The impact of dietary supplements on blood pressure in older adults: A network meta-analysis of randomized controlled trials

Agnieszka Kujawska; Sabri Bromage; Jose Augusto Simoes; Jūratė Zupkauskienė; Nicholas McMahon; Paweł Zalewski; Sławomir Kujawski

doi:10.1016/j.heliyon.2024.e25615

The impact of dietary supplements on blood pressure in older adults: A network meta-analysis of randomized controlled trials

Heliyon. 2024 Feb 8;10(4):e25615. doi: 10.1016/j.heliyon.2024.e25615. eCollection 2024 Feb 29.

Authors

Agnieszka Kujawska¹, Sabri Bromage^{2

3}, Jose Augusto Simoes⁴, Jūratė Zupkauskienė⁵, Nicholas McMahon⁶, Paweł Zalewski^{1

7}, Sławomir Kujawski¹

Affiliations

¹ Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Świętojańska 20, 85-077, Bydgoszcz, Poland.
² Institute of Nutrition, Mahidol University, Salaya, Thailand.
³ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA.
⁴ Department of Medical Sciences, University of Beira Interior, 6200-506, Covilha, Portugal.
⁵ Clinic of Cardiac and Vascular Diseases, Vilnius University, 08661, Vilnius, Lithuania.
⁶ School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD, Australia.
⁷ Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Warsaw Medical University, 1b Banacha Street, 02-097, Warsaw, Poland.

Abstract

Purpose: The prevalence of hypertension (HTN) increases with age and there is a need for effective, evidence-based treatments for HTN among older adults. The objective of this study was to perform a network meta-analysis to evaluate the effectiveness of different forms of nutritional supplementation on reducing blood pressure in older adults.

Methods: A systematic review using PubMed and Clinical Key was performed to identify randomized controlled trials (RCTs) evaluating the effects of dietary supplements on blood pressure in adults older than 65 years of age. Network meta-analysis (NMA) was used to compare and rank the effects of different supplements on systolic (sBP), diastolic (dBP), and mean (mBP) blood pressure. Supplements were ranked according to P score. Meta-regressions were conducted to examine whether treatment effects were moderated by baseline BP and supplementation duration.

Findings: We identified 144 relevant studies in the literature, twelve of which met criteria for inclusion in NMA. The included studies were published between 2003 and 2022. In reducing sBP, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), inorganic nitrates, tart cherry juice, and vitamin D supplementation were more effective than placebo, and the effect of tart cherry juice outranked that of vitamin D, vitamin E, and vitamin K2. In reducing dBP, inorganic nitrates, DHA and EPA, protein, resveratrol, and vitamin D supplementation were more effective than placebo, and the effect of resveratrol outranked that of tart cherry juice, vitamin D, vitamin E, and vitamin K2. However, the effects of tart cherry juice on sBP and resveratrol on dPB were smaller than the pooled effect of placebo, and none of the pairwise differences between the effects of examined supplements were statistically significant. Caution is needed when interpreting these results given concerns about the risk of bias assessed in seven of the twelve studies included in this analysis.

Keywords: Dietary supplements; Elderly; Hypertension; Nutritional supplementation; Older adults.