Fruit, vegetable-rich diets reduce BP, medication costs in patients with CKD

Patients with chronic kidney disease who added more fruits and vegetables to their diet reduced their costs for antihypertensive drugs and improved their BP, according to a presentation at the American Heart Association’s Council on Hypertension Scientific Sessions.

The reduction in those eating more fruits and vegetables was nearly half compared with those treated with a sodium bicarbonate regimen or those who were not administered an acid-reducing treatment.

“It was remarkable that we achieved better [BP] control using fewer drugs and without forcing people to change their diet completely. Instead, we provided food for the entire family so they could add fruits and vegetables to what they normally eat,” Nimrit Goraya, MD, program director for nephrology at Baylor Scott & White Health in Temple, Texas, said in a press release. “This was important because many of these patients lived in neighborhoods without access to fruits and vegetables through local food banks or grocery stores.”

Since fruits and vegetables have been shown to reduce BP, the researchers studied whether the treatment of metabolic acidosis with fruits and vegetables in patients with chronic kidney disease (CKD) was associated with BP control improvement, use of fewer antihypertensive drugs and lower cost of hypertension management.

Goraya and colleagues conducted randomized trial of 108 patients with CKD stage 3, estimated glomerular filtration rate of 30 mL/min/1.73 m² to 59 mL/min/1.73 m² and metabolic acidosis.

Patients were randomly assigned to fruits and vegetables (n = 36), oral sodium bicarbonate (n = 36) or the usual care (n = 36). A goal for those in the fruits and vegetables and sodium bicarbonate groups was to reduce dietary potential renal acid load by 50%.

All patients were treated to a systolic BP target of less than 130 mm Hg with regimens including ACE inhibition, and they were followed for 5 years. The three groups did not differ at baseline in systolic BP or BP treatment regimen.

At 5 years, mean systolic BP was 125 mm Hg in the fruits and vegetables group vs. 135 mm Hg in the sodium bicarbonate group (P < .01) and 134 mm Hg in the usual care group (P < .01), the researchers reported.

Compared with the other groups, dosages were lower at 5 years in the fruits and vegetables group for the following drugs: enalapril (P < .01), diltiazem (P < .01), clonidine (P < .01) and atenolol (P < .02), but there was no difference between the groups in dosage of hydrochlorothiazide, according to the researchers.

The average drug cost for maintaining BP at 5 years was $79,760 for those in the fruit and vegetable group, $155,372 for the sodium bicarbonate group and $152,305 for the usual care group, Goraya and colleagues found.

“We need to strongly inculcate diet as a part of our medical management of diseases; often this simple and basic fact is never discussed,” Goraya told Cardiology Today. “We just tell them matter of factly to lower salt and fast food but do not offer what actually to eat.”– by Dave Quaile

Reference:

Goraya N, et al. Abstract P265. Presented at: American Heart Association’s Council on Hypertension Scientific Sessions; Sept. 14-16, 2016; Orlando, Fla.

Disclosures: Goraya reports no relevant financial disclosures.