Effect of dietary pulses on blood pressure: a systematic review and meta-analysis of controlled feeding trials

Viranda H Jayalath, Russell J de Souza, John L Sievenpiper, Vanessa Ha, Laura Chiavaroli, Arash Mirrahimi, Marco Di Buono, Adam M Bernstein, Lawrence A Leiter, Penny M Kris-Etherton, Vladimir Vuksan, Joseph Beyene, Cyril W C Kendall, David J A Jenkins, Viranda H Jayalath, Russell J de Souza, John L Sievenpiper, Vanessa Ha, Laura Chiavaroli, Arash Mirrahimi, Marco Di Buono, Adam M Bernstein, Lawrence A Leiter, Penny M Kris-Etherton, Vladimir Vuksan, Joseph Beyene, Cyril W C Kendall, David J A Jenkins

Abstract

Background: Current guidelines recommend diet and lifestyle modifications for primary prevention and treatment of hypertension, but do not encourage dietary pulses specifically for lowering blood pressure (BP). To quantify the effect of dietary pulse interventions on BP and provide evidence for their inclusion in dietary guidelines, a systematic review and meta-analysis of controlled feeding trials was conducted.

Methods: MEDLINE, EMBASE, Cochrane Library, and CINAHL were each searched from inception through 5 May 2013. Human trials ≥3 weeks that reported data for systolic, diastolic, and/or mean arterial BPs were included. Two reviewers independently extracted data and assessed methodological quality and risk of bias of included studies. Effect estimates were pooled using random effects models, and reported as mean differences (MD) with 95% confidence intervals (CIs). Heterogeneity was assessed (χ(2) test) and quantified (I(2)).

Results: Eight isocaloric trials (n = 554 participants with and without hypertension) were included in the analysis. Dietary pulses, exchanged isocalorically for other foods, significantly lowered systolic (MD = -2.25 mm Hg (95% CI, -4.22 to -0.28), P = 0.03) and mean arterial BP (MD = -0.75 mm Hg (95% CI, -1.44 to -0.06), P = 0.03), and diastolic BP non-significantly (MD = -0.71 mm Hg (95% CI, -1.74 to 0.31), P = 0.17). Heterogeneity was significant for all outcomes.

Conclusions: Dietary pulses significantly lowered BP in people with and without hypertension. Higher-quality large-scale trials are needed to support these findings.

Clinical trial registration: NCT01594567.

Keywords: blood pressure; dietary pulses; guidelines.; hypertension; legumes; meta analysis.

Figures

Figure 1.
Figure 1.
Flow diagram of the literature search. The search identified 341 reports, 326 of which were determined to be irrelevant based on review of titles and abstracts. The remaining 15 reports were reviewed in full. Eight reports providing data for 8 trials of isocaloric comparisons were included in the analysis.
Figure 2.
Figure 2.
Forest plot of clinical trials investigating the effect of isocaloric exchange of dietary pulses for other adequate comparators on systolic blood pressure (SBP; 2.1), diastolic blood pressure (DBP; 2.2), and mean arterial pressure (MAP; 2.3). The pooled effect estimate is represented as a diamond. Data are represented as mean differences (MDs) with 95% confidence intervals (CIs). P values are for generic inverse variance random effects models. Interstudy heterogeneity was assessed via Cochrane Q (χ2) at a significance level of P <0.10 and quantified by I2, where I2 >50% was considered to be evidence of substantial heterogeneity.

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