Significant Reduction In Systolic Blood Pressure Research Articles

Cinnamon supplementation improves blood pressure in type 2 diabetic patients: A systematic review and meta-analysis of randomized controlled trials

Some studies have suggested that consumption of some herbal medicines may improve blood pressure. The present systematic review and meta-analysis was conducted to assess the efficacy of cinnamon supplementation on blood pressure in type 2 diabetic patients. The systematic search was undertaking using several online databases (PubMed, Embase, Scopus and Web of Sciences) to identify randomized controlled trials (RCTs) investigating the effect of cinnamon supplementation on systolic blood pressure (SBP) or diastolic blood pressure (DBP) in type 2 diabetic patients that were published up until 10 December 2019. Potential publication bias was assessed using the Egger regression test. Five full-text articles were included in this meta-analysis. Pooled results of the meta-analysis on 332 participants indicated a significant reduction in SBP and DBP following cinnamon administration. No publication bias was found. The results of the present study suggested that cinnamon might be effective in improving blood pressure in type 2 diabetic patients.

Effect of Lower Blood Pressure Goals on Left Ventricular Structure and Function in Patients With Subclinical Hypertensive Heart Disease

Subclinical hypertensive heart disease (SHHD) is a precursor to heart failure. Blood pressure (BP) reduction is an important component of secondary disease prevention in patients with SHHD. Treating patients with SHHD utilizing a more intensive BP target (120/80 mm Hg), may lead to improved cardiac function but there has been limited study of this, particularly in African Americans (AAs). We conducted a single center, randomized controlled trial where subjects with uncontrolled, asymptomatic hypertension, and SHHD not managed by a primary care physician were randomized to standard (<140/90 mm Hg) or intensive (<120/80 mm Hg) BP therapy groups with quarterly follow-up for 12 months. The primary outcome was the differences of BP reduction between these 2 groups and the secondary outcome was the improvement in echocardiographic measures at 12 months. Patients (95% AAs, 65% male, mean age 49.4) were randomized to the standard (n = 65) or the intensive (n = 58) BP therapy groups. Despite significant reductions in systolic BP (sBP) from baseline (-10.9 vs. -19.1 mm Hg, respectively) (P < 0.05), no significant differences were noted between intention-to-treat groups (P = 0.33) or the proportion with resolution of SHHD (P = 0.31). However, on post hoc analysis, achievement of a sBP <130 mm Hg was associated with significant reduction in indexed left ventricular mass (-6.91 gm/m2.7; P = 0.008) which remained significant on mixed effect modeling (P = 0.031). In post hoc analysis, sBP <130 mm Hg in predominantly AA patients with SHHD was associated with improved cardiac function and reverse remodeling and may help to explain preventative effects of lower BP goals. Trial Number NCT00689819.

Genistein supplementation improves some cardiovascular risk factors in postmenopausal women with Type 2 diabetes mellitus

PurposeType 2 diabetes mellitus (T2DM) is a worldwide health problem. Blood pressure (BP) and inflammation are well-established risk factors for the cardiovascular complications of T2DM. Genistein is known to improve endothelial dysfunction. The purpose of this study is to investigate the effects of genistein supplementation on BP, high-sensitive C-reactive protein (hs-CRP) and homocysteine (Hcy) levels in postmenopausal women with T2DM.Design/methodology/approachThis randomized, double-blind, placebo-controlled clinical trial is conducted on postmenopausal women with T2DM. A total of 54 subjects aged between 47 and 69 years are divided into two groups. Participants in the genistein group (n = 28) are given two genistein capsules (each capsule contained 54 mg genistein) and those in the placebo group (n = 26) received two placebo capsules (each capsule contained 54 mg maltodextrin) daily for 12 weeks. General characteristics, BP, hs-CRP and Hcy levels are measured at the baseline and at the end of the trial.FindingsGenistein supplementation resulted in a significant reduction in systolic BP (SBP) (p < 0.001), diastolic BP (DBP) (p = 0.020), mean arterial pressure (MAP) (p < 0.001), serum levels of hs-CRP (p = 0.005) and Hcy (p = 0.001) in genistein group compared with placebo group at the end of the study. Significant decreases are also found in SBP by 5.4%, p < 0.001, DBP by 6.7%, p < 0.001, MAP by 6.2%, p < 0.001, serum levels of hs-CRP by 47.0%, p = 0.015 and Hcy by 18.4%, p < 0.001 in the genistein supplemented group. No significant changes are observed in terms of all post-intervention values in the placebo group.Originality/valueGenistein administration improved BP, hs-CRP and Hcy levels in postmenopausal women with T2DM and may be useful in control of some CVD risk factors in these subjects.

Tai Ji Quan as antihypertensive lifestyle therapy: A systematic review and meta-analysis

BackgroundProfessional health organizations are not currently recommending Tai Ji Quan alongside aerobic exercise to treat hypertension. We aimed to examine the efficacy of Tai Ji Quan as antihypertensive lifestyle therapy. MethodsTai Ji Quan interventions published in English and Chinese were included when they involved healthy adults, reported pre- and post-intervention blood pressure (BP), and had a non-exercise/non-diet control group. We systematically searched 11 electronic databases for studies published through July 31, 2018, yielding 31 qualifying controlled trials. We (1) evaluated the risk of bias and methodological study quality, (2) performed meta-regression analyses following random-effects assumptions, and (3) generated additive models representing the largest possible clinically relevant BP reductions. ResultsParticipants (n = 3223) were middle-aged (56.6 ± 15.1 years of age, mean ± SD) adults with prehypertension (systolic BP (SBP) = 136.9 ± 15.2 mmHg, diastolic BP (DBP) = 83.4 ± 8.7 mmHg). Tai Ji Quan was practiced 4.0 ± 1.4 sessions/week for 54.0 ± 10.6 min/session for 22.3 ± 20.2 weeks. Overall, Tai Ji Quan elicited significant reductions in SBP (–11.3 mmHg, 95%CI: –14.6 to –8.0; d+ = –0.75) and DBP (–4.8 mmHg, 95%CI: –6.4 to –3.1; d+ = –0.53) vs. control (p < 0.001). Controlling for publication bias among samples with hypertension, Tai Ji Quan trials published in English elicited SBP reductions of 10.4 mmHg and DBP reductions of 4.0 mmHg, which was half the magnitude of trials published in Chinese (SBP reductions of 18.6 mmHg and DBP reductions of 8.8 mmHg). ConclusionOur results indicate that Tai Ji Quan is a viable antihypertensive lifestyle therapy that produces clinically meaningful BP reductions (i.e., 10.4 mmHg and 4.0 mmHg of SBP and DBP reductions, respectively) among individuals with hypertension. Such magnitude of BP reductions can lower the incidence of cardiovascular disease by up to 40%.

Effect of Slow Breathing on Normal and Overweight Prehypertensives

One of the pathological conditions employing the heart rate variability analysis is a dysregulation of the autonomic nervous system that leads to the development of hypertension. It was shown that slow breathing can reduce blood pressure (BP) in hypertensive patients but not in normotensives. Very little is known if it reduces blood pressure in prehypertensives and if body weight influences the effect of slow breathing.A total of 194 men were recruited from the international student population of the V.N. Karazin Kharkiv National University. The cohort was subdivided into four groups with systolic blood pressure (SBP) 114.8±0.7 mm Hg referred as normotensive and 129.0±0.5 mm Hg as prehypertensive, with BMI 21.3±0.2kg/m2 labelled as normal weigh and 27.7±0.3 kg/m2 as overweight. Written informed consent was obtained from all participants.After 5 minutes resting stage breathing rate was slowed to 6 breaths per minute (CardioLab CS, XAI‐Medica, Ukraine) for 5 minutes.The ECG was continually recorded, LF and HF HRV power was expressed in absolute units. The HF power was interpreted as a measure of cardiovagal outflow, LF power as an index of baroreflex activity and possibly as a sympathoinhibitory arm of baroreflex according to our hypothesis described previously. Measurements of SBP and DBP were conducted using an automatic digital sphygmomanometer (Nissei WS‐1011, Japan). Blood pressure was measured at 4.5 minute of each stage. MANOVA with Bonferroni correction was used to test for effects of slow breathing, prehypertension, and body weight on cardiovascular and HRV variables. All analyses were conducted using SPSS 22.The resting SBP was higher in overweight than in normal weight prehypertensives at rest and at the end of slow breathing stage. Slow breathing reduced significantly SBP in prehypertensives with normal weight and overweight but not in normotensive participants (Fig. 1).The prehypertensives with normal weight had higher resting LnLF and LnHF than normotensives with normal weight (7.1±0.1 vs. 6.7±0.1 and 7.4±0.1 vs. 7.0±0.1 Lnms2, P=0.004 and P=0.002, respectively). Possibly young men with normal weight only developing hypertension used their resources of baroreflex (or sympathoinhibitory) and cardiovagal activity for the controlling of blood pressure. No difference in LnLF and LnHF were found between overweights.The LnLF and LnHF power increased more in normal weight normotensives than in prehypertensives indicating higher reserves of baroreflex (or sympathoinhibitory) and cardiovagal activities (Fig. 2).Overweight normotensives had the increment of LnLF power significantly lower compared with normal weight normotensives (Fig. 2). This finding may be explained by exhausted function of baroreflex or by depletion of resources inhibiting sympathetic nervous system activity.In conclusion, slowing the respiratory rate to 6 breaths per minute led to the significant reduction of SBP in prehypertensives with normal weight and overweight. The resting cardiovagal and baroreflex (or sympathoinhibitory) activities were more in prehypertensives than in normotensives with normal weight, but during breathing these differences were no longer significant. Between overweight normotensives and prehypertensives, no difference in HRV was found.Effect of slow breathing and body weight on SBP in normotensive (A) and prehypertensive (B) young men. *P&lt;0.05, ** P&lt;0.01, *** P&lt;0.001. Data are expressed as means±SE.Figure 1Effect of slow breathing, prehypertension, and body weight on LnLF (A) and LnHF power (B).* P&lt;0.05, ** P&lt;0.01. Data are expressed as means±SE.Figure 2

Effect of Hemoglobin A1c Reduction or Weight Reduction on Blood Pressure in Glucagon-Like Peptide-1 Receptor Agonist and Sodium-Glucose Cotransporter-2 Inhibitor Treatment in Type 2 Diabetes Mellitus: A Meta-Analysis.

BackgroundGlucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) and sodium‐glucose cotransporter‐2 inhibitors (SGLT2is) have shown their beneficial effects on cardiovascular outcomes and multiple cardiovascular risk factors, including hypertension. However, the mechanism of blood pressure (BP)–lowering effects of these agents has not been elucidated. This study aims to evaluate the effect of hemoglobin A1c reduction or body weight reduction with GLP‐1RA treatment and SGLT2i treatment on BP changes in patients with type 2 diabetes mellitus.Methods and ResultsStudies were identified by a search of MEDLINE, EMBASE, and the Cochrane Central Register until June 2019. Meta‐regression analysis was performed to evaluate the association between hemoglobin A1c reduction or body weight reduction and changes of BP. A total of 184 trials were included. Both GLP‐1RA and SGLT2i led to significant reductions in systolic BP (weighted mean difference, −2.856 and −4.331 mm Hg, respectively; P<0.001 for both) and diastolic BP (weighted mean difference, −0.898 and −2.279 mm Hg, respectively; P<0.001 for both). For both drug classes, hemoglobin A1c reduction was not independently associated with systolic BP reduction or diastolic BP reduction. In GLP‐1RA treatment, weight reduction was positively associated with systolic BP reduction and diastolic BP reduction (β=0.821 and β=0.287, respectively; P<0.001 for both). In SGLT2i treatment, weight loss was significantly associated with systolic BP reduction (β=0.820; P=0.001) but was not associated with diastolic BP reduction.ConclusionsTreatment with GLP‐1RA and SGLT2i led to significant reductions in BP in patients with type 2 diabetes mellitus. Weight reduction was significantly and independently associated with BP reductions in GLP‐1RA treatment and SGLT2i treatment.

The effects of cashew nut intake on lipid profile and blood pressure: A systematic review and meta-analysis of randomized controlled trials

BackgroundDyslipidemia and hypertension are important risk factors for cardiovascular disease (CVD). Some studies have suggested that the consumption of nuts may reduce CVD risk. ObjectiveThe present systematic review and meta-analysis was conducted to investigate the efficacy of cashew nut consumption on lipid profile and blood pressure. MethodsPubMed, Embase, Scopus, Web of Science and Cochrane Library were systematically searched to identify randomized control trials (RCTs) examining the effects of cashew nut intake on serum triglycerides (TG), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), serum total cholesterol (TC), systolic blood pressure (SBP) or diastolic blood pressure (DBP) until 15 November 2019. A random-effects model was used to pool weighted mean difference (WMD) and 95 % confidence intervals (CI). Potential publication bias was assessed using Egger’s test. Sensitivity analysis was performed to assess the impact of each individual study on the pooled results. ResultsA meta-analysis on 392 participants showed that cashew nut consumption had no significant effects on lipid profile and DBP. However, there was a significant reduction in SBP (WMD = -3.39, 95 % CI = [-6.13, -0.65], P = 0.01, I2 = 0.0 %) in the group receiving cashew nut compared to the controls. There was no significant publication bias in the meta-analysis. A sensitivity analysis showed that omitting each study did not change the significance of results. ConclusionThis meta-analysis demonstrated that cashew nut consumption might reduce SBP but has no effects on lipid profile and DBP.

The hypotensive effect of salt substitutes in stage 2 hypertension: a systematic review and meta-analysis

BackgroundHypertension (HTN) is a ubiquitous risk factor for numerous non-communicable diseases, including cardiovascular disease and stroke. There are currently no wholly effective pharmacological therapies for subjects with HTN. However, salt substitutes have emerged as a potential therapy for the treatment of HTN. The aim of the present study was to assess the effect of salt substitutes on reducing systolic blood pressure (SBP) and diastolic BP (DBP), following a meta-analysis of randomized controlled trials.MethodsStudies were found via systematic searches of the Pubmed/Medline, Scopus, Ovid, Google Scholar and Cochrane library. Ten studies, comprised of 11 trials and 1119 participants, were included in the meta-analysis.ResultsPooled weighted mean differences showed significant reductions of SBP (WMD − 8.87 mmHg; 95% CI − 11.19, − 6.55, p < 0.001) and DBP (WMD − 4.04 mmHg; 95% CI − 5.70, − 2.39) with no statistically significant heterogeneity between the 11 included comparisons of SBPs and DBPs. The stratified analysis of trials based on the mean age of participants showed a significant reduction in the mean difference of SBP in both adults (< 65 years old) and elderly (≥65 years old). However, the DBP-lowering effect of salt substitutes was only observed in adult patients (WMD − 4.22 mmHg; 95% CI − 7.85, − 0.58), but not in the elderly subjects.ConclusionsThese findings suggest that salt-substitution strategies could be used for lowering SBP and DBP in patients with stage 2 HTN; providing a nutritional platform for the treatment, amelioration, and prevention of HTN.

The effect of zinc supplementation on blood pressure: a systematic review and dose-response meta-analysis of randomized-controlled trials.

Despite previous investigations on the effects of zinc supplementation on blood pressure, inconsistent findings are available in this regard. Therefore, we conducted a systematic review and meta-analysis of randomized clinical trials on the effects of zinc supplementation on blood pressure (BP) in adults. Relevant studies published up to September 2019 were searched through PubMed/Medline, Scopus, ISI Web of Science, and Google Scholar using suitable keywords. All randomized clinical trials (RCTs) that examined the effect of oral zinc supplementation on systolic blood pressure (SBP) or diastolic blood pressure (DBP) in adults were included. Overall, nine trials were included in our study. Zinc supplementation significantly reduced SBP compared to the control [weighted mean differences (WMD) - 1.49mmHg; 95% CI - 2.85 to - 0.13; P = 0.03]. However, zinc supplementation had no significant effects on DBP (WMD - 0.88mmHg; 95% CI - 2.04 to 0.29; P = 0.14). Nonlinear analysis failed to indicate a significant influence of supplementation dosage or duration on both SBP and DBP. Sensitivity analysis showed that no individual study had a significant impact on our final results. In addition, we found no evidence for the presence of small-study effects among studies for both SBP and DBP. We found a significant reduction in SBP following zinc supplementation. However, zinc supplementation had no significant effect on DBP. In addition, no nonlinear association was found between supplementation dosage and duration with changes in both SBP and DBP. Further RCTs using different dosages of zinc in various durations are required to confirm our conclusion.

An evidence-based analysis of managing hypertension with isometric resistance exercise-are the guidelines current?

Exercise guidelines for managing hypertension maintain aerobic exercise as the cornerstone prescription, but emerging evidence of the antihypertensive effects of isometric resistance training (IRT) may necessitate a policy update. We conducted individual patient data (IPD) meta-analyses of the antihypertensive effects of IRT. We utilized a one-step fitted mixed effects model and a two-step model with each analyzed trial using a random effects analysis. We classified participants as responders if they lowered their systolic blood pressure (SBP) by ≥5 mmHg, diastolic (DBP) or mean arterial blood pressure (MAP) by ≥3 mmHg. Twelve studies provided data on 326 participants. IRT produced significant reductions in SBP, DBP, and MAP. The SBP responder rates for both groups, or the absolute risk reduction (ARR) between groups, was 28.1% in favor of the IRT group. The number needed to treat (NNT) to achieve one 5 mmHg reduction in SBP was 3.56, 95% CI [2.56, 5.83], or four people. The ARR for DBP was 20.0% in favor of IRT. Therefore, the NNT to achieve one 3 mmHg decrease in DBP was five people, 95% CI [3.22, 11.10]. The ARR for MAP was 28.2% in favor of IRT. Therefore, the NNT to achieve one 3 mmHg reduction in MAP was four people, 95% CI [2.80, 7.42]. Our analyses demonstrated that IRT (three times per week for a total of 8 min of squeezing activity) is able to reduce the participants' SBP by 6-7 mmHg, equating to a 13% reduction in the risk for myocardial infarction and 22% for stroke.

Retraction Note: Effect of L-citrulline supplementation on blood pressure: a systematic review and meta-analysis of randomized controlled trials.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Effects of genistein on blood pressure: A systematic review and meta-analysis.

Genistein (4',5,7-trihydroxyisoflavone) is a phytoestrogen with potential health benefits in the prevention of cardiovascular disease. However, the evidence regarding its effects on hypertension has not been conclusive. Therefore, we examined the impact of oral genistein supplementation on systolic blood pressure (SBP) and diastolic blood pressure (DBP) via a systematic review and meta-analysis of randomized controlled trials (RCTs). PubMed, ISI Web of Science, Scopus and the Cochrane library databases (until August 2019) were searched to identify potential RCTs with information on genistein supplementation and hypertension. Weighted Mean Difference (WMD) was pooled using a random-effects model. Pooling four RCTs (four treatment arms) together did not show any significant reduction of SBP (WMD: -5.32 mmHg, 95% CI: -14.59 to 3.96) and DBP (WMD: -2.06 mmHg, 95% CI: -6.41 to 2.28) compared to that of the placebo group. However, subgroup analysis by intervention duration suggested that more than 6 months genistein supplementation in metabolic syndrome patients can significantly decrease SBP (WMD: -13.73 mmHg, 95% CI: -18.10 to -9.37) and DBP (WMD: -5.18 mmHg, 95% CI: -6.62 to -3.74). Generally, present study indicated that genistein supplementation had no effect on hypertension, but it seems that longer intervention duration of more than 6 months especially among metabolic syndrome patients may lead to the effectiveness of genistein.

P2643Antiproteinuric efficacy of ACE inhibitors, selective MRAs and ACE inhibitor/selective MRA combination therapy in diabetic hypertensives with microalbuminuria

Abstract Background There is increasing evidence suggesting use of Mineralocorticoid Receptor Antagonists (MRA) in combination with Angiotensin Converting Enzyme Inhibitors (ACEI) or Angiotensin Receptor Blockers (ARB) to have a protective effect on chronic kidney disease patients. Purpose The aim of our study was to compare the antiproteinuric efficacy of ACEI monotherapy, Selective MRA monotherapy and their combination in mildly hypertensive patients with type 2 diabetes mellitus (DM) and microalbuminuria. Methods Seventy five patients with established diagnosis of type 2 DM, mild hypertension (systolic BP 140–159 mmHg and/or diastolic BP 90–99 mmHg) and microalbuminuria (30–299mg/g) were randomly assigned to one of three groups of therapy; ramipril 10 mg monotherapy (25 patients), eplerenone 50 mg monotherapy (25 patients) and eplerenone/ramipril 50/10 mg combination therapy (25 patients).The duration of the study was 24 weeks. All patients had measurement of blood pressure, urinary albumin/creatinine ratio, renal function tests and serum K level at baseline and at the end of the study after 24 weeks. All patients were followed up monthly till the end of the study for detection of side effects and/or treatment failure. Results Both ramipril and eplerenone monotherapy significantly reduced microalbuminuria after 24 weeks nearly to the same extent (37% and 38% respectively) without significant difference between both groups (P=0.95). There was more significant reduction of microalbuminuria in the eplerenone/ramipril combination group (60%) compared with ramipril and eplerenone monotherapy groups (P=0.0001).All groups showed significant reduction of both systolic and diastolic BP with more significant reduction of systolic BP in combination group compared with monotherapy groups (P&lt;0.0001).There was insignificant elevation of serum potassium level among the three groups with slightly higher non significant incidence of sustained hyperkalemia in combination group (P=0.5). All groups showed insignificant changes in serum creatinine and estimated glomerular filtration rate. Conclusion Addition of eplerenone (selective MRA) to an ACE inhibitor may confer further antiproteinuric benefit with low risk of hyperkalemia compared with MRA or ACEI monotherapy. Acknowledgement/Funding None

P3564Percutaneous intervention with stent improves blood pressure and renal function in patients with transplanted renal artery stenosis

Abstract Background Transplanted renal artery stenosis (TRAS) is the main vascular complication of patients undergoing kidney transplantat, with a reported incidence ranging from 1% to 23%. Clinically important TRAS is associated with refractory hypertension, graft dysfunction and increased peak systolic velocity (PSV) above 200 cm/s. Percutaneous intervention (PI) of TRAS with or without stent is widely accepted as a viable and safe treatment option. Purpose To evaluate blood pressure and renal function in patients with TRAS undergoing PI in the following year. Methods Between January 2007 and December 2014, 310 patients with suspected TRAS underwent consecutive angiography. Of these, 173 presented significant stenosis (&gt;60%) and were submitted to PI. Endpoints were systolic blood pressure (SBP), diastolic blood pressure (DBP), serum creatinine (Scr), number of blood pressure medications and PSV with one month and one year post intervention. Results The mean age was 42.89±15.03 years, 78% of the population were male, 84% received kidneys from decesed donors, 94% having received a stent. The angiographic success and complication rates were 98% and 8,4% respectively. 98.7% were on blood pressure medications with 2.13±1.05 drugs/patient. Pre-intervention values of SBP, DBP and Scr were 152.8±25.28 mmHg, 92.67±16.43 mmHg and 3.04±2.75 mg/dL, respectively. After 1 month, there was a significant reduction in SBP (138.34±19.71; p&lt;0.0001), DBP (82.52±12.2; p&lt;0.0001) and Scr (2.13±1.39 mg/dl, p&lt;0.0001). Following 01 year, SBP, DBP and Scr were 133.55±17.51, p&lt;0.0001; 83.51±11.23, p&lt;0.0001 (Figure); and Scr 1.94±1.09 mg/dL, p&lt;0.0001 respectively. There was a significant reduction in post-intervention PSV when compared to baseline results (422.2±148.8 vs. 237.1±104.6 m/s, p&lt;0.0001). There was no significant difference in the number of blood pressure medications pre and post intervention (2.13 vs 2.05; p=0.68). Evolution of Blood Pressure Conclusion PI with stent of TRAS was effective in improving blood pressure and renal function levels on month 1 and on year 1 with a low rate of complications.

Isolation and Characterization of Angiotensin Converting Enzyme Inhibitory Peptides from Peach Seed Hydrolysates: In Vivo Assessment of Antihypertensive Activity.

A peptide fraction with molecular masses below 3 kDa (PSH-3 kDa) from a peach seed hydrolysate demonstrated high angiotensin converting enzyme (ACE) inhibitory activity (concentration to inhibit 50% ACE (IC50) = 16.4 μg/mL) in our previous work. This work proposes a further study of this highly active fraction. RP-HPLC enabled two fractions (F3 and F4) with high inhibitory activity (IC50 = 2.0 ± 0.5 and 1.2 ± 0.2 μg/mL, respectively) to be isolated. Peptide analysis by LC-Q-TOF-MS/MS using reverse-phase and hydrophilic interaction chromatography enabled 33 peptides within both fractions to be identified. Among them, peptide isoleucine-tyrosine-serine-proline-histidine (IYSPH) showed the highest capacity. The lack of cytotoxicity of peptides was demonstrated in three different cell lines (HeLa, HT-29, and HK-2). Oral administration of PSH-3 kDa fraction or peptide IYSPH caused a significant systolic blood pressure reduction (-30 mmHg) on spontaneously hypertensive rats after 3-6 h treatment.

Effect of Steviol Glycosides on Human Health with Emphasis on Type 2 Diabetic Biomarkers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The natural sweetener from Stevia rebaudiana Bertoni, steviol glycoside (SG), has been proposed to exhibit a range of antidiabetic properties. The objective of this systematic review was to critically evaluate evidence for the effectiveness of SGs on human health, particularly type 2 diabetic (T2D) biomarkers, collecting data from randomized controlled trials (RCTs). Electronic searches were performed in PubMed and EMBASE and the bibliography of retrieved full-texts was hand searched. Using the Cochrane criteria, the reporting quality of included studies was assessed. Seven studies, nine RCTs, including a total of 462 participants were included. A meta-analysis was performed to assess the effect of SGs on following outcomes: BMI, blood pressure (BP), fasting blood glucose (FBG), lipids, and glycated hemoglobin (HbA1c). The meta-analysis revealed an overall significant reduction in systolic BP in favour of SGs between SG and placebo, mean difference (MD): −6.32 mm Hg (−7.69 to 0.46). The overall effect of BMI, diastolic BP, FBG, total cholesterol, and high-density lipoprotein cholesterol (HDL-C) was a non-significant reduction in favour of SGs, and a non-significant increase in low-density lipoprotein cholesterol and triglyceride, while no significant effect of HbA1c was found. Heterogeneity was significant for several analyses. More studies investigating the effect of SGs on human health, particularly T2D biomarkers, are warranted.

The effect of green coffee extract supplementation on blood pressure: A systematic review and meta-analysis of randomized controlled trials.

Given the proliferation in studies investigating green coffee bean extract (GCBE) supplementation, the purpose of this study was to determine the efficacy and effectiveness of GCBE supplementation on indices of blood pressure. The literature search was performed in four databases, namely, PubMed/Medline, Scopus, the Cochrane Library, and Google Scholar, to identify clinical trials that examined the effects of green coffee supplements on systolic blood pressure (SBP) and diastolic blood pressure (DBP) up to February 2019. Mean change and standard deviation (SD) of the outcome measures were used to estimate the mean difference between the intervention group and the control group at follow-up. Nine studies reported SBP and DBP as an outcome measure. Results revealed significant reduction in SBP (weighted mean difference: -3.093 mmHg, 95% confidence interval [CI]: -3.914, -2.273; I2 = 0.0%) and DBP (-2.170 mmHg, 95% CI: -2.749, -1.590; I2 = 46.5%) after green coffee supplementation with low heterogeneity among the studies. In addition, in subgroup analysis, a significant reduction in SBP and DBP in studies with hypertensive patients, green coffee dosage <400 mg, and administered for 4 weeks was identified. The results of the current meta-analysis study support the use of GCBE supplementation for the improvement of blood pressure indices, with subgroup analysis highlighting improvements in hypertensive patients.

The impact of pulsed electromagnetic field therapy on blood pressure and circulating nitric oxide levels: a double blind, randomized study in subjects with metabolic syndrome

Purpose: Regulation of blood pressure (BP) is important in reducing the risk for cardiovascular disease. There is growing interest in non-pharmacological methods to treat BP including a novel approach using pulsed electromagnetic field therapy (PEMF). PEMF therapy has been proposed to impact physiological function at the cellular and tissue level and one possible mechanism is through an impact on endothelial function and nitric oxide (NO) related pathways. The focus of the present study was to evaluate the effect of PEMF on BP and NO in subjects with mild to moderate metabolic syndrome.Materials and methods: For 12 weeks, 23 subjects underwent PEMF therapy and 21 subjects underwent sham therapy. BP was measured at rest and near the end of submaximal exercise pre- and 12 week post-therapy. Additionally, plasma NO was measured at similar time points.Results: The PEMF demonstrated an increase in NO after therapy (p = .04) but SHAM did not (p = .37). For resting BP, there were no differences in systolic BP (SBP), diastolic BP (DBP) or mean arterial pressure (MAP) between groups (p > .05). During exercise, PEMF had a reduction in peak SBP (p = .04), but not SHAM (p = .57). PEMF demonstrated significant relationships between baseline SBP and change in SBP following therapy (r = −0.71, p < .01) and between MAP and change in MAP following therapy (r = −0.60, p < .01), but no such relationships were found in SHAM. Subjects with resting hypertension (SBP ≥140 mmHg) in PEMF (n = 11) had significant reductions in SBP, DBP and MAP when compared to SHAM with hypertension (n = 9) (p < .05). In this sub-group analysis, PEMF demonstrated lowered peak SBP (p = .04) at a given exercise load (p = .40) but SHAM did not (p > .05).Conclusion: PEMF may increase plasma NO availability and improve BP at rest and during exercise. However, this beneficial effect appears to be more pronounced in subjects with existing hypertension.

Clinical outcomes of community pharmacy services: A systematic review and meta-analysis.

Community pharmacy services (CPS) have been shown to be positive in many disease management and patient care programs, but clinical outcomes were followed by process indicators and methodological flaws in previous researches made it difficult to prove the effectiveness of clinical outcomes of CPS. Therefore, this study attempted to review the clinical outcomes of CPS. Interventionsincluded are provision of medication review, patient education, adherence assessment, health/lifestyle advice, physical assessment, monitoring, prescribing, or adjusting and administering therapy from community pharmacists. By searching for key words like community pharmacists, pharmaceutical services, clinical outcomes in MEDLINE and EMBASE and manually searching (up to June 2017), 1910 studies investigating the clinical outcomes of CPS were obtained. After screening the titles, abstracts and full texts for relevancy, 52 researches with controlled groups were included and assessed for methodological quality. Finally, 25 studies were selected for the meta-analysis based on their common endpoints: systolic blood pressure, diastolic blood pressure and glycosylated haemoglobin. The Cochrane tool was used to assess the risk of bias. Chi-square and I-square tests were performed to assess heterogeneity, and the weighted mean differences were estimated using random effect models. Of the 52 articles, 47 studies demonstrated that CPS had positive clinical outcomes, 3 studies showed mixed outcomes and 2 studies revealed no effects. In the meta-analysis, intervention groups displayed greater reductions in systolic BP (95% CI: -8.198-2.356), diastolic BP (95% CI: -3.648-0.645) and HbA1c (95% CI: -0.905-0.224) than usual care groups. CPS have positive clinical outcomes, particularly significant reductions in systolic BP, diastolic BP and HbA1c. It was difficult to find out which intervention(s) of CPS directly led to certain changes and influence of CPS might be underestimated for only three common surrogate endpoints. More researches should be conducted with sufficient data.

Physical Activity as a Predictor of Changes in Systolic Blood Pressure for African-American Adolescents Seeking Treatment for Obesity

PurposeThe aim of the study was to examine changes in systolic blood pressure (SBP) and whether physical activity and obesity status predicted SBP change for African-American adolescents (n = 181) participating in a behavioral weight control trial. MethodsData were collected at baseline, 7 months (end-of-treatment), and 9 months (2-month follow-up). ResultsNearly half of adolescents achieved clinically significant SBP reductions at 7 and 9 months. Significantly, fewer adolescents had elevated SBP at 7 and 9 months compared with baseline (both p < .001). Changes in percent overweight and moderate-to-vigorous activity predicted changes in SBP over time. ConclusionsObesity reduction and increases in moderate-to-vigorous physical activity may predict short-term, clinically meaningful reductions in SBP for African American adolescents with obesity.