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      Effect of Dietary Pulses on Blood Pressure: A Systematic Review and Meta-analysis of Controlled Feeding Trials

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          Abstract

          BACKGROUND

          Current guidelines recommend diet and lifestyle modifications for primary prevention and treatment of hypertension, but do not encourage dietary pulses specifically for lowering blood pressure (BP). To quantify the effect of dietary pulse interventions on BP and provide evidence for their inclusion in dietary guidelines, a systematic review and meta-analysis of controlled feeding trials was conducted.

          METHODS

          MEDLINE, EMBASE, Cochrane Library, and CINAHL were each searched from inception through 5 May 2013. Human trials ≥3 weeks that reported data for systolic, diastolic, and/or mean arterial BPs were included. Two reviewers independently extracted data and assessed methodological quality and risk of bias of included studies. Effect estimates were pooled using random effects models, and reported as mean differences (MD) with 95% confidence intervals (CIs). Heterogeneity was assessed (χ 2 test) and quantified (I 2).

          RESULTS

          Eight isocaloric trials (n = 554 participants with and without hypertension) were included in the analysis. Dietary pulses, exchanged isocalorically for other foods, significantly lowered systolic (MD = −2.25 mm Hg (95% CI, −4.22 to −0.28), P = 0.03) and mean arterial BP (MD = −0.75 mm Hg (95% CI, −1.44 to −0.06), P = 0.03), and diastolic BP non-significantly (MD = −0.71 mm Hg (95% CI, −1.74 to 0.31), P = 0.17). Heterogeneity was significant for all outcomes.

          CONCLUSIONS

          Dietary pulses significantly lowered BP in people with and without hypertension. Higher-quality large-scale trials are needed to support these findings.

          CLINICAL TRIAL REGISTRATION

          NCT01594567

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          Most cited references27

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          2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

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            Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program.

            The National High Blood Pressure Education Program Coordinating Committee published its first statement on the primary prevention of hypertension in 1993. This article updates the 1993 report, using new and further evidence from the scientific literature. Current recommendations for primary prevention of hypertension involve a population-based approach and an intensive targeted strategy focused on individuals at high risk for hypertension. These 2 strategies are complementary and emphasize 6 approaches with proven efficacy for prevention of hypertension: engage in moderate physical activity; maintain normal body weight; limit alcohol consumption; reduce sodium intake; maintain adequate intake of potassium; and consume a diet rich in fruits, vegetables, and low-fat dairy products and reduced in saturated and total fat. Applying these approaches to the general population as a component of public health and clinical practice can help prevent blood pressure from increasing and can help decrease elevated blood pressure levels for those with high normal blood pressure or hypertension.
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              Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study.

              Patients with optimum ( 140/90 mm Hg) over time. We aimed to establish the best frequency of BP screening by assessing the rates and determinants of progression to hypertension. We assessed repeated BP measurements in individuals without hypertension (BP<140/90 mm Hg) from the Framingham Study (4200 men, 5645 women; mean age 52 years) who attended clinic examinations during 1978-94. The incidence of hypertension (or use of antihypertensive treatment) and its determinants were studied. A stepwise increase in hypertension incidence occurred across the three non-hypertensive BP categories; 5.3% (95% CI 4.4-6.3%) of participants with optimum BP, 17.6% (15.2-20.3%) with normal, and 37.3% (33.3-41.5%) with high normal BP aged below age 65 years progressed to hypertension over 4 years. Corresponding 4-year rates of progression for patients 65 years and older were 16.0% (12.0-20.9), 25.5% (20.4-31.4), and 49.5% (42.6-56.4), respectively. Obesity and weight gain also contributed to progression; a 5% weight gain on follow-up was associated with 20-30% increased odds of hypertension. High normal BP and normal BP frequently progress to hypertension over a period of 4 years, especially in older adults. These findings support recommendations for monitoring individuals with high normal BP once a year, and monitoring those with normal BP every 2 years, and they emphasise the importance of weight control as a measure for primary prevention of hypertension.
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                Author and article information

                Journal
                Am J Hypertens
                Am. J. Hypertens
                ajh
                ajh
                American Journal of Hypertension
                Oxford University Press (US )
                0895-7061
                1941-7225
                January 2014
                7 September 2013
                7 September 2013
                : 27
                : 1
                : 56-64
                Affiliations
                [ 1 ]Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital , Toronto, Ontario, Canada;
                [ 2 ]Department of Nutritional Sciences, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada;
                [ 3 ]Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University , Hamilton, Ontario, Canada;
                [ 4 ]Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University , Hamilton, Ontario, Canada;
                [ 5 ]Heart and Stroke Foundation of Ontario , Toronto, Ontario, Canada;
                [ 6 ]Wellness Institute of the Cleveland Clinic , Lyndhurst, Ohio;
                [ 7 ]Department of Nutrition, Harvard School of Public Health , Boston, Massachusetts;
                [ 8 ]Division of Endocrinology and Metabolism, St. Michael’s Hospital , Toronto, Ontario, Canada;
                [ 9 ]Department of Medicine, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada;
                [ 10 ]Department of Nutritional Sciences, The Pennsylvania State University , University Park, Pennsylvania;
                [ 11 ]Li Ka Shing Knowledge Institute, St Michael’s Hospital , Toronto, Ontario, Canada;
                [ 12 ]College of Pharmacy and Nutrition Division of Nutrition and Dietetics , University of Saskatchewan Saskatoon Saskatchewan, Canada.
                Author notes
                Correspondence: Russell J. de Souza ( rdesouza@ 123456post.harvard.edu ).
                Article
                10.1093/ajh/hpt155
                5391775
                24014659
                9463baaa-c4d2-4a9b-8716-38c8de650a6b
                © The Author 2013. Published by Oxford University Press on behalf of the American Journal of Hypertension.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 10 June 2013
                : 18 July 2013
                : 26 July 2013
                Page count
                Pages: 9
                Categories
                Original Article

                Cardiovascular Medicine
                blood pressure,dietary pulses,hypertension,legumes,meta analysis,guidelines.
                Cardiovascular Medicine
                blood pressure, dietary pulses, hypertension, legumes, meta analysis, guidelines.

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