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 Medicinepublished by Elsevier, 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 leading 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.
Study lead investigator Donald E. Wesson, MD, MBA, Department of Internal Medicine, Dell Medical School – The University of Texas at Austin, says: “As a nephrologist (kidney doctor), my acid-base laboratory investigates ways to remove acid from the kidney. extracts the blood and introduces it into the urine. Animal studies showed years ago that mechanisms that the kidneys use to remove acid from the blood can cause kidney damage if the animals are chronically (long-term) exposed to an acid. Our studies in patients showed similar results findings emerge: 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 in which fruits and vegetables are both kidney and heart healthy is that they reduce the amount of acid in the diet and therefore the amount of acid. which 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:
- Research participants added 2-4 cups of staple fruits and vegetables in addition to their usual daily food intake
- Study participants prescribed NaHCO3 (acid reducing sodium bicarbonate, common baking soda) tablets in two daily doses of 4-5 tablets of 650 mg
- 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, PhD, 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 control blood pressure. and reduce the risk of cardiovascular disease. This means that one can get the benefits for kidney health 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 we can do this do with lower medication 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. should increase our efforts to include them in patient management and, more broadly, to make healthy diets more accessible to populations at increased risk of kidney and cardiovascular disease.”
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.
