Innovating to alleviate hypertension? It should be a definite consideration!

High blood pressure or hypertension refers to a blood pressure of 140/90mm Hg or higher. Innovation with “hypertension alleviation” as the main focus is currently limited to sodium reduction, but a focus beyond minimal sodium reduction makes perfect sense for many reasons. Firstly, according to a Sept. 2023 World Health Organization (WHO) report, 1 in 3 adults worldwide has hypertension; and nearly half of them are currently unaware of their condition.  Secondly, 4 out of every 5 people with hypertension are not adequately treated, probably because more than three-quarters of adults with hypertension live in low-and-middle income countries. Thirdly, 76 million deaths could be averted between 2023 and 2050, from stroke, heart attack, heart failure, kidney damage and many other health problems, if appropriate measures are taken alleviate hypertension (1).

For years, hypertension has been treated with a healthier low-salt diet and medication. In addition, the recommendation has always been to lose weight if overweight, stay physically active, limit alcohol intake, manage stress, sleep well and avoid smoking (1). Sounds like simple advice, but the challenge is that only about one in five people with hypertension have been able to successfully control hypertension (1).

Very recently, an international panel of experts convened by the International Society of Hypertension College of Experts, compiled lifestyle management recommendations as first line strategy to prevent and control hypertension in adulthood. The committee recommended an increase in consumption of vegetables, fresh fruits, fish, nuts, unsaturated fatty acids, low-fat dairy products and low consumption of red meat; reduction in salt and sugar intake; more dietary potassium intake; increased consumption of plant-based food and dietary fibre (2). From an innovation perspective, let’s look at how some of these recommendations can be leveraged for food and beverages that can help alleviate hypertension and its complications:

1. Reduce sodium and Increase potassium

Everyone just loves the perfect level of salt or sodium chloride in their food, and without it, food just does not taste right. But despite taste challenges and risk of losing consumers, over the last decade, in keeping with WHO’s Sustainability Development Goals, and to local government pressures to reduce sodium, the food industry has successfully reduced sodium levels in their food. However, “more” needs to be done, as:

  1. Reducing sodium intake is the most effective way to improve health and reduce the burden of noncommunicable diseases, especially cardiovascular diseases.
  2. A recent World Health Organization (WHO) Global report on sodium intake reduction showed that the world is off-track to achieve its global target of reducing sodium intake by 30% by 2025 (3). 

The European Food and Safety Administration and the WHO recommend potassium intake of over 3.5 g per day for adults (2).

And this “more” or additional effort to reduce sodium intake, may be possible with the use of low-sodium salt substitutes in place of regular salt. The most common salt substitute involves the partial replacement of common salt or sodium chloride, with potassium chloride (KCl).  A range of other formulations that deliver less sodium are also in use (3), but the advantage of using potassium, is that potassium has been known to lower blood pressure (3, 4, 5). Experts however, are concerned about excessive potassium intake due to increased risk of hyperkalaemia; and WHO is currently developing guidance on the use of low-sodium salt substitutes (3). 

Until WHO’s guidance is out, it is advisable to consider using salt substitutes especially potassium chloride salts in the formulation. Ingredient suppliers have been tweaking current salt substitutes to deliver better tasting, less bitter salt, but the cost may be higher, and will have to be factored into the overall cost. But, if all manufacturers begin to use these salts, a lower cost may be feasible due to economy of scale.

2. More vegetable and fruit-based food and beverages

Vegetables and fruits are a good source of potassium, and are probably the best way to fit the recommended level of potassium in consumers’ diet. 

The challenge however, is that globally vegetable and fruit intakes are below WHO’s daily 400g recommended level. As intake of 200g to 400g daily was observed to lower systolic blood pressure; and 400g or more was observed to reduce diastolic blood pressure (2), it is advisable to consider vegetable and fruit-based innovations, that can help consumers meet their daily vegetable and fruit recommendations, and fit more potassium into their diets. With more people working from and eating at home, ready-to-eat and drink vegetable and fruit-based food and shakes, and frozen vegetable and fruit mixes may appeal to consumers.

As part of a healthy diet low in fat, sugars and sodium, WHO suggests consuming more than 400 grams of fruits and vegetables per day to improve overall health and reduce the risk of certain noncommunicable diseases (2).

More recently, researchers have determined the blood pressure lowering properties of nitrates in beetroot juice (6), and this impact was enhanced with the addition of grapefruit juice (7). Regular consumption of pomegranate juice, a polyphenol-rich fruit juice with high antioxidant capacity, has also been seen to lower blood pressure (8).  Innovating with these three juices as the base is hence another important consideration, if you are innovating for hypertension alleviation.

3. Fiber up

Whole grains, vegetables, fruit, peas, beans, lentils and seeds are all rich in fiber. Fiber is fermented by the microbes in the gut and this results in the release of short-chain fatty acids, which support vasodilation. Vasodilation is the widening of blood vessels, as a result of the relaxation of the blood vessel’s muscular walls.  Hence, it is not surprising that a recent review of clinical studies has determined that short-chain fatty acids can help reduce systolic blood pressure (2). 

As inadequate (<20g / day) fibre consumption is a worldwide concern and often seen as a result of diets rich in processed foods and low in whole foods (2), from an innovation perspective, it is a good idea to fiber up either with the use of fiber-rich food or fiber-rich ingredients.

Fibre intake of 25–29 g/day may support a reduction in blood pressure, but more than 30 g/day is recommended for additional cardiovascular health benefits (2).

4. Include omega-3 fatty acids 

Evidence suggests that consumption of omega-3 fatty acids, found in fish, lowers blood pressure (BP), heart rate and triglycerides (9). A recent research study has determined that the intake of 2–3 g/day of omega-3 fatty acids has optimal BP-lowering effects and more than 3 g/ day might be beneficial for groups at higher risk of cardiovascular disease (10).

As consumption of omega-3 fatty acids is below recommended levels in a significant proportion of the population (11), innovations that include omega-3 fatty acids can definitely help. A range of omega-3 fatty acid ingredient options exist in the market today. Choose one that best matches your overall concept, does not adversely impact taste and smell (fishy odour), is affordable and stable in your formulation.

In Summary

As 33% of the global adult population has hypertension, there is a definite demand for food and beverages that can help alleviate hypertension. Some considerations for these innovations include: sodium reduced products, made with potassium-based salt substitutes; convenient, ready-to-eat vegetable and fruit-based products, which will motivate consumers to eat more vegetables and fruit, and consume more natural potassium; food or beverages with more fibre-rich food or ingredients, to feed the gut bacteria, and produce blood pressure lowering short-chain fatty acids; and addition of omega-3 fatty acids. While not all of these recommendations may fit into one formulation, do consider which one / ones best match your current product pipeline.

Sources:

  1. First WHO report details devastating impact of hypertension and ways to stop it
  2. Charchar FJ, Prestes PR, Mills C, Ching SM, Neupane D, Marques FZ, Sharman JE, Vogt L, Burrell LM, Korostovtseva L, Zec M, Patil M, Schultz MG, Wallen MP, Renna NF, Islam SMS, Hiremath S, Gyeltshen T, Chia YC, Gupta A, Schutte AE, Klein B, Borghi C, Browning CJ, Czesnikiewicz-Guzik M, Lee HY, Itoh H, Miura K, Brunström M, Campbell NRC, Akinnibossun OA, Veerabhadrappa P, Wainford RD, Kruger R, Thomas SA, Komori T, Ralapanawa U, Cornelissen VA, Kapil V, Li Y, Zhang Y, Jafar TH, Khan N, Williams B, Stergiou G, Tomaszewski M. Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension. J Hypertens. 2024 Jan 1;42(1):23-49. doi: 10.1097/HJH.0000000000003563. Epub 2023 Sep 12. PMID: 37712135; PMCID: PMC10713007.
  3. Review of contextual factors to inform the development of the WHO guideline on the use of low-sodium salt substitutes
  4. Binia A, Jaeger J, Hu Y, Singh A, Zimmermann D. Daily potassium intake and sodium-to-potassium ratio in the reduction of blood pressure: a meta-analysis of randomized controlled trials. J Hypertens. 2015;33(8):1509–20 (https://pubmed.ncbi.nlm.nih.gov/26039623/.).
  5. Filippini T, Violi F, D’Amico R, Vinceti M. The effect of potassium supplementation on blood pressure in hypertensive subjects: A systematic review and meta-analysis. Int J Cardiol. 2017;230:127–35 (https://www.internationaljournalofcardiology.com/article/S0167-5273(16)34536-3/fulltext).
  6. Benjamim CJR, Porto AA, Valenti VE, Sobrinho A, Garner DM, Gualano B, Bueno Junior CR. Nitrate Derived from Beetroot Juice Lowers Blood Pressure in Patients with Arterial Hypertension: A Systematic Review and Meta-Analysis. Front Nutr. 2022; 9:823039.
  7. O’Gallagher K, Borg Cardona S, Hill C, Al-Saedi A, Shahed F, Floyd CN, et al. Grapefruit juice enhances the systolic blood pressure-lowering effects of dietary nitrate-containing beetroot juice. Br J Clin Pharmacol 2021; 87:577–587.
  8. Cicero AFG, Grassi D, Tocci G, Galletti F, Borghi C, Ferri C. Nutrients and Nutraceuticals for the Management of High Normal Blood Pressure: An Evidence-Based Consensus Document. High Blood Press Cardiovasc Prev 2019; 26:9–25
  9. Nestel PJ, Beilin LJ, Clifton PM, Watts GF, Mori TA. Practical Guidance for Food Consumption to Prevent Cardiovascular Disease. Heart Lung Circ 2021; 30:163–179. 121. Zhang X, Ritonja JA, Zhou N, Chen BE, Li X.
  10. Omega-3 Polyunsaturated Fatty Acids Intake and Blood Pressure: A Dose-Response Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc 2022; 11: e025071. 122. Bao DQ, Mori TA, Burke V, Puddey IB, Beilin LJ. Effects of dietary fish and weight reduction on ambulatory blood pressure in overweight hypertensives. Hypertension 1998; 32:710–717.
  11. Jayedi A, Shab-Bidar S. Fish Consumption and the Risk of Chronic Disease: An Umbrella Review of Meta-Analyses of Prospective Cohort Studies. Adv Nutr 2020; 11:1123–1133.

VeVeva Nutrition Pte Ltd established in 2019, is a nutrition consultancy for the food and beverage industry, individuals and groups. We provide holistic nutrition consultancy for innovations, communications and product promotions, from concept to launch. For more information, email: yashna.harjani@vevevanutrition.com.

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