Anderson CAM, Woodell TB, Smits G, Persky MS, Block GA, Rifkin DE. Variation in Sodium Intake and Intra-individual Change in Blood Pressure in Chronic Kidney Disease. J Ren Nutr. 2018 Mar;28(2):125-128. doi: 10.1053/j.jrn.2017.07.002. Epub 2017 Aug 31. PMID: 28866091; PMCID: PMC5825234.

Why is this study important?
This study is a  randomized controlled trial looking at  the effect of sodium intake on blood pressure in patients with  chronic kidney disease.  This is important information because it demonstrates the complexity of the disease process (HTN) and the variability among patients with other associated chronic medical conditions.
In the kidney disease setting, higher-than-usual blood pressure is often ascribed to recent dietary sodium indiscretion.  While this is known to be true in the general population , the  same may not be true in the setting of CKD.

Key Findings:
119 patients with  CKD (mean GFR 31) participants eating their usual diets completed at least three 24-hour urine collections over 9 months, from  which sodium was measured . Blood pressure was also measured.   Results of BP were found to be highly variable with  47%  actually having  inverse  correlation on BP with high salt intake.

Clinical Relevance:  This is important information for clinical practice  because CKD is very common and usual first line treatment for Hypertension is  dietary sodium restriction.  The frequent dismissal of elevated blood pressure readings as related to recent sodium intake in clinic  may result in sub optimal treatment for hypertension in patients with CKD. It is important to consider the patient as a whole , taking in to account all co-morbid medical conditions.

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Akilen R, Pimlott Z, Tsiami A, Robinson N. Effect of short-term administration of cinnamon on blood pressure in patients with prediabetes and type 2 diabetes. Nutrition. 2013 Oct;29(10):1192-6. doi: 10.1016/j.nut.2013.03.007. Epub 2013 Jul 16. PMID: 23867208.

This study was interesting to me, because we often encounter patients who take a wide variety of supplements for different health reasons. Often, they are word of mouth recommendations from friends or from internet searches, but occasionally there are some that have recently been found to be backed by science and are drawing enough of an audience to garner interest in more studies. The article I chose was a systematic review of the data from a 12-year span looking at the effect of cinnamon in lowering blood pressure in patients who have pre-diabetes or diabetes. I was curious why it studied specifically this population, but there have been other studies (one notably in 2003) that made the mainstream media stating that cinnamon can have a modest effect on lowering a person’s fasting blood glucose, so this supplementation is more common in the diabetic population. I currently work in anesthesia, and this is a supplement we like to know about as it also (especially in 1 of its 4 forms) contains a potent anticoagulant. The review found that there was a modest but significant decrease of the systolic BP by 5.39mmHg and the diastolic BP by 2.6mmHg. All the studies reviewed were in short term use, and efficacy long term is still unknown. If there was a safe way to provide a common supplement (that would need to be controlled by the FDA to ensure that there was a consistent coumarin content and avoid anticoagulant complications) of such a household and inexpensive ingredient, and it was found to also affect blood glucose, it may be a way to help patients that have borderline BP and pre-diabetes avoid medications and the often staggering accompanying cost.

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Citation: Hsu CN, Tain YL. Early-Life Programming and Reprogramming of Adult Kidney Disease and Hypertension: The Interplay between Maternal Nutrition and Oxidative Stress. Int J Mol Sci. 2020;21(10):3572. Published 2020 May 18. doi:10.3390/ijms21103572

This study is important because the authors review one cause of kidney disease/hypertension, both of which are classified as a global pandemic. They discuss that altered kidney development can be seen due to adverse intrauterine factors. These adverse factors can be introduced through maternal nutrition and oxidative stress and can ‘reprogram’ the kidney during development.

In rat models, the authors found multiple sources that suggested the following exposures resulted in higher blood pressure compared to control groups 1) periods of moderate/intense caloric restriction, 2) consumption of high fructose corn syrup and 3) protein restriction in diet. They also discussed, in rat models, specific amino acids that could potentially be used to prevent oxidative stress.

The clinical implications of this article are clear, even if many of the studies mentioned were conducted in rat models – maintaining nutritious eating habits during pregnancy can potentially reduce the risk of children developing kidney disease/hypertension.

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Article Source: An acceleration in hypertension-related mortality for middle-aged and older Americans, 1999-2016: An observational study
Forrester SJ, Dolmatova EV, Griendling KK (2020) An acceleration in hypertension-related mortality for middle-aged and older Americans, 1999-2016: An observational study. PLOS ONE 15(1): e0225207. https://doi.org/10.1371/journal.pone.0225207

This week I chose an observational study that looked at hypertension related mortality. It was an observational study used to learn more about rates, geographic trends, and other data that did not seem clear from the United States. This study is important because it took unanswered questions related to hypertension into consideration. I like that the study understands how largely hypertension affects Americans and how critical it is to work to lessen future numbers. The study also refers to hypertension as the “silent killer,” knowing that this topic needs to be brought to light. The conclusion of the study said that from 1999-2016, hypertension mortality rates for middle-aged and older Americans increased by 36.4%. There were other contributing factors that worsened these symptoms and increased likelihood like heart failure, diabetes, dementia, atrial fibrillation, and others. The increase of these diseases related directly to nutritional sciences. A largely associated trend that goes along with the increase in hypertensive patients is the typical American diet. This diet has transformed over the years into an excessive sodium calorie, saturated fats, refined grains, fast foods, and a lack of fruits and vegetables. These trends relate to one another and are surely not working in favor of the America population. Clinical implications include being knowledgeable of these trends to help prevent future cases. Other implications include understanding risks and diets to individuals to work to lessen this number.

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Citation:  Hsu, C.-N.; Tain, Y.-L. Early-Life Programming and Reprogramming of Adult Kidney Disease and Hypertension: The Interplay between Maternal Nutrition and Oxidative Stress. Int. J. Mol. Sci. 2020, 21, 3572. https://doi.org/10.3390/ijms21103572

Why is this study important?

Kidney disease and hypertension (HTN) are major healthcare problems on a global scale.  This review expresses them as “a global pandemic”.  While studies have demonstrated that there is a causal effect between maternal nutritional status and fetal development, more research is supporting a relationship between maternal nutritional status and the development of kidney disease and hypertension later in life, suggesting that the developmental origins are programmed in utero during renal programming.  Developing kidneys can be impacted by maternal nutrition, resulting in a change in nephron development.  Research into prevention at this early stage of development can have a far reaching effect on prevention and healthcare.

Key findings and nutritional science:

Key findings support that the start of kidney disease and HTN may be initiated early in life during “renal programming”.  Animal models support the hypothesis that oxidative stress as a result of “suboptimal maternal nutrition” impact the development of adult kidney disease and HTN.  The research also looks into retrospective data regarding antioxidant nutrients as protective measures during the renal programming phase of development and findings are promising regarding the correlation, but “clinical translation remains a critical challenge”.

Clinical implications:

Fascinating information regarding the clinical implications of maternal nutrition and the programmed effects on the health of offspring in adult life.  Maternal nutrition can be impactful in many programming mechanisms of fetal development, positively as well as negatively.  Specifically related to kidney disease and HTN, there are several associations in animal models including insufficient caloric intake as well as over nutrition (an oversupplied nutrient), protein restriction, iron restriction, high fructose intake, and the intake of other micronutrients to combat oxidative effects.  The clinical implications are critically important to the nutritional eduction and support of the mother while pregnant, but also to the long term health of adult offspring and education to future generations, to help combat the impact of these global health diseases.

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Citation: Waksmańska W, Bobiński R, Ulman-Włodarz I, Pielesz A. The differences in the consumption of proteins, fats and carbohydrates in the diet of pregnant women diagnosed with arterial hypertension or arterial hypertension and hypothyroidism. BMC Pregnancy Childbirth. 2020 Jan 13;20(1):29. doi: 10.1186/s12884-019-2711-y. PMID: 31931746; PMCID: PMC6958768.
Many women are overweight during pregnancy, and it causes the fetus health problems, such as the nervous system. Moreover, fat pregnant women lead to a high risk of arterial hypertension and hypothyroidism. Pregnant women consume the food to affect the infants’ health, so this study observes that the daily intake of carbohydrate, protein, and fat are different from the pregnant women with arterial hypertension (or arterial hypertension and hypothyroidism) and healthy women. Therefore, it is critical to understand the difference in daily intake in healthy women and pregnant women with arterial hypertension.

The researchers divide the three groups: healthy women (group one), arterial hypertension women (group two), and the women with arterial hypertension and hypothyroidism (group three) in the trimester. The results show that group two is the highest calorie intake and the most increased fat and protein intake. The authors interpret that protein intake is essential to give the fetus a nutrition source, but excessive protein intake influences kidney function. However, the authors did not explain the effect of the high fat intake in pregnant women and fetuses.

In this study, the readers could understand the correlation of daily intake in pregnant women. It may give the clinicians more nutritional recommendations for pregnant women.

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Citation
Jennings A, Berendsen AM, de Groot LCPGM, Feskens EJM, Brzozowska A, Sicinska E, Pietruszka B, Meunier N, Caumon E, Malpuech-Brugère C, Santoro A, Ostan R, Franceschi C, Gillings R, O' Neill CM, Fairweather-Tait SJ, Minihane AM, Cassidy A. Mediterranean-Style Diet Improves Systolic Blood Pressure and Arterial Stiffness in Older Adults. Hypertension. 2019 Mar;73(3):578-586. doi: 10.1161/HYPERTENSIONAHA.118.12259. PMID: 30636547; PMCID: PMC6380440.

Importance:
This study highlights a dietary pattern that could prove beneficial for elderly populations. In analyzing food consumption status and influencing the pattern of eating toward a Mediterranean style diet, there may be opportunities to recommend this dietary protocol to people who have chronically struggled with hypertension and other heart issues.

Key Findings
In this 12-month randomized control trial study, 1294 adults aged 65-79 were executed two different dietary protocols. Dietary interventions were compared over a year as to their impact on blood pressure and circulatory health. One group was given the education and resources needed to follow a Mediterranean-style diet, while the other maintained whatever diet protocol they typically executed. While this study has many potential confounding variables, the overall significance is noteworthy and favors the Mediterranean diet improving systolic blood pressure. Pre and post arteriole pressure and stiffness were measured to display the desired outcome, which showed a strong positive correlation between the Mediterranean diet and decreased systolic blood pressure and arterial stiffness. The Mediterranean-style diet group showed significant evidence of decreased systolic blood pressure in older adults.

Clinical Implications
This wide-scale study analyzes a dietary impact on a severe chronic found in hypertension. This issue plagues our society, allowing this research to provide a reasonable dietary pattern that could help many people. With CVD being a leading cause of death, discovering mechanisms such as this to combat the illness can only be helpful. This study shows a fairly significant decrease in systolic BP, allowing for another potential avenue for dietary recommendation to those who struggle with hypertension.

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Citation: Gupta, A., Verma, N., Mahesh, N. K., & Mahesh, A. (2019). Role of natural antioxidants on inflammatory markers in primary hypertension. Journal of Evidence Based Medicine and Healthcare, 6(36), 2469-2476. doi:10.18410/jebmh/2019/507

Importance: Hypertension is associated with oxidative stress. This study tested the antioxidant  Epigallocatechin-3 gallate (EGCG), a green tea hypertension a green tea polyphenol on TNF-α and IL-6 levels from isolated peripheral blood mononuclear cells (PBMCs). Both of these inflammatory markers are known to have oxidation effects in vascular cells. Blood samples were taken from 20 patients and 8 healthy controls.

Key findings: It was found that treatment of monocytes with EGCG caused a decrease in expression of TNF-α and IL-6. The researchers hoped that EGCG may reduce  arterial stiffness contributed by IL-6 and TNF-alpha . However, research is still needed. Inflammatory diseases such as HTN can be effected by dietary interventions. This is why nutrition science and food compounds can be so impactful.

Clinical implications: If we could suggest something simple like green tea to help combat HTN, recommendations may be more accepted. Although a diet overhaul is the most effective option, this may not be followed. In addition, adding green tea to a change and diet may benefit the patient even more.