The Role of Pharmaconutrition in the Management of Arterial Hypertension

CODREANU Adela1, BELU Ionela2, NICOLAESCU Oana Elena1, MOCANU Andreea Gabriela2

1 PhD Student, University of Medicine and Pharmacy, 2-4 Petru Rares Str., 200349 Craiova, (ROMANIA)

 2Pharmacy Department I, University of Medicine and Pharmacy, 2-4 Petru Rares Str., 200349 Craiova, (ROMANIA)

cdrn_adela@yahoo.com,  ionela.belu@umfcv.ro, oana.nicolaescu@umfcv.ro, gabriela.mocanu@umfcv.ro

Abstract

Arterial hypertension has a prevalence of 45.1% in Romania. It is estimated that high blood pressure is the main cause for 54% of strokes and 47% of ischemic heart disease cases worldwide. Pharmacological and non-pharmacological recommendations that involve lifestyle and diet changes may keep high blood pressure under control. Furthermore, recent studies show that nutrition plays a key role in the management of arterial hypertension. 

Research has found that a diet that includes fruits, vegetables as well as low fat dairies is beneficial for patients with cardiovascular diseases. Moreover, hypertensive patients must follow a diet low in saturated fats, red meat, sweets as well as sugar – sweetened beverages. Therefore, a nutritionist must be included in the physician – led team that manages the antihypertensive treatment in order to obtain a better outcome. 

Keywords: diet, arterial hypertension, diet recommendations, sage, dietary approaches, cardiovascular diseases, nutrition, potassium 

Introduction

An increased attention has been recently directed towards a better management of cardiovascular diseases, especially arterial hypertension (HTA). 

A healthier diet determined a better outcome in patients that do not respond well to standard therapy.

Arterial hypertension has a high prevalence in Romania as well as the entire world. It is considered a serious health problem due to associated mortality and morbidity that have a major impact on the quality of life of each patient.

SEPHAR II study showed that 45.1% of the adult population in Romania presents HTA and are exposed to high risks involving their health [1].

Physician – hypertensive patient – pharmacist communication is extremely important as it increases the patient compliance and helps in the hypertension management.

Pharmacological and non-pharmacological recommendations that involve lifestyle and diet changes may help keep arterial hypertension under control because recent studies show that nutrition plays a key role in stabilizing blood pressure.

Studies have found that, in addition to pharmacologic therapies, changes in a patient’s diet may help manage high blood pressure. This is determined by minerals such as sodium, potassium, calcium and magnesium that are found in high quantities in various foods and have a direct influence over blood pressure [2].

Diet recommendations

Nutritionists and pharmacologists recommend a diet high in fruits, vegetables as well as low fat dairies for patients with cardiovascular diseases. Hypertensive patients must follow a diet low in saturated fats, red meat, sweets as well as beverages high in sugars. This diet is also known as Dietary Approaches to Stop Hypertension (DASH). Moreover, several clinical studies showed its efficiency.

A balanced diet with a calorie intake lower than necessary and also rich in potassium, calcium and magnesium is recommended to prevent high blood pressure and also for weight loss. 

Potassium

Low fat yogurt, trout, several fruits that include watermelon, grapes, bananas, avocados, carrots, orange juice and vegetables such as zucchinis, tomatoes, broccoli, quinoa, peas and spinach are foods rich in potassium. They are also included as recommendations in the current guidelines for hypertension management. The mechanism of action that explains how potassium helps lower blood pressure involves increased natriuresis. This is determined by the inhibition of renal reabsorption of sodium. Furthermore, potassium helps relax smooth muscles and increases nitic oxide production. Potassium as well as calcium and magnesium controls the contraction of the heart muscle and cardiac output [3].

Calcium

Dairy products, preferably low fat, such as milk, cheese and yogurt are the main sources for calcium. Increasing the daily calcium intake past the recommended daily dose of 1000 – 1300 mg, depending of age and sex, is not recommended. Calcium intake modulates blood pressure by modifying the intracellular calcium level which plays a role in the contraction of the heart muscle. Furthermore, calcium increases natriuresis and modulates the sympathetic nervous system. Studies have shown that an increase in blood pressure directly determined by a diet high in sodium may be counterbalanced by an increase in calcium intake. 

Magnesium

It has been reported that magnesium modulates vascular tone, hence it regulates blood pressure. Furthermore, magnesium is a calcium channels blocker and it stimulates both prostacyclin and nitric oxide production. Moreover, it modifies vascular reaction to vasoactive agonists. An inversely correlation between blood pressure and the serum magnesium level has also been reported. 

The association between magnesium intake and arterial hypertension has not been completely established and not all researchers agree on this matter. Magnesium supplements are not recommended as auxiliary treatment for hypertension. Food sources high in magnesium include spinach, amaranth, quinoa and whole grains [4].

Fish

Weight reduction diets that included a daily consumption of fish have proven to be beneficial in lowering blood pressure. An association between omega – 3 polyunsaturated fatty acids extracted from fish and low blood pressure has been reported. Omega – 3 fatty acids are also known as fish oil. 

Food sources for both omega – 3 and omega – 6 fatty acids include flaxseeds, fish, seafood, olives, walnuts and vegetal oils [5].

Garlic 

Garlic has been used in different cultures for its hypotensive action. Furthermore, garlic also possesses anti-inflammatory, antioxidant and antibacterial properties. Moreover it may be used as an adjuvant therapeutic choice for patients with hypercholesterolemia. Garlic may be consumed raw as well as an aqueous extract, or as a powder. Its therapeutic effect is determined by several organic compounds that include allicin, gallicin and allyl methyl thiosulfonate. Several researchers studied garlic and its association with arterial hypertension. Furthermore, Allium Sativum influences the pharmacokinetics of antiretroviral agents and anticoagulants [6,7,8].  

Vitamin C 

Leek has a high concentration in vitamin C. It manifests a significant diuretic action as it has a good ratio between potassium and sodium (high concentration in potassium and low concentration in sodium). Therefore, it is used in adjuvant therapies of HTA and water retention. The white part of leek has a high concentration of water soluble fibers and saccharides that have a diuretic effect, whereas the green part is rich in vitamin C. 

Hawthorn herbal supplements have a high vitamin C concentration. They are recommended as an adjuvant therapy of HTA because they manifest a double role, leading to vasodilation. Vitamin C may help reduce high blood pressure due to its antioxidant properties and free radical neutralizing action, whereas hawthorn extract controls heart beat frequency. Other sources of vitamin C include broccoli, citrus fruits and forest fruits [9]. 

Sage

Common sage (Salvia officinalis) is a medicinal plant that has antioxidant, anti-inflammatory and antiseptic properties. It may also be used as an antiseptic. Furthermore, it reduces the level of lipids, lowers high blood pressure and improves memory. It contains a wide range of alkaloids, carbohydrates, fatty acids, glycosides (cardiac glycosides, flavonoid glycosides, saponins) and phenolic compounds (tannins, coumarins). A study conducted on healthy volunteers following the effects of sage tea consumption showed no associated side effects or toxicity. Furthermore, the lipid profile in the subjects improved after 4 weeks [8,10,11,12,13]. 

Salvia fruticosa Mill also known as east Mediterranean sage is highly used in Levantine cuisine. Its therapeutic effect is determined by a high concentration in polyphenols. It produces an anti-inflammatory, antioxidant and antiproliferative effect. Furthermore, it determines the inhibition of smooth muscles. It is traditionally used in the eastern parts of the Mediterranean to lower high blood pressure [14,15]. 

Salviae miltiorrhizae also known as Chinese sage or red sage is a traditional plant used regularly in Chinese culture to treat cardiovascular diseases as it produces vasodilation. Moreover, it also has antioxidant, anti-inflammatory and antiproliferative properties [16,17].

Conclusions

Nutrition is extremely important for a better management of arterial hypertension as it represents a key component in HTA treatment. 

Including nutritionists and dieticians in the physician – led team that manages the antihypertensive treatment is essential for a successful outcome. Furthermore, a trusting relationship must exist between patient, its family and the physician – led team to guarantee success. 

Author Contributions: All authors have equally contributed to the work reported.

REFERENCES

  1. Dorobantu, M., Tautu, O., Dimulescu, D., Sinescu, C., Gusbeth-Tatomir, P., Arsenescu-Georgescu, C., Mitu, F., Lighezan, D., Pop, C., Babes, K., Giuca, A., Branza, I., Udrescu, M., Herdea, V., Darabont, R. (2018). Perspectives on hypertensionʼs prevalence, treatment and control in a high cardiovascular risk East European country: Data From the SEPHAR III Survey. Journal of Hypertension 36(3), pp.690-700.
  2. Moore, T., Conlin, P., Ard, J., Svetkey, L. (2001). DASH (Dietary Approaches to Stop Hypertension) Diet Is Effective Treatment for Stage 1 Isolated Systolic Hypertension. Hypertension 38(2), pp.155-158.
  3. Nguyen, H., Odelola, O., Rangaswami, J., Amanullah, A. (2013). A Review of Nutritional Factors in Hypertension Management. International Journal of Hypertension, 2013, pp.1-12.
  4. Sontia, B., Touyz, R.M. (2007). Role of Magnesium in Hypertension, Archives of Biochemistry Biophysics 458(1), pp. 33-9.
  5. Dărmănescu, D., Mihele, D., Dogaru E., Cocu, F. (2010). Experimental evaluation of some biochemical parameters after administration of fatty acids ethanolamides from extra virgin olive oil in rats, Farmacia 58(2), pp. 228-236
  6. El-Saber Batiha, G., Magdy Beshbishy, A., G. Wasef, L., Elewa, Y., A. Al-Sagan, A., Abd El-Hack, M., Taha, A., M. Abd-Elhakim, Y., Prasad Devkota, H. (2020). Chemical Constituents and Pharmacological Activities of Garlic (Allium sativum L.): A Review. Nutrients 12(3), pp.872.
  7. Dumitrescu, VS., Vasiliev, I., Ionita, EI., Morosan, E. (2018) The risk of development phatologies in the colon by infestation with nitrites and nitrates from ecological tradition and conventional processed meat, Proceedings of The Romanian National Congress of Pharmacy – 17th Edition, “21st Century Pharmacy – Between Intelligent Specialization and Social Responsibility”, Filodiritto Editore – Proceedings, pp. 81-83
  8. Seremet, O.A., Morosan, E., Margine, D., Olaru, O.T., Negres, S., Danciulescu Miulescu, R., Dinu, M. (2017). The effects of certain dry plant extracts on some biochemical parameters, in diabetic rats, Proceedings Paper, 3rd International Conference on Interdisciplinary Management of Diabetes Mellitus and its Complications (INTERDIAB), pp. 283-291.
  9. Cherim, M., Sirbu, R., Belu, I. (2017). Isolation of collagen from marine resources from the Black Sea, Current health sciences journal 43 (4), 301
  10. Khedher, M., Khedher, S. B., Chaieb, I., Tounsi, S., Hammami, M. (2017). Chemical composition and biological activities of Salvia officinalis essential oil from Tunisia. EXCLI journal 16, pp. 160–173. 
  11. Sá, C., Ramos, A., Azevedo, M., Lima, C., Fernandes-Ferreira, M., Pereira-Wilson, C. (2009). Sage Tea Drinking Improves Lipid Profile and Antioxidant Defences in Humans. International Journal of Molecular Sciences 10(9), pp. 3937-3950.
  12. Stefănescu, E., Morosan, E., Gurgu, H., Isabel, C., Ghita, V.,Zanfirescu, A., Zbarcea, C.E., Musat, O., Negres, S. (2019). Experimental pharmacological research regarding the effect of some newly synthesized b-phenylethyl amines on the modified parameters of the lipid metabolism, Farmacia 67(4), pp. 596-602
  13. Neguț, C., Pintilie, L., Tănase, C., Udeanu, D.I., Drăghici, C., Munteanu, C., Moroșan, E. (2018). Oleic acid amides with potential pharmacological effects in the overweight treatment. Revista de Chimie 69(5), pp. 790-794
  14. Anwar, M., Samaha, A., Ballan, S., Saleh, A., Iratni, R., Eid, A. (2017). Salvia fruticosa Induces Vasorelaxation In Rat Isolated Thoracic Aorta: Role of the PI3K/Akt/eNOS/NO/cGMP Signaling Pathway. Scientific Reports 7(1).
  15. Yöney, A., Prieto, J., Lardos, A., Heinrich, M. (2009). Ethnopharmacy of turkish-speaking cypriots in greater London. Phytotherapy Research 24(5), pp.731-740.
  16. Al Disi, S., Anwar, M., Eid, A. (2016). Anti-hypertensive Herbs and their Mechanisms of Action: Part I. Frontiers in Pharmacology 6.
  17. Ciulu-Costinescu, F., Chifiriuc, M.C., Popa, M., Bleotu, C., Neamtu, J., Averis, L.M.E., Bubulica, M.V., Simionescu, A., Aldea, I.M., Belu, I. (2015). Screening of polyphenol content and in vitro studies of antioxidant, antibacterial and cytotoxic activities of Capsicum Annuum extracts. Revista de Chimie 66, pp. 1261-1266.