Five-year hypertension study provides further evidence of the benefits of fruit and vegetable consumption

Doctors recommend making fruits and vegetables a fundamental part of the treatment of patients with high blood pressure. Diets high in fruits and vegetables have been shown to lower blood pressure, reduce cardiovascular risk and improve kidney health due to their base-producing effects.

a new study in The American Journal of Medicine describes the findings of a five-year interventional randomized control trial.

Despite continued efforts to improve the treatment of hypertension and reduce its adverse effects with pharmacological strategies, hypertension-related chronic kidney disease and its cardiovascular mortality are increasing. Heart disease is the main reason that patients with chronic kidney disease die.

The Dietary Approaches to Stop Hypertension (DASH) diet, which is rich in fruits and vegetables, lowers blood pressure and is the recommended first-line treatment for primary hypertension. Nevertheless, this diet is underprescribed, and when it is prescribed, it is underimplemented despite supporting epidemiological data.

The DASH diet and others that are generally high in fruits and vegetables are associated with lower blood pressure, lower risk and progression of chronic kidney disease, lower cardiovascular disease risk indicators, and lower mortality to cardiovascular disease.

The study’s lead investigator, Donald E. Wesson, MD, MBA, Department of Internal Medicine, Dell Medical School – University of Texas at Austin, says: “As a nephrologist (kidney doctor), my acid-base laboratory investigates ways to remove acid from the kidney. removes the blood and introduces it into the urine.

“Our animal studies showed years ago that mechanisms used by the kidneys to remove acid from the blood can cause kidney damage if the animals are chronically (long-term) exposed to an acid-producing diet.

“Our patient studies showed similar findings: that is, an acid-producing diet (one high in animal products) is harmful to the kidneys, and an alkali-producing diet (one high in fruits and vegetables) is healthy for the kidneys.

“Other researchers have shown that a diet high in fruits and vegetables is heart healthy. We hypothesized that one way that fruits and vegetables are both kidney and heart healthy is that they reduce the amount of acid in the diet and thus the amount of acid .” acid that the kidneys must remove from the body.”

To test this hypothesis, a study was designed in which participants with hypertension, but not diabetes, and very high urinary albumin excretion (macroalbuminuria) were selected. Patients with macroalbuminuria have chronic kidney disease, a high risk of worsening of their kidney disease over time, and a high risk of subsequently developing cardiovascular disease.

In a randomized control trial over a five-year period, researchers divided the cohort of 153 patients with hypertension into three groups:

1. Research participants added 2 to 4 cups of staple fruits and vegetables in addition to their usual daily food intake
2. Study participants prescribed NaHCO₃ (acid-reducing sodium bicarbonate, common baking soda) tablets in two daily doses of four to five 650 mg tablets
3. Study participants received standard medical care from general practitioners

The results of the study show that both fruit and vegetables and NaHCO₃ improved kidney health, but only fruits and vegetables, and not NaHCO₃reduced blood pressure and improved indices of cardiovascular disease risk.

Co-investigator Maninder Kahlon, Ph.D., Department of Population Health, Dell Medical School – The University of Texas at Austin, explains: “Importantly, fruits and vegetables achieved the latter two benefits with lower doses of medications used to lower blood pressure and reduce the risk of cardiovascular disease.

“This means that one can get the kidney health benefits with fruits and vegetables or NaHCO₃but we get the blood pressure reduction and reduced risk of cardiovascular disease with fruits and vegetables, but not with NaHCO₃.

“This supports our recommendation that fruits and vegetables should be the ‘foundational’ treatment for patients with hypertension, because we achieve all three goals (kidney health, lower blood pressure, and reduced risk of cardiovascular disease) with fruits and vegetables, and can we do too. with lower drug doses.”

The research team emphasizes “fundamental” because many doctors begin treating hypertension with medications and then add dietary strategies if blood pressure is not well controlled. The findings from the studies support the opposite: treatment should start with fruits and vegetables and then add medications as necessary.

Dr. Wesson concludes: “Dietary interventions for the treatment of chronic diseases are often not recommended and even less commonly implemented due to the many challenges in getting patients to implement them.

“Nevertheless, they are effective, and in this case they protect the kidneys and cardiovascular system. We must increase our efforts to include them in patient care and, more broadly, make healthy diets more accessible to populations at risk for kidney disease.” and cardiovascular diseases.”

The researchers also advise patients with hypertension to ask their doctor to measure the urine albumin-creatinine ratio (UACR) to determine whether they have underlying kidney disease and an increased risk of subsequent cardiovascular disease.