This chapter reviews the evidence from epidemiologic studies and controlled clinical trials dealing with dietary fats and blood pressure. Trials studying the effect on blood pressure of n-3 polyunsaturated fatty acids from fish oil show a dose-response hypotensive effect that may be restricted to patients with atherosclerotic cardiovascular disease. However, fish oil is not a practical therapy for hypertension given the large dose required (10 capsules per day) for a small effect (3–4 mmHg). From numerous studies, it is clear that saturated and n−6 polyunsaturated fats have no effect on blood pressure. Monounsaturated fats also have no effect but fewer studies have examined this relation.
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WittemanJWillettWStampferMColditzGSacksFSpeizerF: A prospective study of nutritional factors and hypertension among US women. Circulation1989, 80:1320–1327. The authors analyzed the association of dietary nutrients and the development of hypertension over a 4-year period in a prospective study of 58 218 US nurses. Hypertension was not associated with total and saturated fats, linoleic acid, or transunsaturated fats in multivariate analyses controlling for age, body mass, alcohol consumption, smoking, and other dietary nutrients including calcium, potassium, magnesium, and fiber.
30.
AshcerioARimmEGiovannucciEColditzGRosnerBWillettW: A prospective study of nutritional factors and hypertension among US men. Circulation1992, 86:1475–1484. The authors examined the association of dietary nutrients and the development of hypertension in a 4-year prospective study of 30 681 male health professionals. There was no association between hypertension or self-reported blood pressure and dietary intake of saturated, polyunsaturated, and transunsaturated fats in analyses controlling for age, body mass, or alcohol consumption.
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National Diet Heart Study Research Group: The National Diet Heart Study Final Report. Circulation1968, 37–38 (suppl 1):1228–1230. The authors report on the results of a double-blind, randomized trial of 1007 middle-aged men living in the community and 211 institutionalized psychiatric patients whose diets differed only in the amount of saturated and polyunsaturated fats. After 52 weeks on the test diets, blood pressures were similar among groups with dietary compositions of polyunsaturated to saturated fats (P/S) of 0.3, 1.5, 2.0, and 4.5.
32.
Research Committee to the Medical Research Council: Controlled trial of soya-bean oil in myocardial infarction. Lancet1968, ii:693–699. The authors report on a dietary trial of 393 men discharged from hospital with a first myocardial infarction. There was no difference in blood pressures between dietary groups with P/S of 0.2 and 2.0 up to 5 years of dietary treatment.
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BrussaardJvan RaaijJStasse-WolthuisMKatanMHautvastJ: Blood pressure and diet in normotensive volunteers: Absence of an effect of dietary fiber, protein, or fat. Am J Clin Nutr1981, 34:2023–2039. The authors conducted a randomized trial of healthy normotensive volunteers to examine the effect on blood pressure of diets differing in the amount and type of fat. There was no effect on blood pressure even though total fat was as low as 22% on one test diet and as high as 40% on another diet.
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PuskaPLaconoJNissinenAVartiainenEDoughertyRPietinenP: Dietary fat and blood pressure: An intervention study on the effects of a low fat diet with two levels of polyunsaturated fat. Prev Med1985, 14:573–584.
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MensinkRMensinkMde LouwMKatanM: Effects of dietary trans fatty acids on blood pressure in normotensive subjects. Eur J Clin Nutr1991, 45:375–382.
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BrucknerGWebbPGreenwellLChowCRichardsonD: Fish oil increases peripheral capillary blood cell velocity in humans. Atherosclerosis1987, 66:237–245.
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Von HouwelingenRNordoyAvan der BeekEHoutsmullerUde MetzMHornstraG: Effect of a moderate fish intake on blood pressure, bleeding time, hematology and clinical chemistry in healthy males. Am J Clin Nutr1987, 46:424–436. The authors report on the only randomized, controlled trial of the effect of a dietary supplement of fish on blood pressure. Healthy normotensives received either 100g/day of mackerel or meat for 6 weeks. There was no effect on blood pressure of the fish diet, which provided 4.7 g/day n-3 fatty acids.
55.
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Trials of Hypertension Prevention Collaborative Research Group: The effects of non-pharmacologic interventions on blood pressure of persons with high normal levels: Results of the trials of hypertension prevention (phase I). JAMA1992, 267:1213–1220. The authors report on the largest fish-oil trial to date, which examined the effects on blood pressure of 2.5 g/day n-3 fatty acids in 350 healthy normotensive subjects. There was no difference in blood pressure between the fish-oil and placebo groups after 6 months of treatment.
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KestinMCliftonPBellingGNestelP: −3 fatty acids of marine origin lower systolic blood pressure and triglycerides but raise LDL cholesterol compared with −3 and −6 fatty acids from plants. Am J Clin Nutr1990, 51:1028–1034.
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