ReviewPrevention of fructose-induced hypertension by dietary vitamins
Introduction
There is increasing evidence that glucose intolerance and insulin resistance play a key role in the pathogenesis of essential hypertension in humans. Abnormalities in glucose utilization are estimated to exist in 25% of the general population and in up to 80% of persons with essential hypertension [1], [2], [3]. Insulin resistance is characterized by an inadequate glucose uptake in peripheral tissues at a given concentration of plasma insulin and impairment of the non-oxidative pathway of intracellular glucose metabolism [2]. A diet high in sucrose or fructose sweeteners often used in beverages and processed foods, can give rise to hyperinsulinemia, insulin resistance, hypertriglyceridemia and elevated blood pressure, particularly in susceptible individuals [1], [4], [5], [6]. Fructose-induced hypertension in rats represents an acquired model of such insulin resistance [7], [8], [9], [10], [11]. Insulin resistance is also a feature found in spontaneously hypertensive rats (SHR), a genetic model of hypertension [12], [13], [14].
Altered glucose metabolism due to insulin resistance leads to excess levels of tissue aldehydes. It has been suggested that excess endogenous aldehydes play a major role in hypertension by binding sulfhydryl groups of membrane proteins, altering Ca2+ channels and increasing cytosolic free calcium, peripheral vascular resistance and blood pressure [15], [16], [17], [18]. Fructose-induced hypertensive Wistar–Kyoto (WKY) rats have been shown to have hyperinsulinemia, hypertriglyceridemia and both elevated tissue aldehydes and elevated cytosolic free Ca2+ [19].
The purpose of this review is to describe the consequences of a high sucrose or fructose diet in animal models and in humans, to examine the mechanism of sucrose- or fructose-induced hypertension and to give evidence for the effectiveness of some dietary supplements to decrease elevated tissue aldehydes, improve glucose metabolism and lower blood pressure in insulin resistance hypertension. We will discuss the possible roles of vitamin B6, vitamin C, vitamin E and lipoic acid.
Section snippets
Evidence for sucrose- or fructose-induced hypertension in animal models
Rats given a diet high in fructose have elevated fasting insulin and glucose, elevated insulin response to oral glucose load, significantly elevated triglycerides and elevated blood pressure [7], [8], [9], [10]. Similar hyperinsulemia, hypertriglyceridemia and hypertension have also been demonstrated in dogs fed a high fructose diet [20]. Vasdev et al. [19] have shown that WKY rats develop hyperinsulemia and hypertension associated with renal arterial hyperplasia when consuming a diet with only
Role of aldehydes in hypertension
Aldehydes react nonenzymatically with sulfhydryl and amino groups of proteins and inhibit their function. Protein sulfhydryl groups are necessary for the proper functioning of L-type calcium channels [41], [42]. Disruption of vascular calcium channels by aldehyde binding to critical sulfhydryl groups can raise cytosolic free calcium levels and lead to increased peripheral vascular resistance and hypertension [17], [18]. Excess metabolic aldehydes may also act through binding and inactivation of
Dietary management of hypertension
The DASH II trials emphasize a diet consisting of fruits and vegetables, low-fat dairy, high fibre grain, modest portions of lean meat and reduced salt. This study has important implications for practicing physicians in the dietary management of hypertension. Hypertensive patients on the DASH II diet had a reduction in mean systolic blood pressure of 11.5 mm Hg which is comparable to what can be achieved by antihypertensive drug therapy. This DASH II diet is low in simple sugars and this may be
Acknowledgements
We thank the Canadian Institutes of Health Research for financial support to carry out this study.
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