Effects of artichoke on blood pressure: A systematic review and meta-analysis

PurposeClinical trials considering the effects of artichoke supplementation on blood pressure have yielded different and contradictory outcomes. Thus, a systematic review and meta-analysis were performed to assess effects of artichoke administration on blood pressure.MethodsRelated studies were detected by searching the Cochrane Library, PubMed, Embase and Scopus databases up to 15 March 2020. Weighted Mean Differences (WMD) were pooled using a random-effects model. Heterogeneity, sensitivity analyses, and publication bias were evaluated using standard methods.ResultsPooled analysis of eight randomized controlled trials revealed that artichoke supplementation did not have an effect on systolic blood pressure (SBP), (WMD: -0.77 mmHg, 95 % CI: −2.76 to 1.22) or diastolic blood pressure (DBP) (WMD: −0.11 mmHg, 95 % CI: −1.72 to 1.50) when compared to the placebo group. However, subgroup analyses based on health status suggested that artichoke administration among hypertensive patients may significantly reduce SBP (WMD: −3.19 mmHg, 95 % CI: −3.32 to −3.06) and DBP (WMD: −2.33 mmHg, 95 % CI: −2.23 to −2.43), but no such reduction was found in NAFLD patients. Furthermore, our results indicated that artichoke supplementation for 12 weeks led to a significantly decreased DBP (WMD: -2.33 mmHg, 95 % CI: −2.43 to −2.23), but 8 weeks of intervention did not (WMD: 0.80 mmHg, 95 % CI: −1.06 to 2.66).ConclusionArtichoke supplementation may potentially lead to SBP and DBP reduction in hypertensive patients. In addition, artichoke supplementation for 12 weeks may significantly improve DBP.     

Soy intake is associated with lowering blood pressure in adults: A systematic review and meta-analysis of randomized double-blind placebo-controlled trials

BackgroundSoy has several beneficial effects on cardiovascular disease (CVD); however, results of clinical trial studies are equivocal. Thus, the present study sought to discern the efficacy of soy intake on blood pressure.MethodsThe search process was conducted in PubMed, Scopus, Web of Science, and Cochrane Library, to ascertain studies investigating the efficacy of soy intake on blood pressure in adults, published up to June 2020. A random-effects model was applied to pool mean difference and 95 % confidence interval (CI). Begg’s and Egger’s methods were conducted to assess publication bias.ResultsPooled effects from 17 effect sizes revealed a significant improvement in systolic blood pressure (SBP) (−1.70; −3.34 to −0.06 mmHg; I² = 45.4 %) and diastolic blood pressure (DBP) (−1.27; −2.36 to −0.19 mmHg, I² = 43.9 %) following soy consumption, in comparison with controls. Subgroup analysis demonstrated a reduction in both SBP and DBP in younger participants with lower baseline DBP and intervention durations of <16 weeks.ConclusionOur results suggest that soy intake is associated with an ameliorating effect on blood pressure in adults.     

Dose-dependent effect of vinegar on blood pressure: A GRADE-assessed systematic review and meta-analysis of randomized controlled trials

BackgroundThere are controversial findings regarding the effect of vinegar on blood pressure based on the evidence accumulated so far.MethodsA systematic search was conducted through PubMed, Scopus, and ISI Web of Science up to April 2022. We estimated the change in blood pressure for each 30 ml/d increments in vinegar consumption in each trial and then, calculated the mean difference (MD) and 95 %CI using a fixed-effects model. A dose-response meta-analysis of differences in means provided us with the estimation of the dose-dependent effect. The certainty of evidence was rated by the GRADE tool.ResultsEach 30 ml/d increment in vinegar consumption reduced SBP by − 3.25 mmHg (95 %CI: − 5.54, − 0.96; I² = 67.5 %, GRADE = low). Levels of SBP decreased linearly and slightly (P_nonlinearity = 0.69, P_{dose-response} = 0.02) up to vinegar consumption of 30 ml/d (MD30 ml/d: − 3.36, 95 %CI: − 5.77, − 0.94). Each 30 ml/d increment in vinegar consumption reduced DBP by − 3.33 mmHg (95 %CI: − 4.16, − 2.49; I² = 57.1 %, GRADE = low). Levels of DBP decreased linearly and slightly (P_nonlinearity = 0.47, P_{dose-response} = 0.004) up to vinegar consumption of 30 ml/d (MD30 ml/d: − 2.61, 95 %CI: − 4.15, − 1.06)ConclusionsAccording to the findings, vinegar significantly reduces systolic and diastolic blood pressure and may be considered an adjunct to hypertension treatment. Thus, clinicians could incorporate vinegar consumption as part of their dietary advice for patients.     

Effect of Calcium and Vitamin D Co-supplementation on Blood Pressure: A Systematic Review and Meta-Analysis

PurposeVitamin D and calcium insufficiency has been related to elevated blood pressure (BP) and cardiovascular complications. This systematic review and meta-analysis investigates the effect of calcium and vitamin D co-supplementation on BP.MethodsA systematic search was conducted of electronic databases, including Web of Sciences, MEDLINE, Scopus, EMBASE, and the Cochrane Library, along with searches of gray literature and reference lists from included trials. There were no language restrictions, and the databases were searched from inception to October 2019. Randomized controlled trials, using calcium and vitamin D co-supplementation and reporting mean systolic BP and/or diastolic BP (DBP) with SDs, were included in the systematic review. Articles were evaluated independently by 2 researchers based on inclusion and exclusion criteria. A random effects model was conducted to synthesize the data.FindingsEight trials were included in the meta-analysis. Meta-analysis of these 8 trials indicated a nonsignificant reduction in systolic BP in the calcium and vitamin D co-supplementation group compared with control (standardized mean difference, −0.23; 95% CI, −0.52 to 0.06). Conversely, there was a statistically significant decrease in DBP (standardized mean difference, −0.29; 95% CI, −0.55 to −0.02). Subgroup analysis suggested that young adults achieve a greater reduction in DBP than other age groups.ImplicationsCalcium and vitamin D co-supplementation can modulate DBP and should be investigated more specifically in large, well-designed trials of hypertensive populations. (Clin Ther. 2020;42:XXX–XXX) © 2020 Elsevier HS Journals, Inc.     

Pilot study of Qigong/Tai Chi Easy acute effects of meditative movement,breath focus and “flow” on blood pressure,mood and oxytocin in older adults

BackgroundOlder adults are increasingly lonely and at risk for hypertension. Endogenous oxytocin levels are associated with lowering blood pressure (BP), suggesting value in increasing oxytocin. Regular practice of Tai Chi improves BP and mood; we explored a single session of Tai Chi Easy (TCE) with older adults and feasibility of measuring oxytocin as a key biomarker.MethodIn a single-arm pre-post design pilot study, 21 older adults (age 55–80) with mild-moderate hypertension practiced a single session (50-min) TCE. BP, psychosocial measures, and saliva samples were collected pre/post to examine feasibility of acute measures of oxytocin and explore effect sizes of outcomes. Participants (N = 21; 19 % Latinx, 76.2 % female, mean age 66.76).ResultsBP systolic: 138.43–134.86; diastolic 78.48–78.00 (p > .05; Cohen’s d −0.23; −0.08 respectively). Total Mood Disturbance (TMD) and Connection (CN) improved [TMD mean pre 41.891 (SD=19.60) to post 35.00 (SD=10.21), p = .01; Cohen’s d − 0.67); CN mean 7.85 (SD=2.01) to post 9.05 (SD=1.00), p = .01; Cohen’s d 0.70]. Baseline oxytocin was positively correlated with baseline loneliness (N = 14, r = .599); pre/post oxytocin changes were negatively correlated with baseline loneliness (N = 14, r = −.585). BP decrease was associated with characteristics of the intervention: “flow” (coef=.=0.58N = 17) and meditative/breath focus (coef=−1.78; N = 17).Discussion/ConclusionMedium to large effect sizes indicating change in mood and connection were found for this single session intervention. Knowing that Tai Chi improves BP when practiced over time, this TCE intervention shows promise for planning a fully powered, randomized controlled study of BP, mood and perceptions of connection in hypertensive older adults. Feasibility of assessing acute salivary oxytocin is less promising. Increase in oxytocin levels occurred for those less lonely, but declined for lonelier participants. With different responses based on baseline loneliness scores, no mean change in oxytocin levels was found. Seemingly unstable levels (possibly related to interaction with study staff) suggests the need for further testing in more controlled study designs. Finally, BP associations with meditative/breath focus and flow could be further explored in future study designs addressing mediation.     

Policosanol supplementation significantly improves blood pressure among adults: A systematic review and meta-analysis of randomized controlled trials

Background and AimsPolicosanol contains a mixture of concentrated primary aliphatic alcohols extracted from sugar cane wax and is recognized as a cholesterol-lowering drug but previous studies reported that it could be helpful for reducing blood pressure as well. We aimed to systematically review all randomized control trials (RCTs) evaluating the efficacy of policosanol supplementation for lowering high blood pressure.Methods and ResultsThe following databases were searched up to March 2019: PubMed, Scopus, ISI Web of Science and the Cochrane library. Eligible RCTs were included if they investigate the effects of policosanol supplementation on systolic (SBP) and diastolic (DBP) blood pressure. Pooled effect size was measured using random effect model (DerSimmonon method). A total of nineteen studies with twenty-four arms were considered. Pooled effect size showed that SBP (WMD: −3.423 mmHg, 95% CI: −5.315, −1.531; p < 0.001) and DBP (WMD: −1.468 mmHg 95% CI: −2.632, −0.304, p = 0.013). decrease significantly after policosanol supplementation with significant heterogeneity among included studies (I² = 78.5% and 78.9% for SBP and DBP respectively). All subgroups showed a significant effect of policosanol supplementation except patients with mixed dyslipidemia for SBP and DBP and overweight subjects for DBP.ConclusionPolicosanol could lower SBP and DBP significantly; future long term studies are required to confirm these findings in the general population.     

The effects of regular consumption of green or black tea beverage on blood pressure in those with elevated blood pressure or hypertension: A systematic review and meta-analysis

ObjectiveAs a popular beverage, there has been much interest in studying the effects of tea intake on hypertension (HTN), a particular risk factor for cardiovascular disorders (CVDs). We have thus aimed to isolate the randomized controlled trials investigating the efficacy of black or green tea as a beverage in subjects with elevated blood pressure (BP), or HTN.MethodsPubMed, Scopus, Web of Science, and ProQuest dissertations and theses databases were searched from February 1, 1995, up to July 20, 2019, to identify relevant studies.ResultsThe search strategy generated 1119 trials, of which finally five trials fulfilled the criteria for being included in the current study. Three out of 5 articles showed a low risk of bias. According to nine measurements derived from 5 trials on 408 individuals, it was found that regular tea intake resulted in the reduction in SBP (weighted mean difference (WMD): −4.81 mmHg, 95 %CI: −8.40 to −1.58, P = .004) and DBP (WMD:-1.98 mmHg, 95 %CI: −3.77 to −0.20, P = .029); however, excluding the most heterogeneous trials showed that regular tea intake might reduce SBP and DBP by about −3.53 and −0.99 mmHg, respectively. Based on meta-regression findings, we found the longer the duration of tea intake (≥3months), the higher the decrease in both SBP and DBP. Categorized studies, according to the tea type, revealed that the hypotensive effects of green tea were more pronounced compared to black tea. None of the studies reported any side effects.ConclusionThese results suggest the positive effects of regular tea intake on BP in subjects with elevated BP or HTN. Hence, it may be applicable to physicians, health care providers, and particularly HTN patients.     

Differential time effect profiles of amlodipine, as compared to valsartan, revealed by ambulatory blood pressure monitoring, self blood pressure measurements and dose omission protocol

Amlodipine and valsartan are once-daily antihypertensive agents. To date, no comparison between these agents given as monotherapies was reported. This study was aimed to evaluate the therapeutic coverage and safety of amlodipine and valsartan in mild-to-moderate hypertensive patients. Multicenter, double-blind, randomized, comparative study. After a 4-week placebo wash-out period, 246 outpatients with office diastolic blood pressure 95 < or = DBP < or =110 mmHg and systolic blood pressure (SBP) < 180 mmHg, in addition to a mean daytime SBP and/or DBP > 135/85 mmHg on 24-h ambulatory blood pressure monitoring (ABPM), were randomly allocated to once-daily amlodipine 5-10 mg or valsartan 40-80 mg, for 12 weeks. In a subgroup of patients, 48-h ABPM were performed at the end of the treatment period. Dose omission was simulated by a single-blind placebo dosing. The primary efficacy end-point was the 24-h trough office BP after 12 weeks of active therapy. The reductions in 24-h trough BP were more pronounced in amlodipine compared with valsartan group as well in office [SBP: -17.8 +/- 10.9 vs. -14.6 +/- 11.2, P = 0.025, DBP: -12.7 +/- 7.2 vs. -10.9 +/- 7.8 mmHg, P = 0.06) as in ambulatory BP (SBP/DBP: -13.0 +/- 13.7/-10.8 +/- 9.1 vs. -7.2 +/- 19.4/-4.9 +/- 13.4 mmHg, P < 0.05). Forty-eight hours after the last active dose, the slope of the morning BP surge (4-9 h) was less steep with amlodipine vs. valsartan [DBP (P < 0.04), SBP (n.s.)]. Ankle edema were more often reported in amlodipine group. These results suggest a superior BP lowering and a longer duration of action with amlodipine compared with valsartan.     

Combined exercise circuit session acutely attenuates stress-induced blood pressure reactivity in healthy adults

Objective

To investigate the blood pressure (BP) responses to cardiovascular stress test after a combined exercise circuit session at moderate intensity.

Method

Twenty individuals (10 male/10 fem; 33.4± 6.9 years; 70.2± 15.8 kg; 170.4± 11.5 cm; 22.3± 6.8% body fat) were randomized in a different days to control session with no exercise or exercise session consisting of 3 laps of the following circuit: knee extension, bench press, knee flexion, rowing in the prone position, squats, shoulder press, and 5 min of aerobic exercise at 75-85% of age-predicted maximum heart rate and/or 13 on the Borg Rating of Perceived Exertion [scale of 6 to 20]. The sets of resistance exercise consisted of 15 repetitions at ~50% of the estimated 1 repetition maximum test. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at rest and during 1h of recovery in both experimental sessions. After that, blood pressure reactivity (BP_R) was evaluated using the Cold Pressor Test.

Results

During 1h of exercise recovery, there was a reduction in SBP (3-6 mmHg) and DBP (2-5 mmHg) in relation to pre-session rest (p<0.01), while this reduction was not observed in the control session. A decline in BP_R (4-7 mmHg; p<0.01) was observed 1h post-exercise session, but not in the control session. Post-exercise reductions in SBP and DBP were significantly correlated with BP_R reductions (r=0.50-0.45; p<0.05).

Conclusion

A combined exercise circuit session at moderate intensity promoted subsequent post-exercise hypotension and acutely attenuated BP_R in response to a cardiovascular stress test. In addition, the post-exercise BP reduction was correlated with BP_R attenuation in healthy adults of both genders.     

Pilates training reduces blood pressure in older women with type 2 diabetes: A randomized controlled trial

IntroductionThe study investigated the effect of 12 weeks of pilates training on the hemodynamic responses of older women with type-2 diabetes (T2D). Methods: 22 individuals with T2D were randomly allocated into two groups: CONTROL (n = 11; 67.5 ± 6.3 years; 154.7 ± 6.1 cm; 73.5 ± 6.1 kg; calorie intake: 1487.5 ± 360.6 kcal/day) and PILATES (n = 11; 65.5 ± 5.5 years; 155.0 ± 4.5 cm; 66.2 ± 5.4 kg; calorie intake: 1289.3 ± 385.0 kcal/day). The PILATES group executed a 12-week PILATES training program at moderate intensity, 3x/week with each session lasting 60-min. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and postprandial blood glucose were assessed at four timepoints: i) baseline; ii) 4th week; iii) 8th week; and iv) 12th week (s) of intervention. Two-way ANOVA for repeated measures and the Pearson's correlation coefficient were adopted. The alpha level was set at 0.05.ResultsA time1group interaction effect was found for SBP (F = 4.206; η² = 0.17; p = 0.02) and DBP (F = 2.624; η² = 0.12; p = 0.05) with significant reductions (mmHg) in the 4^ths and 8^ths in the PILATES (PILATES SBP baseline: 134.9 ± 27.6; 4^ths: 112.4 ± 15.7; 8^ths: 115.8 ± 18.3; 12^ths: 124.3 ± 19.1 vs. CONTROL SBP baseline: 126.5 ± 15.7; 4^ths: 126.3 ± 16.2; 8^ths: 124.5 ± 13.1; 12^ths: 126.3 ± 21.4 | PILATES DBP baseline: 72.9 ± 11.3; 4^ths: 65.1 ± 12.2; 8^ths: 65.8 ± 12.2; 12^ths: 67.6 ± 7.5 vs. CONTROL DBP baseline: 74.6 ± 12.0; 4^ths: 73.9 ± 11.5; 8^ths: 75.3 ± 11.9; 12^ths: 74.5 ± 9.2).ConclusionFour and eight weeks of PILATES training promotes reduction in the SBP and DBP of older women with T2D. The exercises performed in this study were mainly body weight exercises and required a few auxiliary materials, which turns this method of training accessible.     

About 7–day (circaseptan) and circadian changes in cold pressor test (CPT)

We assess circadian (CD) and circaseptan (CS) changes in the blood pressure (BP) response to a 1–min immersion of the hand into ice water, the cold pressor test (CPT). An about 8 mmHg BP increase in the CPT reported by others for health and an elevation >25 mmHg for patients with “hypertension” have been viewed as predisease, but variables related to the vascular system exhibit prominent CD, CS and circannuals, among other components of their genetically anchored time structure or chronome, and may also have to be considered. Hence, a 16-year-old adolescent (ML) immersed her hand into ice water every 2–4 h for 2 days and once daily in the morning thereafter for 1 week (N = 25), as did, only for <2 days (≥24 h), four adults 20–66 years of age. BP and heart rate (HR) were monitored automatically around the clock at 15–min intervals and at 1–min intervals before and immediately after the CPT. Data were analyzed by cosinor. The difference between the first post-CPT BP value and the mean of the last seven values prior to the CPT was a measure of CPT response (at 1–min). Overall, ML’s systolic (S) BP increased by 8.2 ± 1.4 mmHg and her diastolic (D) BP by 6.2 ± 0.9 mmHg (P < 0.001). Increases were found in 96% of the tests for SBP, 92% for DBP and 20% for HR. There was only one tie for HR (4%), resulting in a HR decrease in 76% of CPTs. The BP response to CPT at 1 min was CS-dependent. The CS double amplitudes are 12.5 ± 4.1 for SBP (P = 0.019) and 7.8 ± 2.8 mmHg for DBP (P = 0.030), with acrophases occurring on late Sunday, early Monday (at –50° and –67° from 00:00 h from Saturday to Sunday for SBP and DBP, respectively, with 360° ≡ 1 week). The response of HR did not allow the detection of a CS rhythm (P = 0.969). The CD response peaked in the early morning hours; with 24 h ≡ 360° and 0° = local midnight, the acrophase (φ) for SBP is at –80° and for DBP at –113°, in keeping with earlier results from four adult subjects (SBP: –37°; DBP: –42°), individual differences notwithstanding. The average timing of the largest overall response of BP to CPT coincides with the timing of the response to other stimuli. The CS acrophases coincide with the times of increased morbidity/mortality from vascular diseases. Chronomes, time structures broader than circadian, notably their about-weekly components, should be considered, not only at the extremes of life when the CS and about-half-weekly rhythms are particularly prominent in BP and HR but also in interpreting BP responses as a gauge of vascular disease status in adolescents.     

The effect of ginger supplementation on metabolic profiles in patients with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials

BackgroundThere is some evidence regarding the positive effects of ginger supplementation on metabolic profile in patients with type 2 diabetes (T2DM). However, they are conflicting. The present systematic review and meta-analysis aimed to summarize earlier findings for the effect of ginger supplementation on metabolic profile in patients with T2DM.MethodsScopus, PubMed and Google Scholar databases were systematically searched up until September 2021 to collect all randomized clinical trials that evaluated the effect of ginger supplementation on FBS, HbA₁c, TC, TG, LDL, HDL, SBP and DBP in patients with T2DM. We conducted our study according to the 2020 PRISMA guidelines. We included only English language publications. Pooled effect sizes were measured using a random-effects model and were reported as the weighted mean difference (WMD) and 95% CI. In addition, the Cochrane Collaboration's risk of bias tool was used to evaluate quality of the trials.ResultsIn overall, 10 articles were included in this systematic review and meta-analysis. Our pooled meta-analysis indicated a significant reduction in FBS following ginger supplementation by polling 8 effect sizes [weighted mean difference (WMD): − 18.81; 95% CI: − 28.70, − 8.92), I² = 77.4%] and in HbA₁C through 7 effect sizes (WMD: −0.57; 95% CI: −0.93, −0.20, I² =88.6%). Pooling 5 effect sizes, we found a significant reduction in SBP (WMD: −4.20; 95% CI: −7.64, −0.77, I2 =97%) and DBP [WMD: − 1.61; 95% CI: − 3.04, − 0.18), I2 = 93.2%] after supplementation with ginger. However, our pooled meta-analysis indicated that ginger supplementation had no significant influence on lipid profile involving TG, TC, LDL and HDL.ConclusionsWe found significant reductions in FBS, HbA₁C, SBP and DBP after supplementation with ginger in patients with T2DM compared to control group, with no significant changes in serum lipids. Further large RCTs are required to shed light on this issue.     

A Randomized,Double-blind,Active-controlled,Two Parallel-Group,Optional Titration,Multicenter, Phase IIIb Study to Evaluate the Efficacy and Safety of Fimasartan Versus Perindopril Monotherapy With and Without a Diuretic Combination in Elderly Patients With Essential Hypertension

PurposeThe efficacy and tolerability of fimasartan in elderly patients have not been fully evaluated. This study was therefore conducted to determine the efficacy and tolerability of fimasartan compared with perindopril in elderly Korean patients aged >70 years with essential hypertension (defined by a mean sitting systolic blood pressure [SBP] ≥140 mm Hg).MethodsThis randomized, double-blind, active-controlled, 2 parallel-group, optional titration, multicenter, Phase IIIb trial (FITNESS [Fimasartan in the Senior Subjects]) enrolled 241 patients from 23 cardiac centers in the Republic of Korea between August 2017 and December 2019. After the placebo run-in period, treatment started with fimasartan 30 mg or perindopril arginine 2.5 mg once daily at a 1:1 ratio; if BP was not controlled at week 4, the dose was doubled. If BP was not controlled at week 8, a diuretic combination (fimasartan 60 mg/hydrochlorothiazide 12.5 mg or perindopril arginine 5 mg/indapamide 1.25 mg) was administered. After 16 weeks of the double-blind treatment, the patients with controlled BP participated in an 8-week open-label extension study, with the 2 groups unified by fimasartan 60 mg with or without hydrochlorothiazide 12.5 mg for 8 weeks. The primary outcome was a change in SBP for 8 weeks. The secondary outcomes included a change in sitting diastolic BP (DBP) for 8 weeks and changes in SBP and DBP for 4, 16, and 24 weeks.FindingsAt week 8, mean SBP significantly decreased from baseline in both groups: –14.2 (14.4) mm Hg in the fimasartan group and –9.0 (16.1) mm Hg in the perindopril group. The difference between the 2 groups was 5.4 (2.1) mm Hg, indicating the noninferiority of fimasartan to perindopril. Moreover, fimasartan exhibited a higher BP-lowering effect than perindopril (P = 0.0108). In addition, reductions in SBP and DBP from baseline to weeks 4, 8, and 16 were significantly greater in the fimasartan group than in the perindopril group, although the SBP reduction was comparable at week 16. Both groups reported an excellent mean compliance rate of 97.4% (4.7%) through week 16. During the study period, 82 adverse events were reported in 52 patients, 40 in the fimasartan group and 42 in the perindopril group (P = 0.4647). Dizziness was the most commonly reported adverse event (7 cases). Remarkably, only 1 case of orthostatic hypotension was reported during the study period.ImplicationsIn elderly patients with essential hypertension, fimasartan 30 to 60 mg with a possible hydrochlorothiazide 12.5-mg combination was noninferior to perindopril 2.5 to 5 mg with a possible indapamide 1.25-mg combination. Furthermore, fimasartan exhibited higher BP-lowering efficacy than perindopril. There was no difference in tolerability between the 2 groups. Clinicaltrials.gov Identifier: NCT03246555.     

A placebo-controlled comparison of the efficacy and tolerability of candesartan cilexetil, 8 mg, and losartan, 50 mg, as monotherapy in patients with essential hypertension, using 36-h ambulatory blood pressure monitoring

This double-blind, randomised, controlled study compared the efficacy of candesartan cilexetil 8 mg (n = 87) and losartan 50 mg (n = 89), once daily for 6 weeks, relative to placebo (n = 80) in patients with mild-to-moderate essential hypertension (diastolic blood pressure (DBP): 95-115 mmHg). Ambulatory BP measurements were done every 15 min over 36 h. At the end of the 6-week treatment, the mean change in DBP between the baseline and the 0-24-h period after the last dose of study medication was greater in patients receiving candesartan cilexetil 8 mg (-7.3 mmHg +/- 6.9 mmHg) compared with losartan 50 mg (-5.1 mmHg +/- 4.9 mmHg) (p < 0.05) or placebo (0.3 mmHg +/- 6.5 mmHg) (p < 0.001). The mean change in systolic BP (SBP) during this time was greater in patients receiving candesartan cilexetil 8 mg (-10.8 mmHg +/- 11.3 mmHg), or losartan 50 mg (-8.8 mmHg +/- 8.9 mmHg) than placebo (1.2 mmHg +/- 9.9 mmHg) (p < 0.001). Candesartan cilexetil 8 mg was associated with a greater reduction in DBP and SBP, relative to placebo, when compared with losartan 50 mg, during both daytime and night-time, and between 12 and 24 h after dosing (p < 0.001). Both active treatments were well tolerated. In patients with mild-to-moderate essential hypertension, candesartan cilexetil 8 mg therefore had greater, more consistent antihypertensive efficacy throughout the day and the night, and long-lasting efficacy after the last dose, compared with losartan 50 mg. This greater efficacy is maintained with an excellent tolerability associated with members of the angiotensin Il type 1-receptor blocker class.     

The Effect of Lactobacillus Consumption on Human Blood Pressure: a Systematic Review and Meta-Analysis of Randomized Controlled Trials

ObjectivesPrevious clinical studies have shown controversial results regarding the effect of Lactobacillus supplementation on blood pressure (BP). The purpose of this systematic review and meta-analysis is to examine the effect of Lactobacillus consumption on BP.MethodsEligible randomized controlled trials (RCTs) were searched from five electronic databases until May 2020. In total, 18 studies were included in our meta-analysis. Quality of the selected studies was assessed, and a random-effects model was used to calculate the overall effect sizes of weighted mean differences (WMD). This systematic review was registered in PROSPERO with the number: CRD42019139294.ResultsLactobacillus consumption significantly reduced systolic blood pressure (SBP) by −2.74 mmHg (95% confidence interval, −4.96 to −0.51) and diastolic blood pressure (DBP) by −1.50 mmHg (95% confidence interval, −2.44 to −0.56) when comparing with the control group. Subgroup analysis showed that type 2 diabetes mellitus (T2DM) patients, Asian individuals, or borderline hypertension participants were more sensitive to daily consumption of Lactobacillus. And the effect of Lactobacillus on BP-reduction was more significant in capsule form, with the dose was above 5 × 10⁹ colony-forming unit (CFU)/day or lasted for more than 8 weeks.ConclusionsOur present study suggests that Lactobacillus consumption in capsule form when the daily dose is above 5 × 10⁹ CFU for more than 8 weeks can decrease SBP or DBP in T2DM patients, borderline hypertension participants or Asian individuals.     

Association of blood pressure components with mortality and cardiovascular events in prehypertensive individuals: a nationwide population-based cohort study

Background: The effects of each blood pressure index [systolic and diastolic blood pressure (SBP, DBP), pulse pressure (PP), mean arterial pressure (MAP)] on the occurrence of mortality and cardiovascular (CV) events have not yet been investigated in prehypertensive populations.

Methods: A total of 30,258 prehypertensive Korean participants underwent periodic health examination between 2003 and 2004 were enrolled, and the associations of BP components with mortality and CV events were investigated. Moreover, based on the DBP [80 ≤ DBP <90?mmHg (N?=?21,323) and DBP <80?mmHg (N?=?8,935)], the effects of BP components were also evaluated.

Results: Multivariate Cox analyses in prehypertensive group revealed that the hazard ratios (HRs) were 1.121 and 1.130 per 10?mmHg increase in SBP and PP for mortality, respectively. Additionally, 10?mmHg increase of SBP (HR:1.090) was still significantly, but increase of PP (HR:1.060) was marginally associated with higher incidence of CV events. However, there were no significant associations with increase in DBP or MAP on adverse clinical outcomes in prehypertensive group. In the prehypertensive subjects with DBP <80?mmHg, CV events more frequently occurred by 38.8% and 28.5% per 10?mmHg increase in SBP and PP, respectively.

Conclusions: Prehypertensive subjects might need to be cautioned when they have high SBP or PP with low DBP even in healthy populations.

• Key message

• Prehypertensive subjects should be cautioned when they have high-systolic blood pressure or pulse pressure with low-diastolic blood pressure, even without previous hypertension, diabetes mellitus or chronic kidney disease.

     

LONG-TERM POTASSIUM SUPPLEMENTATION LOWERS BLOOD PRESSURE IN ELDERLY HYPERTENSIVE SUBJECTS

Following a randomised cross-over trial of the effect of a four-week 60 mmol/day potassium supplement versus placebo on blood pressure (BP), eight of the original 18 hypertensive subjects continued with a 48 mmol daily potassium supplement for four months. For these eight subjects 24-h potassium excretion during placebo, one month of 60 mmol and four months of 48 mmol daily potassium supplementation phases was 56 ± 23, 102 ± 28 and 90 ± 35 mmol/24 hours, respectively, and mean 24-h BP following each phase was 160 ± 16/89 + 11, 147 ± 13/83 ± 12 and 145 ± 14/81 ± 9 mmHg respectively, a significant fall in mean 24-h SBP between four months of potassium supplement and placebo period of 15 ± 13 mmHg (95% CI: 4, 26 mmHg, p=0.02), although the fall in 24-h DBP was not significant (8 ± 11 mmHg, 95% CI: 0, 17 mmHg, p=0.08). Modest increases in dietary potassium intake could have significant effects on lowering BP in the large proportion of elderly subjects with hypertension.     

Hypopressive exercise in normotensive young women: A case series

Hypopressive exercise (HE) has been contraindicated for people with cardiovascular disease because it involves isometric postures performed with low-pulmonary volume breath-holds, which are thought to increase blood pressure. The objective of this study was to analyze the hemodynamic responses to HE performed in the seated posture on systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) in normotensive females. Ten women (age = 31.2 ± 6.3 years) with previous experience in HE participated. Three sets of eight breathing cycles of HE breathing were completed. The HE breathing protocol consisted of three complete breathing cycles of controlled latero-costal inhalations and slow deep exhalations followed by a breath-hold and rib-cage expansion after every third exhalation. Measurements of SBP, DBP, MAP and HR were assessed at baseline, at the end of each set and at the end of minute 5, 10, 15 and 20 during the recovery period. The measurement of hemodynamic variables used a digital photoplethysmography device. Significant differences for SBP (baseline compared to SET2, p = 0.0182) and MAP (baseline compared to SET1, p = 0.0433; and SET2, p = 0.0072) were found. No significant differences were found in the recovery periods compared with baseline. Medium effect size for HR during REC5 (ES = 0.50) and REC10 (ES = 0.56) was observed. These findings indicate that HE in the seated posture performed by normotensive females leads to significant increases in SBP and MAP with no significant increase of HR and no hypotensive effect during recovery period. Our preliminary results should be supported by future randomized controlled trials.     

Excessive dietary supplement use and blood pressure among Brazilian male resistance training practitioners and bodybuilders

ABSTRACT

Objective: The aims of the present research were to determine the prevalence of the use of dietary supplements and anabolic-androgenic steroids (AAS) without professional guidance in the countryside of Northeastern Brazil, and to compare blood pressure (BP) between nonusers of dietary supplements, thermogenic supplement users and AAS users. Methods: The sample consisted of 346 resistance training (RT) practitioners and bodybuilders. The participants answered a questionnaire on the use of dietary supplements and/or AAS. In addition, the participants underwent BP assessment. Results: 76.9% of the sample consumed dietary supplements and AAS at some point in their lives. 66.8% (95%CI: 61.5–71.7) of our sample used only food supplements without any guidance from a qualified professional. AAS and cosmetic doping was reported by 8.1% (95%CI: 5.6–11.2%) and 2.0% (95%CI: 1.0–4.2%) of the sample, respectively. Regarding BP, a significant difference was observed for systolic BP when nonusers of dietary supplements were compared to users of thermogenic supplements (126.5 ± 15.1 mmHg s. 134.7 ± 14.5 mmHg; p= .034) and when compared to AAS users (126.5 ± 15.1 mmHg vs. 136.6 ± 12.2 mmHg; p= .010). Conclusions: Our findings point to excessive consumption of dietary supplements and AAS (without professional guidance) by RT practitioners and bodybuilders. In addition, we observed high systolic blood pressure in users of thermogenic supplements and AAS users.