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Pomegranate Juice for the Management of Hypertension and the Improvement of Cardiovascular Health Konstantinos Tzimalos

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Pomegranate Juice for the Management of Hypertension and the Improvement of Cardiovascular Health Konstantinos Tzimalos Himmelfarb Health Sciences Library, The George Washington University Health Sciences Research Commons Medicine Faculty Publications Medicine 2013 No-pharmacological intervention: Pomegranate juice for the management of hypertension and the improvement of cardiovascular health Konstantinos Tzimalos Michael N. Doumas George Washington University Vasilios Athyros Aristotle University of Thessaloniki Follow this and additional works at: http://hsrc.himmelfarb.gwu.edu/smhs_medicine_facpubs Part of the Medicine and Health Sciences Commons Recommended Citation Tziomalos, K., Doumas, M., Athyros, V.G. (2013). No-pharmacological intervention: Pomegranate juice for the management of hypertension and the improvement of cardiovascular health. Open Hypertension Journal, 5, 23-26. This Editorial is brought to you for free and open access by the Medicine at Health Sciences Research Commons. It has been accepted for inclusion in Medicine Faculty Publications by an authorized administrator of Health Sciences Research Commons. For more information, please contact [email protected]. Send Orders for Reprints to [email protected] The Open Hypertension Journal, 2013, 5, 23-26 23 Open Access EDITORIAL No-Pharmacological Intervention: Pomegranate Juice for the Management of Hypertension and the Improvement of Cardiovascular Health Konstantinos Tziomalos1, Michael Doumas2,3 and Vasilios G. Athyros2,* 1First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hos- pital, Thessaloniki, Greece; 2Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece; 3Veteran Administration Medical Center and George Washington University, Washington, DC, USA Keywords: Hypertension, non-pharmacological treatment, cardiovascular health, life's 7 simple, pomegranate juice. The concept of ideal cardiovascular (CV) health, with participants [7]. The National and Nutrition Exami- emphasis on the prevention of CV disease (CVD), was in- nation Surveys (NHANES) 2003-2008 evaluated the preva- cluded by the American Heart Association (AHA) among its lence of the 7 CV health metrics in 14,515 adults [8]. Par- strategic goals for 2020 [1]. This concept was intended to ticipants were stratified in young (20-39 years), middle-aged focus mainly on the promotion of a healthy lifestyle and the (40-64 years) and elderly (65 years). Less than 1% of sub- adoption of a multifactorial intervention with non- jects exhibited CV for all 7 . Among pharmacological or pharmacological means, aiming at the CV behaviors, non-smoking was the most prevalent prevention or the effective control of CVD risk factors [1]. (60.2-90.4%), Healthy Diet Score was least prevalent Ideal CV health is defined as optimal levels of 3 CVD risk (0.2-2.6%) across groups, while (36.5-45.3%) factors [blood pressure (BP), fasting plasma glucose and and physical activity levels (50.2-58.8%) were higher total cholesterol) and 4 behaviours [body mass index (BMI), in young adults compared with middle-aged or elderly [8]. smoking, physical activity and healthy diet] [1]. These 7 total cholesterol (23.7-36.2%), blood pressure (11.9%- ideal CV metrics, called life's simple 7, are probably the best 16.3%), and fasting blood glucose (31.2-42.9%) were less available markers of life-time CVD risk [2]. Recent studies frequent in older adults compared with young and middle- have shown that the levels of ideal CV health in the United aged adults. The prevalence of poor CV status was States to be very low at a community level [3-5] and to be lowest in young age compared with higher middle and older associated with cardiac events [3], stroke [2] and total mor- ages [8]. Again, ideal BP was the least prevalent among tality [6]. A large study was conducted in 5,785 young adults clinical CVD risk factors [8]. (20-39 years old) from 5 international populations: the Min- A relevant Chinese study included 91,698 participants neapolis Childhood Cohort Study, the Princeton Follow-up (72,826 men, age 18-98 years-old), free of myocardial in- Study, the Bogalusa Heart Study, the Cardiovascular Risk in farction and stroke at baseline (2006-2007) [2]. The hazard Young Finns Study, and the Childhood Determinants of ratios (HR) and 95% confidence interval (CI) for total stroke Adult Health (CDAH) Study; all members of the Interna- according to the adherence to life's 7 simple [0 (reference), 1, tional Childhood Cardiovascular Cohort (i3C) Consortium 2, 3, 4, 5, and 6/7 ideal CV metrics] were: 1, 0.92 (0.69- [7]. Results of the study showed that ideal CV health, as de- 1.23), 0.69 (0.52-0.92), 0.52 (0.39-0.68), 0.38 (0.28-0.51), fined by the AHA, was rare among young participants of the 0.27 (0.18-0.40), and 0.24 (0.11-0.54), respectively (p for study. An amazingly low (only 1%) percentage of the par- trend <0.01), after adjusting for age, sex, education, income ticipants had all 7 health metrics in the 5,785 young adults and hospital [2]. Similar inverse associations were observed participating from all international cohorts [7]. Many of the for both ischaemic and haemorrhagic stroke (p for trend participants had ideal glucose (73%), cholesterol (64%), and <0.01) [2]. In this study, high BP played a major role in were non-smokers (64%); diet (7%) was the least common stroke incidence [2]. metric for participants from any of the cohorts [7]. The low- est prevalence of a clinical CVD risk factor from the life's 7 The above data suggest that in the effort of achieving simple was BP; this was normal in only 52% of the ideal CV health, hypertension should be one of the primary targets, because of its high prevalence in the general popula- tion and the low levels of effective control [9]. Moreover, if *Address correspondence to this author at the 2nd Popedeutic Department we can control BP and improve some of the other CV met- of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece. 15 Marmara St, Thessaloniki, rics of ideal CV health, this will have significant additive 55132, Greece; Tel: +30 2310 892606; Fax: +30 2310 835955; beneficial effects. E-mails: [email protected] or [email protected] 1876-5262/13 2013 Bentham Open 24 The Open Hypertension Journal, 2013, Volume 5 Tziomalos et al. Non-pharmacological interventions to control hyperten- A very recent study included 21 hypertensive patients (aged sion or to augment the effects of antihypertensive drug 30-67 years) [23]. These were assigned to receive either PJ treatment (thereby potentially reducing the need for more (150 ml/day in a single occasion between lunch and dinner; n drugs), have been used for a long time [10,11]. The recent = 11) or the same amount of water (n = 10) for a period of 2 (2013) ESH/ESC Guidelines for the management of hyper- weeks. PJ consumption was associated with significant re- tension [12] suggest: salt restriction to 5-6 g/d, moderation of ductions in systolic BP (p=0.002) and diastolic BP alcohol consumption to <20-30 g/d of ethanol in men and (p=0.038), but not flow mediated dilation (FMD) (p>0.05). <10-20 g/d in women, increased consumption of vegetables, Serum levels of vascular cell adhesion molecule 1(VCAM- fruits, and low-fat dairy products, reduction of BMI to <25 1)(p=0.008) were significantly reduced by PJ while those of kg/m2 and of waist circumference to <102 cm in men and E-selectin were elevated (p=0.039). However, no significant <88 cm in women, regular exercise (at least 30 min of mod- PJ effect was observed on serum levels of intercellular adhe- erate dynamic exercise on 5 to 7 days per week), and ad- sion molecule 1 (ICAM-1), high-sensitivity C-reactive pro- vice/support for smoking cessation [12]. Moreover, high tein (hs-CRP), lipid profile, and interleukin-6; this null effect quality evidence suggests that increased potassium intake is might be due to the short duration of the study [23]. There- beneficial in most adults without impaired renal handling of fore, consumption of PJ for 2 weeks has effective hypoten- potassium for the prevention or control of elevated BP and sive action and may also improve endothelial function. prevention of stroke (reduction of incidence by 24%), with- These findings suggest PJ as a beneficial cardioprotective out adverse effects on lipid concentrations, catecholamine supplement for hypertensive subjects, with actions extending concentrations or renal function [13]. However, compliance beyond BP reduction [23]. In an earlier (2001) study in hy- to long-term lifestyle changes to treat hypertension is very pertensive patients, the consumption of PJ (50 ml, 1.5 mmol low, and special programs and interventions to improve this of total polyphenols per day, for 2 weeks) decreased serum adherence may need to consider the existing barriers [14]. A angiotensin converting enzyme (ACE) activity by 36% and low desire, interest or awareness are commonly reported systolic BP by 5% [24]. Similar inhibitory effect (31%) of PJ barriers to salt restriction, changes in diet, weight loss, smok- on serum ACE activity was also observed in vitro [24]. Since ing cessation and alcohol reduction [14]. In contrast, the a reduction in serum ACE activity was previously shown to most common barrier to engaging in physical activity to attenuate atherosclerosis, PJ can offer protection against regulate BP is time limitations and the challenge of manag- CVD, which could also be related to its inhibitory effect on ing a co-existing physical condition/disease; arthritis (60%), oxidative stress [24]. Another study demonstrated reduced back problems (41%), diabetes (27%), CVD or stroke (27%), BP in patients with carotid artery stenosis who had con- asthma (23%) and chronic obstructive pulmonary disease sumed pomegranate juice for 3 years [25].
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