The lowest prevalence of a clinical cardiovascular disease risk factor from the life’s 7 simple was blood pressure ; this was normal in only 52% of the participants. The Nationaland Nutrition Examination Surveys (NHANES) 2003-2008 evaluated the prevalence of the 7cardiovascular health metrics in 14,515 adults.
RESEACH TITLE: No-Pharmacological Intervention: Pomegranate Juice for the Management of Hypertension and the Improvement of Cardiovascular Health
COUNTRY: Greece and USA
CONDUCTED BY: George Washington University and Aristotle University of Thessaloniki
PUBLISHED ON: The Open Hypertension Journal
The concept of ideal cardiovascular (CV) health, with emphasis on the prevention of CV disease (CVD), was included by the American Heart Association (AHA) among its strategic goals for 2020 . This concept was intended to focus mainly on the promotion of a healthy lifestyle and the adoption of a multifactorial intervention with nonpharmacological or pharmacological means, aiming at the prevention or the effective control of CVD risk factors . Ideal cardiovascular health is defined as optimal levels of 3 CVD risk factors [blood pressure (BP), fasting plasma glucose and total cholesterol) and 4 behaviours [body mass index (BMI), smoking, physical activity and healthy diet] . These 7 ideal CV metrics, called life’s simple 7, are probably the best available markers of life-time CVD risk . Recent studies have shown that the levels of ideal CV health in the United States to be very low at a community level [3-5] and to be associated with cardiac events , stroke  and total mortality . A large study was conducted in 5,785 young adults (20-39 years old) from 5 international populations: the Minneapolis Childhood Cohort Study, the Princeton Follow-up Study, the Bogalusa Heart Study, the Cardiovascular Risk in Young Finns Study, and the Childhood Determinants of Adult Health (CDAH) Study; all members of the International Childhood Cardiovascular Cohort (i3C) Consortium . Results of the study showed that ideal CV health, as defined by the AHA, was rare among young participants of the study. An amazingly low (only 1%) percentage of the participants had all 7 health metrics in the 5,785 young adults participating from all international cohorts . Many of the participants had ideal glucose (73%), cholesterol (64%), and were non-smokers (64%); diet (7%) was the least common metric for participants from any of the cohorts . The lowest prevalence of a clinical CVD risk factor from the life’s 7 simple was BP; this was normal in only 52% of the participants . The Nationaland Nutrition Examination Surveys (NHANES) 2003-2008 evaluated the prevalence of the 7 CV health metrics in 14,515 adults . Participants were stratified in young (20-39 years), middle-aged (40-64 years) and elderly (65 years).
Beyond hypertension, oxidative stress is also causally related with several CVD risk factors such as diabetes, dyslipidaemia, metabolic syndrome and smoking; oxidative stress has been proved to play a key role in the pathogenesis of atherosclerosis . Oxidized LDL (Ox-LDL) is present in atherosclerotic lesions and in plasma from patients with CVD, and it correlates with the presence of angiographically documented complicated plaques , thus identifying patients who are at increased risk for future myocardial infarction, independently of other risk factors . Since Pomegranate Juice contains very potent antioxidants (tannins, anthocyanins), which are also considered potent anti-atherogenic agents, it might attenuate atherosclerosis development by reducing oxidative stress in these patients . Indeed, human plasma obtained from healthy subjects after 2 weeks of Pomegranate Juice consumption (50 mL Pomegranate Juice concentrate/day, equivalent to 1.5 mmol total polyphenols) demonstrated a significantly decreased susceptibility to free radical-induced lipid peroxidation, in comparison to plasma obtained at baseline prior to Pomegranate Juice consumption initiation, as measured by lipid peroxides formation or by total antioxidant status in serum [31,35]. Very recently, a study evaluated a product a new functional beverage based on a de-alcoholized red wine matrix supplemented by a pomegranate extract. This product is expected to have even more potent antioxidant action .
Regarding patients with metabolic syndrome (one of the components of which is hypertension), it has been demonstrated that Pomegranate Juice exerts hypoglycaemic effects by increasing insulin sensitivity, inhibiting -glucosidase, and modulating glucose transporter type-4 function, but also lowers total cholesterol and exerts anti-inflammatory effects through the regulation of peroxisome proliferator-activated receptor pathways .
In conclusion, current data suggest that long-term (at least for 1 year) use of Pomegranate Juice has a beneficial effect on BP, improves endothelial function, reduces arterial stiffness and delays or reverses the progression of atherosclerosis. These effects could result in an improvement in CV and overall health status. Therefore, pomegranate Juice might be useful as an adjunctive therapy for the management of hypertension on top of other non-pharmacological interventions or drug therapy. The use of pomegranate Juice might reduce the number of drugs or their doses for patients requiring antihypertensive drug therapy. Pomegranate Juice might be more useful in patients with hypertension and high oxidative burden such as those with diabetes, obesity, metabolic syndrome or who smoke. However, our knowledge on the CV effects of Pomegranate Juice are based on studies with a small number of patients and limitations in their design. Therefore, future long-term well-designed studies with polyphenols-rich foods (alone or in combination), but also with isolated phenolic compounds would provide valuable data to establish public health recommendations on the use of polyphenols forhealth protection.