Dietary Flavonoids Added to Pharmacological Antihypertensive Therapy are Effective in Improving Blood Pressure

Abstract

Epidemiological studies have suggested that the daily intake of flavonoids is associated with a decreased risk of developing cardiovascular disease. Our purpose was to evaluate the effect of the addition of dietary flavonoids (DF) to antihypertensive treatment (AHT), based on telmisartan (Tms) or captopril (Cpr), on blood pressure (BP), body mass index (BMI), waist/hip ratio, leptin, lipid profile and inflammation in hypertensive young patients. An open-label, randomized, controlled trial was performed among 79 patients aged 20-55 years with grade I or grade II systemic arterial hypertension. The subjects were assigned to one of four groups for AHT plus DF during 6 months: Cpr (n = 14), Cpr + DF (n = 19), Tms (n = 25) and Tms + DF (n = 21). DF consisted of dark chocolate, dehydrated red apple and green tea in an infusion to obtain a daily dose of 425.8 AE 13.9 mg epicatechin equivalents. The BP and anthropometric parameters were measured every 2 weeks. Lipid profile, leptin and hsCRP were determined by standard methods. The combination AHT-DF produced an additional and significant reduction in (i) SBP/DBP of À5/À4 mmHg, being À7/À5 for Cpr + DF and À4/À3 for Tms + DF; (ii) triglyceride levels (À30.6%) versus AHT alone (À9.6%); and (iii) leptin: Cpr + DF versus Tms + DF (p < 0.005). Finally, C-reactive protein plasma levels were reduced significantly in all groups independently of the applied treatment. We conclude that the addition of flavonoids to pharmacological antihypertensive therapy shows additional benefits on BP, lipid profile, leptin, obesity and inflammation.High blood pressure is an important public health issue worldwide. It has been considered a major and independent factor that could lead to coronary heart disease, stroke and peripheral artery disease associated with metabolic alterations [1,2]. The therapeutic approach for hypertension (HT) is lifestyle modification and pharmacotherapy. Angiotensin converting enzyme (ACE) inhibitors (captopril, enalapril and ramipril), as antihypertensive therapy (AHT), are not considered able to correct the concomitant metabolic condition. Telmisartan, an angiotensin receptor blocker (ARB), has demonstrated pleiotropic effects on carbohydrate and lipid profiles, as well as on inflammatory processes [3]. Flavan-3-ols are aromatic compounds with a 2-phenyl-3,4-dihydro-2H-chromen-3-ol chemical skeleton (catechin) that are found as principal components in vegetables and other herbals such as green tea, red apple and cacao beans. These organic compounds have demonstrated beneficial effects on blood pressure (BP), inflammation, obesity and dyslipidaemia [4][5][6]. The Kuna people (Panama) that consume high quantities of cacao on a daily basis have shown a significant low mortality rate (9.2 AE 3.1 versus 83.4 AE 0.7 deaths/age/100,000) caused by cardiovascular diseases in comparison with other Pan American inhabitants [7]. In recent years, the anti-inflammatory and anticarcinogenic properties of flavan-3-ols, which are different from antioxidants, have been s...

The effect of green tea on inflammatory mediators: A systematic review and meta‐analysis of randomized clinical trials

“…Titles and abstracts of 813 articles were read, and 774 articles were excluded. By considering criteria for inclusion and exclusion, 22 articles were excluded due to following reasons: not having a control group ( N = 3; Alghadir, Gabr, & Al‐Eisa, ; Lee et al, ; Sung et al, ), intervention less than 1 day ( N = 3; Alexopoulos et al, ; Hsu et al, ; Koutelidakis et al, ), and using other nutrients beside green tea in the intervention group ( N = 16; Bakker et al, ; Braga et al, ; Cialdella‐Kam et al, ; de Jesus Romero‐Prado et al, ; Dominiak, McKinney, Heilbrun, & Sarkar, ; Kim et al, ; Madaric et al, ; Nieman et al, ; Nieman et al, ; Ormsbee et al, ; Peluso et al, ; Rondanelli et al, ; Rubio‐Perez, Albaladejo, Zafrilla, Vidal‐Guevara, & Morillas‐Ruiz, ; Scolaro et al, ; Soriano‐Maldonado, Hidalgo, Arteaga, de Pascual‐Teresa, & Nova, ; Thomas, Williams, Sharma, Chaudry, & Bellamy, ; Figure ). Therefore, 17 articles were included in our systematic review (Basu et al, ; Bogdanski et al, ; de Maat et al, ; Dower et al, ; Fukino et al, ; Fukino, Shimbo, Aoki, Okubo, & Iso, ; Gutierrez‐Salmean et al, ; Hu et al, ; Hussain, Habib Ur, & Akhtar, ; Mielgo‐Ayuso et al, ; Mombaini & Jafarirad, ; Nogueira, Nogueira Neto, Klein, & Sanjuliani, ; Oyama et al, ; Oyama, Maeda, Sasaki, et al, ; Ryu et al, ; Shin et al, ; Sone et al, ); because the article by Ryu et al () did not report baseline values, we did not include it in our meta‐analysis (Table ).…”

“…not having a control group (N = 3;Alghadir, Gabr, & Al-Eisa, 2016;Lee et al, 2005;Sung et al, 2005), intervention less than 1 day (N = 3;Alexopoulos et al, 2008;Hsu et al, 2007;Koutelidakis et al, 2014), and using other nutrients beside green tea in the intervention group (N = 16;Bakker et al, 2010;Braga et al, 2012;Cialdella-Kam et al, 2016;de Jesus Romero-Prado et al, 2015;Dominiak, McKinney, Heilbrun, & Sarkar, 2010;Kim et al, 2016;Madaric et al, 2013;Nieman et al, 2013;Nieman et al, 2017;Ormsbee et al, 2014;Peluso et al, 2014;Rondanelli et al, 2013;Rubio-Perez, Albaladejo, Zafrilla, Vidal-Guevara, & Morillas-Ruiz, 2016; Scolaro et al, 2018; Soriano-Maldonado, Hidalgo, Arteaga, de Pascual-Teresa, & Nova, 2014; Thomas, Williams, Sharma, Chaudry, & Bellamy, 2014; Figure 1).Therefore, 17 articles were included in our systematic review(Basu et al, 2011;Bogdanski et al, 2012;de Maat et al, 2000;Dower et al, 2015;Fukino et al, 2008;Fukino, Shimbo, Aoki, Okubo, & Iso, 2005;Gutierrez-Salmean et al, 2016;Hu et al, 2016;Hussain, Habib Ur, & Akhtar, 2017;Mielgo-Ayuso et al, 2014;Mombaini & Jafarirad, 2017;Nogueira, Nogueira Neto, Klein, & Sanjuliani, 2017;Oyama, Maeda, Sasaki, et al, 2010;Ryu et al, 2006;Shin et al, 2018;Sone et al, 2011)…”

A Systematic Review and Meta-Analysis of the Effects of Flavanol-Containing Tea, Cocoa and Apple Products on Body Composition and Blood Lipids: Exploring the Factors Responsible for Variability in Their Efficacy

“…After detailed analysis of the full text, 71 articles were excluded, due to lack of relevant outcomes, aspects of study design or publication language. The final number of articles selected for meta-analysis was selected from a total of 117 articles published between 1997 and July 2015 (included) [21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,…”

Nutraceuticals and Blood Pressure Control: Results from Clinical Trials and Meta-Analyses

“…Epidemiological studies have suggested that the daily intake of flavonoids is associated with a decreased risk of developing cardiovascular disease [57].…”