Fruits and vegetables ‘foundational management’ for treating hypertension

Key takeaways:

• Intake of base-producing fruits and vegetables slowed CKD progression and reduced CVD risk indices.
• These interventions should be more accessible to those at risk for such diseases, researchers said.

Dietary acid reduction from fruits and vegetables or sodium bicarbonate improved kidney health in patients with hypertension and macroalbuminuria, findings from a randomized controlled trial showed.

However, only fruits and vegetables lowered BP and reduced the risk for CVD, a surprising result to the researchers, Donald E. Wesson, MD, FASN, MBA, a professor of medicine at Texas A&M College of Medicine, told Healio.

“We showed years ago in our animal studies that an acid-producing diet — one high in animal products like meat — was kidney harmful and a base-producing diet — mostly fruits and vegetables — was kidney healthy,” Wessen said.

The Dietary Approaches to Stop Hypertension — or DASH — diet is recommended as first-line treatment for primary hypertension, Wesson and colleagues noted in their study published in the American Journal of Medicine. Nevertheless, the DASH diet is also underprescribed and underimplemented, they added.

Acid-producing diets are tied to increased risk for CVD and incidence of chronic kidney disease (CKD), and acid reduction can either come from adding base-producing vegetables and fruits into modern diets “or more simply and less expensively, adding oral mineral alkali like sodium bicarbonate (NaHCO₃), ” the researchers wrote.

“We wanted to know if kidney and/or heart benefits of dietary acid reduction can be obtained more simply with NaHCO₃, or does one need fruits and vegetables instead,” Wessen said.

Researchers evaluated both options during a 5-year trial by randomly assigning 153 patients with hypertension and macroalbuminuria to one of three study arms that included:

• two to four cups of base-producing fruits and vegetables like apples and carrots alongside their usual daily food intake;
• NaHCO₃ tablets in two daily doses of four to five 650 mg tablets; or
• standard medical care from primary care clinicians.

Participants continued receiving pharmacologic CKD and CVD protection, such as statin therapy and guideline medications.

Overall, results showed slower CKD progression in participants who received fruits and vegetables (mean, –1.08 mL per minute/1.73m² a year) or NaHCO₃ (mean, –1.17 mL per minute/1.73m² a year) vs. those who received usual care (mean, –1.94 mL per minute/1.73m² a year).

Notably, participants assigned to the fruits and vegetables group had lower systolic BP and CVD risk indices like BMI and plasma low-density lipoprotein in the fruits and vegetables group compared with the NaHCO₃ and usual care groups.

“This apparent better CVD protection with fruits and vegetables emerged in year 1 of the intervention,” the researchers wrote.

Additionally, lower amounts of fruits and vegetables achieved protective effects from fruits in tandem with lower doses of antihypertensive and statin therapy vs. the other two treatment groups.

Wessen told Healio that fruits and vegetables “should be foundational management” of patients with primary hypertension.

“These results emphasize the need for primary care clinicians, and all those who treat patients with primary hypertension, to emphasize inclusion of diets high in fruits and vegetables, in addition to drugs, in the treatment of hypertension,” he added.

References:

• Eating more fruits & vegetables to reduce dietary acid lowers blood pressure and improves kidney and heart health in patients with hypertension. Available at: https://www.elsevier.com/about/press-releases/eating-more-fruits-and-vegetables-to-reduce-dietary-acid-lowers-blood. Published Aug. 6, 2024. Accessed Aug. 12, 2024.
• Goraya N, et al. Am J Med. 2024;doi:10.1016/j.amjmed.2024.06.006.