ABC | Volume 113, Nº4, October 2019

Updated Updated Cardiovascular Prevention Guideline of the Brazilian Society Of Cardiology – 2019 Arq Bras Cardiol. 2019; 113(4):787-891 Chart 5.2 – Dietary supplements and interventions with evidence of a potential reducing effect on blood pressure Recommendation supplement or intervention SBP/DBP reduction Recommendation grade Level of evidence Reference Potassium: 90-120 mmol/day SBP/DBP= -5.3/-3.1 mmHg IIa A 166 Vitamin C: 500 mg/day SBP/DBP= -4.9/-1.7 mmHg IIa A 166 Bioactive peptides: 2.6-1500 mg/day SBP/DBP = -5.3/-2.4 mmHg I A 166 Garlic: 12.3-2400 mg/day SBP/DBP= -4.6/-2.4 mmHg I A 166 Dietary fiber: 11.5 g/day SBP/DBP= -2.4/-1.8 mmHg I A 166 Linseed: 28-60 g/day (crushed) SBP/DBP= -2.9/-2.4 mmHg IIb B 166 Dark chocolate: 46-100 g/day SBP/DBP= -2.9/-2.4 mmHg I B 166 Soybean: substituting 25g of dietary protein SBP -10%, DBP -7% IIa B 166 Organic nitrates: 15.5 ± 9.2 mmol +140-500 mL of beet juice/day SBP/DBP= -4.4/-1.1 mmHg IIb B 166 Omega-3: 3 to 4 g/day SBP/DBP= -4.5/-3.1 mmHg I A 166 Weight loss: - 5.8% / SBP/DBP= -4.4/-3.6 mmHg I A 166 Reduced alcohol consumption: - 67% / SBP/DBP= 3.9/2.4 mmHg IIa B 166 DBP: diastolic blood pressure; SBP: systolic blood pressure. Adapted from reference. 166 Chart 5.1 – Methods and characteristics of dietary interventions proposed to prevent and control arterial hypertension a. DASH: high consumption of vegetables and fruits, low-fat dairy products, whole grains, and low sodium intake b. Mediterranean: high consumption of fruits, vegetables, olive oil, legumes, cereals, fish, and moderate intake of red wine during meals c. Low-carbohydrate: < 25% of carbohydrates in the total energy intake; high consumption of animal and/or plant protein; in many cases, it has a high intake of fat d. Paleolithic: lean meat, fish, fruits, leafy and cruciferous vegetables, tubers, eggs, and nuts, excluding dairy products, cereal grains, beans, refined fats, sugar, sweets, soft drinks, beer, and extra salt e. Moderate carbohydrate: 25 to 45% of carbohydrates in the total energy intake; 10 to 20% of protein consumption f. High-protein: > 20% of protein in the total energy intake; high consumption of animal and/or plant protein; < 35% of fat g. Nordic: wholegrain products, plenty of fruits and vegetables, rapeseed oil, three fish meals per week, low-fat dairy products, no sugary foods h. Tibetan: foods rich in protein and vitamins, preferably cooked and hot i. Low-fat: < 30% of fat in the total energy intake; high consumption of cereals and grains; 10-15% of protein j. Low-glycemic index: low-glycemic load k. Vegetarian/vegan: without meat and fish/without animal products l. Low-sodium: less than 2 g of sodium/day Adapted from reference. 165 SBP (-8,73 to -2,32 mmHg) and DBP (-4,85 to -1,27 mmHg) compared to the control diet. 165 Regarding food supplements, several meta-analyses have evaluated the potential effects of additives on BP reduction with supplementation of certain substances in populations of individuals with NT, PH, and AH. 166 The effects of these supplements on BP reduction are usually mild, heterogeneous, and their statistical significance is difficult to assess. The substances whose supplementation has evidence of significant BP reduction are: potassium, vitamin C, food-derived bioactive peptides, garlic, dietary fiber, linseed, dark chocolate (cocoa), soy, organic nitrates, and omega-3. 167 Chart 5.2 shows the recommended mean daily portions, their potential impact on BP, the level of evidence, and the recommendation grade of each of these supplements, as well as other food interventions. Supplementation with calcium, magnesium, combined vitamins, tea, and coenzyme Q10 did not present a significant BP reduction. 168 5.5. Alcohol and Hypertension The relationship between alcohol consumption and hypertension is known since 1915, when a pioneer publication reported this association. 169 Several epidemiological studies corroborate the almost linear and dose-dependent relationship between alcohol and AH. 170 The difficulty in determining the effect of alcohol on the development of AH is the difference in the quantification of the 814