DOI QR코드

DOI QR Code

Flaxseed Lowers Blood Pressure in Hypertensive Subjects: A Meta-Analysis of Randomized Controlled Trials

  • Ezatollah Fazeli Moghadam (Nutritional Health Research Center, Lorestan University of Medical Sciences) ;
  • Leili Khaghani (Halal Research Center of IRI, Food and Drug Administration, Ministry of Health and Medical Education) ;
  • Parivash Shekarchizadeh-Esfahani (Department of General Courses, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences)
  • Received : 2024.03.25
  • Accepted : 2024.10.21
  • Published : 2024.10.30

Abstract

This systematic review and meta-analysis study aimed to evaluate the effectiveness of flaxseed supplementation on blood pressure (BP) in patients with hypertension based on the data from randomized clinical trials (RCTs). Three databases (PubMed [MEDLINE], Scopus, and ISI Web of Science) were searched from inception up to August 10, 2024. Relevant studies meeting our eligibility criteria were obtained. A random-effects model was used to estimate pooled weighted mean differences (WMDs) with 95% confidence intervals (CIs). The methodological quality of individual studies was assessed using the Cochrane Collaboration risk of bias tool. A total of 5 studies were included and analyzed using STATA software version 12. The results show that there is a significant decrease in systolic BP (WMD, -8.64 mmHg; 95% CI, -15.41 to -1.87; p ≤ 0.001) and diastolic BP (WMD, -4.87 mmHg; 95% CI, -8.37 to -1.37; p = 0.006) of patients with hypertension as compared to control groups. This study supported that flaxseed supplementation had favorable effects on BP control in hypertensive patients. It may be a promising adjuvant therapy for patients with hypertension.

Keywords

References

  1. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019;140:e596-646.
  2. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension. Arter Hypertens 2013;17:69-168.
  3. Park C, Wang G, Durthaler JM, Fang J. Cost-effectiveness analyses of antihypertensive medicines: a systematic review. Am J Prev Med 2017;53:S131-42.
  4. Croog SH, Levine S, Testa MA, Brown B, Bulpitt CJ, et al. The effects of antihypertensive therapy on the quality of life. N Engl J Med 1986;314:1657-64.
  5. Gay HC, Rao SG, Vaccarino V, Ali MK. Effects of different dietary interventions on blood pressure: systematic review and meta-analysis of randomized controlled trials. Hypertension 2016;67:733-9.
  6. Siervo M, Shannon O, Kandhari N, Prabhakar M, Fostier W, et al. Nitrate-rich beetroot juice reduces blood pressure in Tanzanian adults with elevated blood pressure: a double-blind randomized controlled feasibility trial. J Nutr 2020;150:2460-8.
  7. Filippou CD, Tsioufis CP, Thomopoulos CG, Mihas CC, Dimitriadis KS, et al. Dietary approaches to stop hypertension (DASH) diet and blood pressure reduction in adults with and without hypertension: a systematic review and meta-analysis of randomized controlled trials. Adv Nutr 2020;11:1150-60.
  8. Valenzuela PL, Carrera-Bastos P, Galvez BG, Ruiz-Hurtado G, Ordovas JM, et al. Lifestyle interventions for the prevention and treatment of hypertension. Nat Rev Cardiol 2021;18:251-75.
  9. De Pergola G, D'Alessandro A. Influence of Mediterranean diet on blood pressure. Nutrients 2018;10:1700.
  10. Borjesson M, Onerup A, Lundqvist S, Dahlof B. Physical activity and exercise lower blood pressure in individuals with hypertension: narrative review of 27 RCTs. Br J Sports Med 2016;50:356-61.
  11. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, et al. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation 2019;139:e56-528.
  12. Agrawal M, Nandini D, Sharma V, Chauhan NS. Herbal remedies for treatment of hypertension. Int J Pharm Sci Res 2010;1:1-21.
  13. Singh A, Kumar R, Sharma S. Natural products and hypertension: scope and role in antihypertensive therapy. Asia J Nurs Educ Res 2023;13:162-6.
  14. Al-Madhagy S, Ashmawy NS, Mamdouh A, Eldahshan OA, Farag MA. A comprehensive review of the health benefits of flaxseed oil in relation to its chemical composition and comparison with other omega-3-rich oils. Eur J Med Res 2023;28:240.
  15. Basch E, Bent S, Collins J, Dacey C, Hammerness P, et al. Flax and flaxseed oil (Linum usitatissimum): a review by the Natural Standard Research Collaboration. J Soc Integr Oncol 2007;5:92-105.
  16. Mueed A, Ibrahim M, Shibli S, Madjirebaye P, Deng Z, et al. The fate of flaxseed-lignans after oral administration: a comprehensive review on its bioavailability, pharmacokinetics, and food design strategies for optimal application. Crit Rev Food Sci Nutr 2024;64:4312-30.
  17. Nowak W, Jeziorek M. The role of flaxseed in improving human health. Healthcare (Basel) 2023;11:395.
  18. Hadi A, Askarpour M, Ziaei R, Venkatakrishnan K, Ghaedi E, et al. Impact of flaxseed supplementation on plasma lipoprotein(a) concentrations: a systematic review and meta-analysis of randomized controlled trials. Phytother Res 2020;34:1599-608.
  19. Musazadeh V, Abolghasemian M, Kavyani Z, Moridpour AH, Nazari A, et al. The effects of flaxseed (Linum usitatissimum) supplementation on anthropometric indices: an updated systematic review and metaanalysis of randomized clinical trials. Complement Ther Med 2024;84:103066.
  20. Hadi A, Askarpour M, Salamat S, Ghaedi E, Symonds ME, et al. Effect of flaxseed supplementation on lipid profile: an updated systematic review and dose-response meta-analysis of sixty-two randomized controlled trials. Pharmacol Res 2020;152:104622.
  21. Hajiahmadi S, Khosravi M, Hosseinzadeh E, Hosseinzadeh M. Flaxseed and its products improve glycemic control: a systematic review and meta-analysis. Obes Med 2021;22:100311.
  22. Askarpour M, Karimi M, Hadi A, Ghaedi E, Symonds ME, et al. Effect of flaxseed supplementation on markers of inflammation and endothelial function: a systematic review and meta-analysis. Cytokine 2020;126:154922.
  23. Ahmed DH, Fateh HL. Impact of flaxseed supplementation on lipid profile and liver enzymes in patients with non-alcoholic fatty liver disease: systematic review and meta-analysis of randomized controlled trials. Prostaglandins Other Lipid Mediat 2024;173:106838.
  24. Musazadeh V, Jafarzadeh J, Keramati M, Zarezadeh M, Ahmadi M, et al. Flaxseed oil supplementation augments antioxidant capacity and alleviates oxidative stress: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med 2021;2021:4438613.
  25. Haghighatsiar N, Askari G, Saraf-Bank S, Feizi A, Keshmiri H. Effect of flaxseed powder on cardiovascular risk factor in dyslipidemic and hypertensive patients. Int J Prev Med 2019;10:218.
  26. Rodriguez-Leyva D, Weighell W, Edel AL, LaVallee R, Dibrov E, et al. Potent antihypertensive action of dietary flaxseed in hypertensive patients. Hypertension 2013;62:1081-9.
  27. Toulabi T, Yarahmadi M, Goudarzi F, Ebrahimzadeh F, Momenizadeh A, et al. Effects of flaxseed on blood pressure, body mass index, and total cholesterol in hypertensive patients: a randomized clinical trial. Explore (NY) 2022;18:438-45.
  28. Verma R, Singh B, Rauniyar GP, Koirala B, Sharma SK, et al. Effects of flaxseed on blood pressure in patients taking antihypertensive drugs: a randomized trial. Nepalese Heart Journal 2024;21:11-9.
  29. Yang B, Shi L, Wang AM, Shi MQ, Li ZH, et al. Lowering effects of n-3 fatty acid supplements on blood pressure by reducing plasma angiotensin II in inner Mongolia hypertensive patients: a double-blind randomized controlled trial. J Agric Food Chem 2019;67:184-92.
  30. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264-9.
  31. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
  32. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.1.0 [updated March 2011]. Available from https://handbook-5-1.cochrane.org/ [cited 2024 July 2]. 2011.
  33. Khalesi S, Irwin C, Schubert M. Flaxseed consumption may reduce blood pressure: a systematic review and meta-analysis of controlled trials. J Nutr 2015;145:758-65.
  34. Mahmudiono T, Jasim SA, Karim YS, Bokov DO, Abdelbasset WK, et al. The effect of flaxseed oil consumtion on blood pressure among patients with metabolic syndrome and related disorders: a systematic review and meta-analysis of randomized clinical trials. Phytother Res 2022;36:3766-73.
  35. Ursoniu S, Sahebkar A, Andrica F, Serban C, Banach M, et al. Effects of flaxseed supplements on blood pressure: a systematic review and meta-analysis of controlled clinical trial. Clin Nutr 2016;35:615-25.
  36. Li L, Li H, Gao Y, Vafaei S, Zhang X, et al. Effect of flaxseed supplementation on blood pressure: a systematic review, and dose-response meta-analysis of randomized clinical trials. Food Funct 2023;14:675-90.
  37. Caligiuri SP, Edel AL, Aliani M, Pierce GN. Flaxseed for hypertension: implications for blood pressure regulation. Curr Hypertens Rep 2014;16:499.
  38. Oyedepo TA, Palai S. Chapter 6 - Herbal remedies, toxicity, and regulations. In: Egbuna C, Prakash Mishra A, Goyal MR, editors. Preparation of phytopharmaceuticals for the management of disorders: the development of nutraceuticals and traditional medicine. San Diego: Academic Press; 2021. p. 89-127.
  39. Kamyab R, Namdar H, Torbati M, Ghojazadeh M, Araj-Khodaei M, et al. Medicinal plants in the treatment of hypertension: a review. Adv Pharm Bull 2021;11:601-17.
  40. Matole V, Thorat Y, Ghurghure S, Ingle S, Birajdar A, et al. A brief review on herbal medicines. Res J Pharmacogn Phytochem 2021;13:101-2.
  41. Shayan M, Kamalian S, Sahebkar A, Tayarani-Najaran Z. Flaxseed for health and disease: review of clinical trials. Comb Chem High Throughput Screen 2020;23:699-722.
  42. Mueed A, Shibli S, Jahangir M, Jabbar S, Deng Z. A comprehensive review of flaxseed (Linum usitatissimum L.): health-affecting compounds, mechanism of toxicity, detoxification, anticancer and potential risk. Crit Rev Food Sci Nutr 2023;63:11081-104.