Blood pressure.KEY POINTS
* Most population epidemiological studies have shown an inverse association between estimated protein intake and blood pressure. Total and plant proteins are consistently associated with lower blood pressure. Inverse associations of animal protein with blood pressure have also been shown.
* A reduction in blood pressure with protein, in comparison with carbohydrate, is a consistent finding in controlled trials. Animal (including lean red meat and milk proteins) and plant (primarily soy) proteins appear to be similar with respect to effects on blood pressure.
* It remains uncertain whether protein itself can lower blood pressure, or whether the benefits are due to partial replacement of some other factor in the diet, such as refined carbohydrate. Potential mechanisms remain speculative.
* The implications of the available research for 'healthy eating' advice remains uncertain: the long-term effect of a dietary approach to increase protein intake, which is widely applicable to the population, needs to be evaluated, as does the influence of refined carbohydrate on blood pressure.
It was initially thought that a higher intake of animal protein specifically, and total protein intakes more generally, are detrimental for blood pressure. This idea derived from studies showing that vegetarian diets, which are lower in total protein and lack meat protein, can lower blood pressure. (1) However, several studies have investigated whether type of dietary protein (animal vs plant) could explain the lower blood pressure with vegetarian diets. (2-5) In addition, more recently, several studies have shown that non-vegetarian diets rich in vegetables, fruits and legumes Legumes
A family of plants that bear edible seeds in pods, including beans and peas.
Mentioned in: Cholesterol, High
legumes (l can also lower blood pressure. (6) This paper takes the position that it is possible that higher protein intakes could actually benefit blood pressure.
The relationship between protein intake and blood pressure has been investigated in many population studies. (7-9) In cross-sectional and longitudinal epidemiological studies, the estimated protein intake has generally been inversely associated with blood pressure. Higher total and plant protein intake is consistently associated with lower blood pressure. Higher animal protein intake has also been associated with lower blood pressure in several epidemiological studies. This paper reviews research addressing the links between dietary components, notably protein and carbohydrate, with blood pressure.
TOTAL PROTEIN INTAKE
Most cross-sectional population studies have shown an inverse association between estimated protein intake and blood pressure. (7-12) For example, the INTERSALT study The Intersalt study was a landmark observational study that showed a strong association between dietary salt and risk of cardiovascular disease. The results were disputed by the Salt Institute (the salt producers' trade organisation), who demanded that the results be , which involved over 10000 men and women, reported an inverse relationship A inverse or negative relationship is a mathematical relationship in which one variable decreases as another increases. For example, there is an inverse relationship between education and unemployment — that is, as education increases, the rate of unemployment between urinary nitrogen urinary nitrogen
The nitrogen that is excreted as urea, amino acids, or uric acid, as in the urine. and urea--as indicators of total protein intake--and blood pressure. Estimates from the present study indicate that an increase of 37 g/day of protein would lead to falls in population mean systolic Systolic
The phase of blood circulation in which the heart's pumping chambers (ventricles) are actively pumping blood. The ventricles are squeezing (contracting) forcefully, and the pressure against the walls of the arteries is at its highest. and diastolic blood pressures Diastolic blood pressure
Blood pressure when the heart is resting between beats.
Mentioned in: Hypertension of ~3 and ~2.5 mmHg, respectively. (10) The estimated fall in blood pressure in individuals with elevated blood pressure may be greater. An increase in protein intake of 37 g/day represents a modest shift in protein intake from 30% below the population mean to 30% above the mean. To date, there have been more than 25 reported cross-sectional studies, with approximately two-thirds reporting an inverse relationship of protein intake with blood pressure and most of the remaining studies reporting no association. (7,8)
Fewer prospective studies have reported on the relationship between dietary protein and blood pressure or hypertension. Of these studies, two have found an inverse association, three have found no significant association, and one has found an inverse association for plant protein but a positive association for animal protein. (8)
PLANT VERSUS ANIMAL PROTEIN
Total and plant proteins are consistently associated with lower blood pressure. Where animal and plant proteins have been analysed separately, some cross-sectional studies suggest stronger associations for plant protein. (12-14) In addition, in the Western Electric study, a prospective study of more than 1700 men with nine-year follow up, an inverse association was found for plant protein, but a positive association was found for animal protein. (15) These results may not be surprising because many dietary sources of plant protein also contain other factors, such as fibre, folate folate /fo·late/ (fo´lat)
1. the anionic form of folic acid.
2. more generally, any of a group of substances containing a form of pteroic acid conjugated with l-glutamic acid and having a variety of substitutions. and phytochemicals, which could contribute to lower blood pressure. In addition, plant and animal protein intakes may be associated with differences in dietary patterns and lifestyle factors. (16,17)
In contrast, results of several cross-sectional studies suggest an inverse association of animal protein with blood pressure. Many of the large populations studied, where total protein intake has been inversely associated with blood pressure, eat predominantly animal (meat) protein. (10,11) In addition, results of several studies, primarily in Chinese and Japanese populations, suggest that animal protein specifically is associated with lower blood pressure. (18-21)
RANDOMISED Adj. 1. randomised - set up or distributed in a deliberately random way
irregular - contrary to rule or accepted order or general practice; "irregular hiring practices" CONTROLLED TRIALS
Protein versus carbohydrate
A reduction in blood pressure with protein, in comparison with carbohydrate, is a consistent finding in controlled trials. (22-27) Three studies have now compared plant (soy) protein with carbohydrate. (22-24) In a randomised controlled parallel-designed trial, 36 treated hypertensive hypertensive /hy·per·ten·sive/ (-ten´siv)
1. characterized by increased tension or pressure.
2. an agent that causes hypertension.
3. a person with hypertension. individuals followed a low-protein (~12% of energy), high-carbohydrate (~60% of energy) diet. Against this background, plant protein (66 g of soy protein), compared with carbohydrate (66 g of maltodextrin), resulted in a reduction in 24-hour ambulatory systolic and diastolic blood pressures by 5.9 and 2.6 mmHg. (22) Washburn et al. (23) found falls in clinic diastolic blood pressure in a randomised controlled crossover trial that compared 20 g/day of soy protein with 20 g/day of carbohydrate. He et al. (24) found significantly lower systolic and diastolic blood pressure, by 4.3 and 2.8 mmHg respectively, with 26 g/day of soy protein in comparison with wheat carbohydrate.
Delbridge et al., (25) in a 12-month study comparing a high-protein with a high-carbohydrate diet, found a 6.6 mmHg lower systolic blood pressure Systolic blood pressure
Blood pressure when the heart contracts (beats).
Mentioned in: Hypertension in those randomised to high protein. Appel et al. (26) showed that partial substitution of carbohydrate in a modified DASH (dietary approaches to stop hypertension Dietary Approaches to Stop Hypertension or the DASH diet is a diet promoted by the National Heart, Lung, and Blood Institute (part of the NIH) to control hypertension. ) diet with approximately 55 g/day of protein from primarily plant-based sources resulted in a further 1.4 mmHg lower systolic blood pressure. This plant-based approach may be an ideal approach to increasing protein in the diet because of the accompanying increase in other potentially beneficial dietary factors. However, this is likely to be difficult to achieve within populations who consume primarily animal-based protein. In Australia, any advice to partially substitute carbohydrate-rich foods for higher-protein low-fat foods is likely to result in increases in animal protein intake.
The impact on blood pressure of an increase in animal protein at the expense of carbohydrate has also been investigated. In a controlled trial in 60 hypertensive individuals, the effect of an increase in protein intake from lean red meat on blood pressure was investigated. Partial substitution of carbohydrate (primarily starch) for protein (-36 g/day) in isoenergetic diets for eight weeks resulted in a relative reduction in clinic and 24-hour ambulatory systolic blood pressure by 5.2 and 4.0 mmHg, respectively. (27)
In these studies, the increase in protein intake has ranged from 20 to 66 g/day. None of the diets would be regarded as very high protein. Because of differences in study design, it is difficult to ascertain whether there is a dose-response. Changes in body weight are unlikely to be an important confounding confounding
when the effects of two, or more, processes on results cannot be separated, the results are said to be confounded, a cause of bias in disease studies.
confounding factor factor. In studies that used a dietary approach to alter protein and carbohydrate intakes, (22,25) as opposed to studies using supplements, changes in sodium intake may have contributed to some of the blood pressure lowering observed. However, differences in sodium intake are unlikely to account fully for observed differences in blood pressure.
The potential role of refined carbohydrate
All these intervention studies intervention studies,
n.pl the epidemiologic investigations designed to test a hypothesized cause and effect relation by modifying the supposed causal factor(s) in the study population. have compared protein with carbohydrate. The possible role of the refined carbohydrate on the observed blood pressure differences remains uncertain. The population data on carbohydrate and blood pressure are limited and inconsistent, (11-13) although there are data to indicate that wholegrain-derived carbohydrate may lower blood pressure. (28-31) Studies comparing high-carbohydrate diets with higher-monounsaturated-fat diets are consistent with detrimental effects of refined carbohydrates. (26,32,33) Appel et al. (26) found that partial substitution of carbohydrate with either protein or monounsaturated fat monounsaturated fat A saturated fatty acid–ie, an alkyl chain fatty acid with one ethylenic–double bond between the carbons in the fatty acid chain. See Fatty acid, Saturated fatty acid; Cf Polyunsaturated fatty acid, Unsaturated fatty acid. resulted in lower blood pressure of a similar magnitude. This finding needs confirmation. Shah et al. (32) found that a high-carbohydrate diet resulted in higher blood pressure in type 2 diabetic patients in comparison with a high-monounsaturated-fat diet. A recent meta-analysis of controlled trials to assess the effect of high-carbohydrate in comparison with high-monounsaturated-fat diets on blood pressure found that diets rich in carbohydrate were associated with higher systolic (2.6 mmHg) and diastolic Diastolic
The phase of blood circulation in which the heart's pumping chambers (ventricles) are being filled with blood. During this phase, the ventricles are at their most relaxed, and the pressure against the walls of the arteries is at its lowest. (1.8 mmHg) blood pressures. (33) In contrast, a high-carbohydrate low-glycaemic-index diet was found to reduce diastolic blood pressure in comparison with a high-monounsaturated-fat diet. (34) The studies that have compared the effects on blood pressure of high- and low-glycaemic-index diets suggest that glycaemic index is not a major determinant of blood pressure. (35,36) These studies were neither designed nor powered to address this question. Thus, it is premature to make any conclusions regarding glycaemic index and blood pressure. However, it appears that differences in carbohydrate intake may have contributed to the observed effects on blood pressure in studies to have compared protein with carbohydrate.
Plant versus animal protein
Several studies investigated whether type of dietary protein could explain blood pressure lowering with vegetarian diets. (2-5) These studies consistently found that animal and plant proteins did not differ with respect to effects on blood pressure. For example, Prescott et al. (5) conducted a 12-week trial comparing diets matched in protein from meat and non-meat sources and found no difference in blood pressure. More recently, researchers have been interested in the effects of soy protein on blood pressure. Several studies have compared soy protein with other sources of protein, primarily casein casein (kā`sēn), well-defined group of proteins found in milk, constituting about 80% of the proteins in cow's milk, but only 40% in human milk. or milk proteins. These studies have been reviewed by Sacks et al. (37) Most studies found no effect on blood pressure, and the weighted average change was -1 mmHg in systolic blood pressure. Thus, there is little evidence for differential effects on blood pressure of different sources of protein.
It remains uncertain whether protein per se can lower blood pressure, or whether the benefits are due to partial replacement of some other factor in the diet, such as refined carbohydrate. Thus, the potential mechanisms remain speculative. Amino acid amino acid (əmē`nō), any one of a class of simple organic compounds containing carbon, hydrogen, oxygen, nitrogen, and in certain cases sulfur. These compounds are the building blocks of proteins. composition of proteins may be relevant: several amino acids have been reported to affect blood pressure either in human studies or in animal experiments. (38) Arginine arginine (är`jənĭn), organic compound, one of the 20 amino acids commonly found in animal proteins. Only the l-stereoisomer participates in the biosynthesis of proteins. , with the potential to act via nitric oxide nitric oxide or nitrogen monoxide, a colorless gas formed by the combustion of nitrogen and oxygen as given by the reaction: energy + N2 + O2 → 2NO; m.p. −163.6°C;; b.p. −151.8°C;. , (39) has been the amino acid most widely investigated in relation to blood pressure and endothelial endothelial /en·do·the·li·al/ (-the´le-al) pertaining to or made up of endothelium.
A layer of cells that lines the inside of certain body cavities, for example, blood vessels. function. Taurine taurine /tau·rine/ (taw´ren) an oxidized sulfur-containing amine occurring conjugated in the bile, usually as cholyltaurine or chenodeoxycholyltaurine; it may also be a central nervous system neurotransmitter or neuromodulator. has also been reported to lower blood pressure in animals (40) and to be inversely related to blood pressure in population studies. (41) A non-specific dose-dependent diuretic diuretic (dī'yərĕt`ĭk), drug used to increase urine formation and output. Diuretics are prescribed for the treatment of edema (the accumulation of excess fluids in the tissues of the body), which is often the result of underlying effect of amino acids may also contribute to the blood pressure-lowering effect. (42)
At present, information about the effects of specific amino acids on blood pressure is inadequate to allow any conclusion about the need to consider amino acid content of proteins. The INTERSALT data (10) have been gathered worldwide from a range of populations with considerable variation in the type of protein consumed. If dietary protein can lower blood pressure, then this data source would suggest that the amino acid composition of the protein and source of protein are not critical determinants.
The results of cross-sectional and prospective epidemiological studies and randomised controlled trails support the proposal that higher protein intakes from plant and animal sources can reduce blood pressure. Results of the controlled trials suggest that for individuals with above optimal blood pressure, the partial replacement of refined-carbohydrate-rich foods with high-protein low-fat foods will reduce blood pressure. If there are benefits on blood pressure of increased protein intake, then a similar message is likely to be conveyed to this population: 'to partially replace refined carbohydrate-rich foods with a variety of high-protein low-fat foods'. However, it remains uncertain whether this would be the most appropriate advice. This is largely because it is uncertain whether the protein per se lowers blood pressure, and/or whether refined carbohydrate raises blood pressure.
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Disease that affects the heart and blood vessels.
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1. characterized by normal tone, tension, or pressure, as by normal blood pressure.
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The packages in which cholesterol and triglycerides travel throughout the body.
Mentioned in: Lipoproteins Test
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tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es
To make random in arrangement, especially in order to control the variables in an experiment. , controlled trial. Ann Intern Med 2005; 143: 1-9.
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ARIC Alliance for Rational Intercarrier Compensation
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39 Pedrinelli R, Ebel M, Catapano G et al. Pressor pressor /pres·sor/ (pres´or) tending to increase blood pressure.
1. Producing increased blood pressure.
2. Causing constriction of the blood vessels. , renal and endocrine effects of 1-arginine in essential hypertension essential hypertension
Hypertension without known cause or preexisting renal disease.
essential hypertension . Eur J Clin Pharmacol 1995; 48: 195-201.
40 Fujita T, Sato Y. Hypotensive hypotensive /hy·po·ten·sive/ (-ten´siv) marked by low blood pressure or serving to reduce blood pressure.
1. Of or characterized by low blood pressure.
2. effect of taurine. Possible involvement of the sympathetic nervous system and endogenous opiates Opiates
Analgesic, pain killing drugs, such as heroin and morphine that depress the central nervous system.
Mentioned in: Withdrawal Syndromes . J Clin Invest 1988; 82: 993-7.
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Jonathan M HODGSON
School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia This article is about the metropolitan area of Perth, Western Australia. For the local government area, see City of Perth.
Perth is the capital of the Australian state of Western Australia. , Australia