Advertisement
Research Article| Volume 25, ISSUE 1, P60-67, January 2015

Download started.

Ok

Effects of total dietary polyphenols on plasma nitric oxide and blood pressure in a high cardiovascular risk cohort. The PREDIMED randomized trial

  • A. Medina-Remón
    Affiliations
    Department of Internal Medicine, IDIBAPS, Hospital Clinic, University of Barcelona, Spain

    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain
    Search for articles by this author
  • A. Tresserra-Rimbau
    Affiliations
    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain

    Nutrition and Food Science Department, XaRTA, INSA, Pharmacy School, University of Barcelona, Barcelona, Spain
    Search for articles by this author
  • A. Pons
    Affiliations
    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain

    Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands, Spain
    Search for articles by this author
  • J.A. Tur
    Affiliations
    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain

    Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands, Spain
    Search for articles by this author
  • M. Martorell
    Affiliations
    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain

    Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands, Spain
    Search for articles by this author
  • E. Ros
    Affiliations
    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain

    Lipid Clinic, Endocrinology and Nutrition Service, IDIBAPS, Hospital Clinic, Barcelona, Spain
    Search for articles by this author
  • P. Buil-Cosiales
    Affiliations
    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain

    Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, and Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
    Search for articles by this author
  • E. Sacanella
    Affiliations
    Department of Internal Medicine, IDIBAPS, Hospital Clinic, University of Barcelona, Spain

    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain
    Search for articles by this author
  • M.I. Covas
    Affiliations
    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain

    Cardiovascular Risk and Nutrition Research Group, IMIM-Institut de Recerca Hospital del Mar, Barcelona, Spain
    Search for articles by this author
  • D. Corella
    Affiliations
    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain

    Department of Preventive Medicine and Public Health, Nutrition and Food Sciences, School of Medicine, University of Valencia, Spain
    Search for articles by this author
  • J. Salas-Salvadó
    Affiliations
    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain

    Human Nutrition Unit, School of Medicine, IISPV, University Rovira i Virgili, Reus, Spain
    Search for articles by this author
  • E. Gómez-Gracia
    Affiliations
    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain

    Department of Epidemiology, School of Medicine, University of Malaga, Spain
    Search for articles by this author
  • V. Ruiz-Gutiérrez
    Affiliations
    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain

    Nutrition and Lipids Metabolism, Instituto de la Grasa, Consejo Superior de Investigaciones Cientificas, Sevilla, Spain
    Search for articles by this author
  • M. Ortega-Calvo
    Affiliations
    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain

    Department of Family Medicine, Primary Care Division of Sevilla, Esperanza Macarena Health Center, Sevilla, Spain
    Search for articles by this author
  • M. García-Valdueza
    Affiliations
    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain

    Institut Universitari d'Investigació en Ciències de la Salut(IUNICS), Palma de Mallorca, Spain
    Search for articles by this author
  • F. Arós
    Affiliations
    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain

    Clinical Trials Unit, Hospital Universitario de Araba(HUA), Vitoria, Spain
    Search for articles by this author
  • G.T. Saez
    Affiliations
    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain

    Department of Biochemistry and Molecular Biology Service of Clinical Analysis, Hospital General Universitario, Universitat de Valencia, Spain
    Search for articles by this author
  • L. Serra-Majem
    Affiliations
    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain

    Research Institute of Biomedical and Health Sciences of Las Palmas, IUIBS, University of Las Palmas de Gran Canaria, Spain
    Search for articles by this author
  • X. Pinto
    Affiliations
    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain

    Lipid and Vascular Risk Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge, University of Barcelona, Spain
    Search for articles by this author
  • E. Vinyoles
    Affiliations
    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain

    Mina Primary Care Center, University of Barcelona, Spain
    Search for articles by this author
  • R. Estruch
    Affiliations
    Department of Internal Medicine, IDIBAPS, Hospital Clinic, University of Barcelona, Spain

    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain
    Search for articles by this author
  • R.M. Lamuela-Raventos
    Correspondence
    Corresponding author. Nutrition and Food Science Department, Pharmacy School, University of Barcelona, Av. Joan XXIII s/n, 08028 Barcelona, Spain. Tel.: +34 934034843; fax: +34 934035931.
    Affiliations
    CIBER: CB06/03, CB12/03 Fisiopatología de la Obesidad y la Nutrición(CIBERobn), Instituto de Salud Carlos III(ISCIII), Spain

    Nutrition and Food Science Department, XaRTA, INSA, Pharmacy School, University of Barcelona, Barcelona, Spain
    Search for articles by this author
  • on behalf of thePREDIMED Study Investigators
Published:September 18, 2014DOI:https://doi.org/10.1016/j.numecd.2014.09.001

      Highlights

      • Effects of one-year intervention with a traditional Med-diet supplemented with either extra virgin olive oil or nuts.
      • Decrease in blood pressure (BP) was mediated by plasma nitric oxide (NO) production.
      • Total polyphenol excretion in spot urine was positively correlated with plasma NO.
      • Mediterranean diets may help to decrease BP due to a high polyphenol consumption.

      Abstract

      Background and aim

      Hypertension is one of the main cardiovascular risk factors in the elderly. The aims of this work were to evaluate if a one-year intervention with two Mediterranean diets (Med-diet) could decrease blood pressure (BP) due to a high polyphenol consumption, and if the decrease in BP was mediated by plasma nitric oxide (NO) production.

      Methods and results

      An intervention substudy of 200 participants at high cardiovascular risk was carried out within the PREDIMED trial. They were randomly assigned to a low-fat control diet or to two Med-diets, one supplemented with extra virgin olive oil (Med-EVOO) and the other with nuts (Med-nuts). Anthropometrics and clinical parameters were measured at baseline and after one year of intervention, as well as BP, plasma NO and total polyphenol excretion (TPE) in urine samples. Systolic and diastolic BP decreased significantly after a one-year dietary intervention with Med-EVOO and Med-nuts. These changes were associated with a significant increase in TPE and plasma NO. Additionally, a significant positive correlation was observed between changes in urinary TPE, a biomarker of TP intake, and in plasma NO (Beta = 4.84; 95% CI: 0.57–9.10).

      Conclusions

      TPE in spot urine sample was positively correlated with plasma NO in Med-diets supplemented with either EVOO or nuts. The statistically significant increases in plasma NO were associated with a reduction in systolic and diastolic BP levels, adding to the growing evidence that polyphenols might protect the cardiovascular system by improving the endothelial function and enhancing endothelial synthesis of NO.

      Keywords

      Abbreviations:

      BMI (body mass index), BP (blood pressure), CHD (coronary heart disease), CI (confidence interval), DASH (Dietary-Approaches-to-Stop-Hypertension), EVOO (extra virgin olive oil), FFQ (food frequency questionnaire), GAE (gallic acid equivalent), Med-diet (Mediterranean diet), Med-EVOO (Mediterranean diet-extra virgin olive oil), Med-nuts (Mediterranean diet-nuts), NO (Nitric oxide), PREDIMED (prevention with Mediterranean diet study), SD (standard deviations), TP (total polyphenols), TPE (total polyphenols excreted)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Nutrition, Metabolism and Cardiovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Estruch R.
        • Martínez-González M.A.
        • Corella D.
        • Salas-Salvadó J.
        • Ruiz-Gutiérrez V.
        • Covas M.I.
        • et al.
        Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial.
        Ann Intern Med. 2006 Jul 4; 145: 1-11
        • Mancia G.
        • De Backer G.
        • Dominiczak A.
        • Cifkova R.
        • Fagard R.
        • Germano G.
        • et al.
        2007 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).
        J Hypertens. 2007 Jun; 25: 1105-1187
        • Estruch R.
        • Ros E.
        • Salas-Salvadó J.
        • Covas M.I.
        • Corella D.
        • Arós F.
        • et al.
        Primary prevention of cardiovascular disease with a Mediterranean diet.
        N Engl J Med. 2013 Apr 4; 368: 1279-1290
        • Trichopoulou A.
        • Costacou T.
        • Bamia C.
        • Trichopoulos D.
        Adherence to a Mediterranean diet and survival in a Greek population.
        N Engl J Med. 2003 Jun 26; 348: 2599-2608
        • Chiva-Blanch G.
        • Urpi-Sarda M.
        • Ros E.
        • Arranz S.
        • Valderas-Martínez P.
        • Casas R.
        • et al.
        Dealcoholized red wine decreases systolic and diastolic blood pressure and increases plasma nitric oxide: short communication.
        Circ Res. 2012 Sep 28; 111: 1065-1068
        • Toledo E.
        • Hu F.B.
        • Estruch R.
        • Buil-Cosiales P.
        • Corella D.
        • Salas-Salvadó J.
        • et al.
        Effect of the Mediterranean diet on blood pressure in the PREDIMED trial: results from a randomized controlled trial.
        BMC Med. 2013; 11: 207
        • Hooper L.
        • Kroon P.A.
        • Rimm E.B.
        • Cohn J.S.
        • Harvey I.
        • Le Cornu K.A.
        • et al.
        Flavonoids, flavonoid-rich foods, and cardiovascular risk: a meta-analysis of randomized controlled trials.
        Am J Clin Nutr. 2008 Jul; 88: 38-50
        • Reshef N.
        • Hayari Y.
        • Goren C.
        • Boaz M.
        • Madar Z.
        • Knobler H.
        Antihypertensive effect of sweetie fruit in patients with stage I hypertension.
        Am J Hypertens. 2005 Oct; 18: 1360-1363
        • Whelton P.K.
        • He J.
        • Appel L.J.
        • Cutler J.A.
        • Havas S.
        • Kotchen T.A.
        • et al.
        Primary prevention of hypertension: clinical and public health advisory from the national high blood pressure education program.
        JAMA. 2002 Oct 16; 288: 1882-1888
        • Fisher N.D.
        • Hughes M.
        • Gerhard-Herman M.
        • Hollenberg N.K.
        Flavanol-rich cocoa induces nitric-oxide-dependent vasodilation in healthy humans.
        J Hypertens. 2003 Dec; 21: 2281-2286
        • Martínez-González M.A.
        • Corella D.
        • Salas-Salvadó J.
        • Ros E.
        • Covas M.I.
        • Fiol M.
        • et al.
        Cohort profile: design and methods of the PREDIMED study.
        Int J Epidemiol. 2012 Apr 1; 41: 377-385
        • Iglesias-Bonilla P.
        • Mayoral-Sánchez E.
        • Lapetra-Peralta J.
        • Iborra-Oquendo M.
        • Villalba-Alcalá F.
        • Cayuela-Domínguez A.
        Validación de dos sistemas de automedida de presión arterial, modelos OMRON HEM 705 CP y OMRON MI (HEM 422C2-E).
        Atención Primaria. 2002; 30: 22-28
        • Medina-Remón A.
        • Barrionuevo-González A.
        • Zamora-Ros R.
        • Andres-Lacueva C.
        • Estruch R.
        • Martínez-González M.A.
        • et al.
        Rapid folin-ciocalteu method using microtiter 96-well plate cartridges for solid phase extraction to assess urinary total phenolic compounds, as a biomarker of total polyphenols intake.
        Anal Chim Acta. 2009 Feb 16; 634: 54-60
        • Bescós R.
        • Rodríguez F.A.
        • Iglesias X.
        • Ferrer M.D.
        • Iborra E.
        • Pons A.
        Acute administration of inorganic nitrate reduces VO(2peak) in endurance athletes.
        Med Sci Sports Exerc. 2011 Oct; 43: 1979-1986
        • Braman R.S.
        • Hendrix S.A.
        Nanogram nitrite and nitrate determination in environmental and biological materials by vanadium (III) reduction with chemiluminescence detection.
        Anal Chem. 1989 Dec 15; 61: 2715-2718
        • Castegnaro M.
        • Massey R.C.
        • Walters C.L.
        The collaborative evaluation of a procedure for the determination of N-nitroso compounds as a group.
        Food Addit Contam. 1987 Jan; 4: 37-43
        • Kris-Etherton P.M.
        • Hu F.B.
        • Ros E.
        • Sabaté J.
        The role of tree nuts and peanuts in the prevention of coronary heart disease: multiple potential mechanisms.
        J Nutr. 2008 Sep; 138: 1746S-1751S
        • Medina-Remón A.
        • Estruch R.
        • Tresserra-Rimbau A.
        • Vallverdú-Queralt A.
        • Lamuela-Raventos R.M.
        The effect of polyphenol consumption on blood pressure.
        Mini Rev Med Chem. 2013 Jun 1; 13: 1137-1149
        • Gonthier M.P.
        • Donovan J.L.
        • Texier O.
        • Felgines C.
        • Remesy C.
        • Scalbert A.
        Metabolism of dietary procyanidins in rats.
        Free Radic Biol Med. 2003 Oct 15; 35: 837-844
        • Doménech M.
        • Roman P.
        • Lapetra J.
        • García de la Corte F.
        • Sala-Vila A.
        • de la Torre R.
        • et al.
        Mediterranean diet reduces 24-Hour ambulatory blood pressure, blood glucose, and lipids: one-year randomized, clinical trial.
        Hypertension. 2014 May 5; 64: 69-76
        • McCullough M.L.
        • Chevaux K.
        • Jackson L.
        • Preston M.
        • Martinez G.
        • Schmitz H.H.
        • et al.
        Hypertension, the kuna, and the epidemiology of flavanols.
        J Cardiovasc Pharmacol. 2006; 2: S103-S109
        • Erlund I.
        • Koli R.
        • Alfthan G.
        • Marniemi J.
        • Puukka P.
        • Mustonen P.
        • et al.
        Favorable effects of berry consumption on platelet function, blood pressure, and HDL cholesterol.
        Am J Clin Nutr. 2008 Feb; 87: 323-331
        • Naruszewicz M.
        • Laniewska I.
        • Millo B.
        • Dluzniewski M.
        Combination therapy of statin with flavonoids rich extract from chokeberry fruits enhanced reduction in cardiovascular risk markers in patients after myocardial infraction (MI).
        Atherosclerosis. 2007 Oct; 194: e179-e184
        • Furchgott R.F.
        • Zawadzki J.V.
        The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine.
        Nature. 1980 Nov 27; 288: 373-376
        • Palmer R.M.
        • Ferrige A.G.
        • Moncada S.
        Nitric oxide release accounts for the biological activity of endothelium-derived relaxing factor.
        Nature. 1987 Jun 11; 327: 524-526
        • Taylor S.G.
        • Weston A.H.
        Endothelium-derived hyperpolarizing factor: a new endogenous inhibitor from the vascular endothelium.
        Trends Pharmacol Sci. 1988 Aug; 9: 272-274
        • Fitzpatrick D.F.
        • Hirschfield S.L.
        • Coffey R.G.
        Endothelium-dependent vasorelaxing activity of wine and other grape products.
        Am J Physiol. 1993 Aug; 265: H774-H778
        • Ndiaye M.
        • Chataigneau T.
        • Andriantsitohaina R.
        • Stoclet J.C.
        • Schini-Kerth V.B.
        Red wine polyphenols cause endothelium-dependent EDHF-mediated relaxations in porcine coronary arteries via a redox-sensitive mechanism.
        Biochem Biophys Res Commun. 2003 Oct 17; 310: 371-377
        • Lorenz M.
        • Wessler S.
        • Follmann E.
        • Michaelis W.
        • Düsterhöft T.
        • Baumann G.
        • et al.
        A constituent of green tea, epigallocatechin-3-gallate, activates endothelial nitric oxide synthase by a phosphatidylinositol-3-OH-kinase-, cAMP-dependent protein kinase-, and Akt-dependent pathway and leads to endothelial-dependent vasorelaxation.
        J Biol Chem. 2004 Feb 13; 279: 6190-6195
        • Medina-Remón A.
        • Zamora-Ros R.
        • Rotchés-Ribalta M.
        • Andres-Lacueva C.
        • Martinez-Gonzalez M.A.
        • Covas M.I.
        • et al.
        Total polyphenol excretion and blood pressure in subjects at high cardiovascular risk.
        Nutr Metab Cardiovasc Dis. 2011 May; 21: 323-331