Can Purified Omega-3 Polyunsaturated Fatty Acids Supplementation Act Blood Pressure Levels in Untreated Normal-High Blood Pressure Subjects with Hypertriglyceridemia?
- 1 University of Naples Federico II, Faculty of Medicine, Naples, Italy
Abstract
Omega-3 ( ω -3) polyunsaturated fatty acids (PUFAs) from fish and fish oils appear to protect against coronary heart disease: their dietary intake is in fact inversely associated with cardiovascular disease morbidity/mortality in population studies. Recent evidence suggests that at least a part of this protective effect is mediated by a relatively small but significant decrease in blood pressure (BP) level. In fact, omega-3 PUFAs exhibit wide-ranging biological actions that include regulating both vasomotor tone and renal sodium excretion, partly competing with omega-6 PUFAs for common metabolic enzymes and thereby decreasing the production of vasoconstrictor rather than vasodilator and anti-inflammatory eicosanoids. PUFAs also reduce angiotensin-converting enzyme (ACE) activity, angiotensin II formation. We retrospectively evaluated the long-term effect of a omega-3 PUFAs supplementation on the blood pressure level of 91 hypertriglyceridemic subjects with untreated normal-high blood pressure that were prescribed a 3 grams omega-3 PUFAs supplementation in order to improve their plasma lipid pattern. After 24 months of treatment, systolic blood pressure (SBP) meanly decreased by 2.6 +/- 2.5 mmHg (p = 0.001) and diastolic blood pressure (DBP) by 1.4 +/- 3.1 mmHg (p < 0.001), while basal heart rate decreased by 4.1 +/- 4.6 bpm (p < 0.001). Both SBP and DBP reduction were significantly related to the baseline SBP (p < 0.001) and DBP (p < 0.001), respectively. Diastolic blood pressure change was also inversely related to the patient’s age (p = 0.004). No significant difference was perceived in the metabolic syndrome subgroup. In our retrospective study, highly purified omega-3 PUFAs long-term supplementation is associated with a significant reduction in SBP, DBP, and basal heart rate in hypertriglyceridemic patients with normal-high blood pressure. The main determinants of the omega-3 PUFAs anti-hypertensive effect appear to be the basal blood pressure level and age. Future research will clarify if omega-3 PUFAs supplementation could improve the antihypertensive action of specific blood pressure lowering drug classes and of statins.
- D. P. Begg, A. J. Sinclair, L. A. Stahl, M. L. Garg, M. Jois and R. S. Weisinger, “Dietary Protein Level Interacts with ω-3 Polyunsaterated Fatty Acid Deficiency to Induce Hypertension,” American Journal of Hypertension, Vol. 23, No. 2, 2010, pp. 125-128.
- U. N. Das, “Essential Fatty Acids and Their Metabolites Could Function as Endogenous HMG-CoA Reductase and ACE Enzyme Inhibitors, Anti-Arrhythmic, Anti-Hypertensive, Anti-Atherosclerotic, Anti-Inflammatory, Cytoprotective and Cardioprotective Molecules,” Lipids in Health and Disease, Vol. 7, 2008, p. 37.
- U. N. Das, “Interaction of Polyunsaturated Fatty Acids with Dietary Protein and Its Relationship to the Pathogenesis of Hypertension,” American Journal of Hypertension, Vol. 23, No. 2, 2010, pp. 111-112.
- D. Mozaffarian, R. Micha and S. Wallace, “Effects on Coronary Heart Disease of Increasing Polyunsaturated Fat in Place of Saturated Fat: A Systematic Review and Meta-Analysis of Randomized Controlled Trials,” PLoS Medicine, Vol. 7, 2010, Article ID: 1000252.
- J. M. Geleijnse, E. J. Giltay, D. E. Grobbee, A. R. Donders and F. Kok, “Blood Pressure Response to Fish Oil Supplementation: Metaregression Analysis of Randomized Trials,” Journal of Hypertension, Vol. 20, 2002, pp. 1493-1499. doi:10.1097/00004872-200208000-00010
- C. Borghi and A. F. G. Cicero, “Blood Pressure Modulating Properties of Omega-3 Polyunsaturated Fatty Acids(PUFA). Another PUFA Heart Protective Effect?” High Blood Pressure and Cardiovascular Prevention, Vol. 14, No. 2, 2007, pp. 1-7. doi:10.2165/00151642-200714020-00001
- D. G. Altman, “Practical Statistics for Medical Research,” Chapman and Hall, London, 1991.
- C. R. Mehta, N. R. Patel and A. A. Tsiatis, “Exact Significance Testing to Establish Treatment Equivalence with Ordered Categorical Data,” Biometrics, Vol. 40, No. 3, 1984, pp. 819-825. doi:10.2307/2530927
- A. H. Lichtenstein, L. J. Appel, M. Brands, et al., “Diet and Lifestyle Recommendations: Revision 2006. A Scientific Statement from the American Heart Association Nutrition Committee,” Circulation, Vol. 114, No. 1, 2006, pp. 82-96
- W. S. Harris, “Omega-3 Fatty Acids and Cardiovascular Disease a Case for Omega-3 Index as a New Risk Factor,” Pharmacological Research, Vol. 55, No. 3, 2007, pp. 217-223.
- H. O. Ventura, R. V. Milani, C. J. Lavie, et al., “Cycosporine-Induced Hypertension: Efficacy of Omega-3 Fatty Acids in Patients after Cardiac Transplantation,” Circulation, Vol. 88, 1993, pp. 11281-11285.