Sex May Modulate the Effects of Combined Polyphenol Extract and L-citrulline Supplementation on Ambulatory Blood Pressure in Adults with Prehypertension: A Randomized Controlled Trial.

Cécile Vors,Patrick Couture,Charles Couillard,Iris Gigleux,Maryka Rancourt-Bouchard,Benoît Lamarche

doi:10.3390/nu13020399

Abstract

Increased blood pressure (BP), vascular dysfunction and inflammation are involved in the etiology of cardiovascular disease (CVD). Although several dietary components such as polyphenols and L-citrulline may help to control BP, their combined impact on ambulatory BP in individuals at risk of CVD remains unknown. The objective of this research was to investigate the short-term impact of supplementation with a combination of polyphenol extract and L-citrulline on ambulatory BP, endothelial function and inflammation. In a randomized double-blind parallel trial, 73 men and women with prehypertension were supplemented with a placebo (cellulose, n = 34, Plac) or 548 mg/day of polyphenols and 2 g/day of L-citrulline (n = 35, Suppl) for 6 weeks. The primary outcome of this study was the difference between groups in 24-h ambulatory diastolic BP (DBP) at week six. Secondary outcomes were a difference between groups at week six in ambulatory systolic BP (SBP), casual BP, serum lipids and high-sensitivity C-reactive protein (hs-CRP) concentrations and skin advanced glycation end products (AGEs). Potential interaction of treatment with sex was examined. Suppl had no impact on mean ambulatory SBP and DBP (p > 0.10 vs. placebo). Daytime and 24-h SBP were reduced with Suppl in women (p ≤ 0.01), but not in men (p ≥ 0.27). A non-significant reduction in AGEs was observed after Suppl compared to Plac among all participants (p = 0.07) and there was no difference in the concentrations of blood lipids (p > 0.20) or CRP (p = 0.36) between treatments at week six. Therefore, supplementation with polyphenol extract and L-citrulline for 6 weeks has no impact on ambulatory BP, blood lipids and CRP in adults with prehypertension. However, the polyphenol extract/L-citrulline supplement may reduce ambulatory SBP in women, but not in men. These preliminary results need further research efforts towards further documenting this sex-dependent BP response to supplementation with polyphenols and L-citrulline.

Highlights

Hypertension is a causal risk factor for a variety of cardiovascular diseases (CVDs) [1]
Ambulatory blood pressure (BP) monitoring (ABPM) is a proven and reliable method to assess BP according to hypertension guidelines around the world [4]
Several lines of evidence indicate that ambulatory BP monitoring data correlate more closely with target organ injury [3] and CVD risk [11] than conventional in-office measurements

Summary

Introduction

Hypertension is a causal risk factor for a variety of cardiovascular diseases (CVDs) [1]. Treatment of high blood pressure is one of the cornerstones of CVD prevention, even among individuals with prehypertension who are at increased risk for progression to hypertension. Substantial evidence suggests that diet and lifestyle play an important role in BP control [5,6,7,8] and adoption of healthy dietary habits by individuals with prehypertension remains the cornerstone therapy. Recent studies suggest that ABPM data more accurately reflect an individual’s actual BP than casual or in-office BP measurements [9,10]. Several lines of evidence indicate that ambulatory BP monitoring data correlate more closely with target organ injury [3] and CVD risk [11] than conventional in-office measurements. Very few nutritional intervention studies have used 24-h ABPM to assess nutrient/food and diet efficacy in modifying BP [12,13,14,15,16]

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