Abstract
The burden of hypertension in Sub-Saharan African countries is rising. Low-cost and effective interventions are needed to mitigate these alarming trends. No evidence is available on the use of dietary nitrate for treating hypertension in African populations. The objectives of this study are to assess the feasibility and efficacy of using beetroot and folate as a combined dietary intervention to treat Tanzanian adults with pre- and mild to moderate hypertension. This was a three-arm double-blind, placebo-controlled, parallel randomised clinical trial conducted within the Hai Demographic Surveillance Site in the Kilimanjaro region in Tanzania. 48 participants were randomised to one of three groups for a 60-day intervention period. Group 1: Combined dietary intervention (beetroot juice and folate), Group 2: Single dietary intervention (beetroot juice and placebo capsule), and Group 3: Control group (placebo beetroot juice and placebo capsule). The primary outcome of the trial was to evaluate the feasibility of the study in a low-income setting. Trial assessments included resting clinic and ambulatory 24-hr blood pressure measurements, lifestyle and dietary questionnaires and collection of biological samples. Our cohort included 8 (16.7%) males and 40 (83.3%) females with mean age 60.7 years (SD 6.5). The mean (SD) BMI, clinic systolic blood pressure and ambulatory systolic blood pressure at baseline were 27.6 kg/m2 (5.4), 151.0 (19.4), and 140.4 (15.0) mmHg, respectively. Eight (16.7%) participants were classified as pre-hypertensive, 20 (41.7%) as stage-1 hypertensive, and 20 (41.7%) as stage-2 hypertensive. Overall, the results support the feasibility of a study of this nature within a hypertensive African population. Trial Registration NumberISRCTN67978523.
Highlights
Hypertension is associated with a significant risk of cardiovascular morbidity and mortality worldwide [1]
Our study was a three-arm, placebo-controlled, double blind, rand omised clinical trial (RCT) that was conducted in the Hai Demographic Surveillance Site (DSS) in the Kilimanjaro region of Northern Tanzania
We have demonstrated the rationale, design and baseline data of the participants who took part in our dietary inter vention trial
Summary
Hypertension is associated with a significant risk of cardiovascular morbidity and mortality worldwide [1]. A recent study conducted by our group established a ‘rule of sixths’ in a cohort of hypertensive patients, where 2/6th of the cohort were previously diagnosed, 1/6th of those with a diagnosis were on treatment, and only 1/6th of those on treatment were adequately controlled [3]. Optimal control of hypertension remains challenging and the rising prevalence of hypertension in Tanzania calls for effective interventions. The Dietary Approach to Stop Hypertension (DASH) diet is one of the best proven non-pharmacologic interventions for the prevention of hypertension [4] and the high inorganic nitrate content in the DASH diet may be responsible for this effect [5]. Recent studies have shown that dietary nitrate supplementation can reduce blood pressure and improve endothelial dysfunction [6,7,8]. Proposed mechanisms involve the generation of nitrite and subsequently nitric oxide, which promotes vasodilation to lower blood pressure [9]
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