ReviewThe role of nutraceuticals in prevention and treatment of hypertension: An updated review of the literature
Graphical abstract
Introduction
Based on the 2018 European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) guidelines, hypertension (HTN) is defined as “office systolic blood pressure (SBP) values ≥ 140 mmHg and/or diastolic blood pressure (DBP) values ≥ 90 mmHg”. The 2018 ESC and the ESH guidelines for the management of arterial HTN reported the uncontroversial evidence based on improvement in the poor rates of blood pressure (BP) control by promoting simple and effective treatment strategies (Williams et al., 2018). Table 1 presents the classification of office BP and definitions of HTN grades (Gabb, Mangoni, & Arnolda, 2017).
Relatively numerous epidemiological and genome-wide association studies (GWAS) have been investigated to identify the risk factors of HTN. Endothelial dysfunction (ED), vascular and cardiac smooth muscle dysfunction, excessive adiposity, inflammation, oxidative stress, and genetic factors (e.g. single nucleotide polymorphisms (SNPs) and non-coding (micro) RNAs) are well recognized risk factors of HTN (Butler, 2010, Hamet and Seda, 2007, Houston, 2005).
High prevalence of HTN across the world and its relationship with the risk of cardiovascular events (hemorrhagic and ischemic stroke, myocardial infarction, heart failure, sudden death, and peripheral artery disease) have been considered as a major leading global contributor to premature death in 2015 (Forouzanfar et al., 2017). Lifestyle modifications and drug treatment are two well-accepted strategies for lowering BP. Based on BP level and grade of total cardiovascular (CV) risk factors such as dyslipidemia and glucose intolerance, antihypertensive therapy should be initiated (Chumphukam et al., 2019, Kjeldsen et al., 2014).
Dietary interventions such as reducing dietary sodium, dietary approaches to stop hypertension (DASH), and Mediterranean diet have been considered the mainstay treatment of BP, lipid levels and CV events (Dickinson et al., 2006a, Doménech et al., 2014, Estruch et al., 2013). Extensive body of literature has reported beneficial effects of functional foods and nutraceuticals as adjunctive therapies to pharmacotherapy for treating HTN (Fitzpatrick, 2004, Shaterzadeh-Yazdi et al., 2017).
The concept of “nutraceutical” is the hybrid of ‘nutrition’ and ‘pharmaceutical’ which was coined by Dr. Stephen L. DeFelice, MD, the founder and chairman of the Foundation for Innovation in Medicine (FIM), (Cranford, in 1989 for the first time) (Das, Bhaumik, Raychaudhuri, & Chakraborty, 2012). The term “nutraceuticals” evolved over the years and the terminology varies across countries. This term can be defined as “a food (or a part of food) that provides medical or health benefits, including the prevention and or treatment of a disease” (Dillard and German, 2000, Olas, 2018).
“[A food] consumed as part of a usual diet, and is demonstrated to have physiological benefits and/or reduce the risk of chronic disease beyond basic nutritional functions” (Chumphukam et al., 2019). In general, nutraceuticals as natural functional/medical foods or bioactive phytochemicals are substances derived from foods and used in the medicinal forms of pills, capsules, potions and liquids, which provide physiological benefits or protect against chronic disease (Kailasapathy, 2009). According to a recent cross-sectional study, 82.5% of CV patients used nutraceuticals as a health promoting activity (Aykan & Aykan, 2018).
The potential health effects of nutraceuticals are current research topics in the area of the management and prevention of degenerative diseases such as cancer, diabetes, HTN, cardiovascular disease (CVD), non- alcoholic fatty liver, etc.
In recent years researchers have focused on the effects of nutraceuticals for modification of CVD and high BP (Cicero et al., 2018, Cicero et al., 2019, Dyck et al., 2019, Figueiredo et al., 2018, Rivellese et al., 2019, Sosnowska et al., 2017). Given the fact that there are some limitations on the comprehensive survey of nutraceuticals in the previous studies, the lack of outcome data and absence of definite conclusions are important research gaps in this field. To cover these knowledge gaps, we reviewed the current literature and conducted an updated comprehensive review for providing a summary of all the published literature with special focus on findings from clinical experiments and meta-analysis. Moreover, in this review, we considered the beneficial effects of common nutraceuticals on other CV risk biomarkers, recommendation class, and evidence level, involved biological mechanisms in the reduction of BP as well as their side effects and toxicity.
Section snippets
Materials and methods
A literature search was done through narrative reviews, including electronic databases of PubMed, Cochrane Library, Scopus, and Google Scholar. We aimed to summarize the published literature on the nutraceutical supplements in the treatment of HTN. A combination of the terms “high blood pressure”, “hypertension”, “nutraceuticals”, “functional foods”, “nutrients”, “vitamins”, “dietary supplements”, “spices”, “prebiotics”, and “cardiovascular disease” was used. Case reports, editorial letters,
Categories of nutraceuticals and their role in hypertension
The mechanism of action and chemical nature of nutraceuticals can be considered for their classification. The BP lowering nutraceuticals can be categorized as foods (i.e., tea and cocoa), nutrients (i.e., magnesium, calcium, vitamin C, omega 3 polyunsaturated fatty acids (PUFAs), soluble fibers) and non-nutrient nutraceuticals (i.e., coenzyme Q10, lycopene, prebiotics) (Cicero et al., 2019, Kokate et al., 2002, Olas, 2018, Sirtori et al., 2015). Table 2 provides the list of common
Conclusion
Literature review suggested that some dietary ingredients and nutraceuticals can be key modulators of some chronic disease including HTN. Despite the many claims about the protective effects of nutraceuticals against HTN, more scientific evidence and well-designed clinical trials are required to incorporate them in the routine treatment of HTN either solo or combined with other medications. Beyond this, the safety of the potential nutraceuticals is another major concern. Such agents should be
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declaration of Competing Interest
The authors declared that there is no conflict of interest.
Acknowledgements
The authors would like to thank the Cardiovascular Research Center of Tabriz University of Medical Sciences. Mr Sigaroodi is gratefully acknowledged for co-operation in the figure preparation. Authors thank Mr. Hafez Mohammadhassanzadeh for his valuable comments on the manuscript regarding academic writing.
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