Wetenschappelijke informatie over een hoge bloeddruk

Het gebruik van natuurlijke middelen bij de behandeling van hoge bloeddruk (hypertensie)

1. The natural treatment of hypertension
   For the purpose of this review, dietary supplements are defined as exhibiting some evidence of benefit if a systolic blood pressure reduction of 9.0 mm Hg or greater and/or a diastolic blood pressure reduction of 5.0 mm Hg or greater has been observed in previously published, peer-reviewed trials. These defining limits are based on the average blood pressure reduction associated with the implementation of certain lifestyle modifications. Agents with some evidence of benefit include coenzyme Q10, fish oil, garlic, vitamin C, and L-arginine.
2. Dietary modulation of endothelial function: implications for cardiovascular disease
   Emerging evidence suggests an important role of dietary factors in modulating endothelial function. In particular, n-3 fatty acids, antioxidant vitamins (especially vitamins E and C), folic acid, and L-arginine appear to have beneficial effects on vascular endothelial function, either by decreasing endothelial activation or by improving endothelium-dependent vasodilation in patients at high risk of cardiovascular disease as well as in healthy subjects.
3. Dietary Approaches to Prevent and Treat Hypertension
   A substantial body of evidence strongly supports the concept that multiple dietary factors affect blood pressure (BP). Well-established dietary modifications that lower BP are reduced salt intake, weight loss, and moderation of alcohol consumption (among those who drink). Over the past decade, increased potassium intake and consumption of dietary patterns based on the "DASH diet" have emerged as effective strategies that also lower BP.

Het gebruik van knoflook bij de behandeling van hoge bloeddruk (hypertensie)

1. Hypotensive effect of long-acting garlic tablets allicor (a double-blind placebo-controlled trial)
   Allicor is more effective than kwai in reduction of diastolic blood pressure. It can be recommended as a hypotensive treatment in mild and moderate arterial hypertension.
2. A meta-analysis of the effect of garlic on blood pressure
   The results suggest that this garlic powder preparation may be of some clinical use in subjects with mild hypertension. However, there is still insufficient evidence to recommend it as a routine clinical therapy for the treatment of hypertensive subjects. More-rigorously designed and analysed trials are needed.
3. Can garlic lower blood pressure? A pilot study
   A popular garlic preparation containing 1.3% allicin at a large dose (2400 mg) was evaluated in this open-label study in nine patients with rather severe hypertension (diastolic blood pressure > or = 115 mm Hg). Sitting blood pressure fell 7/16 (+/- 3/2 SD) mm Hg at peak effect approximately 5 hours after the dose, with a significant decrease in diastolic blood pressure (p < 0.05) from 5-14 hours after the dose. No significant side effects were reported. Our results indicate that this garlic preparation can reduce blood pressure. Further controlled studies are needed, particularly with more conventional doses (e.g., < or = 900 mg/day), in patients with mild to moderate hypertension and under placebo-controlled, double-blind conditions.
4. Garlic supplementation prevents oxidative DNA damage in essential hypertension
   These findings point out the beneficial effects of garlic supplementation in reducing blood pressure and counteracting oxidative stress, and thereby, offering cardioprotection in essential hypertensives.

Het gebruik van magnesium bij de behandeling van hoge bloeddruk (hypertensie)

1. Effects of magnesium on blood pressure and intracellular ion levels of Brazilian hypertensive patients
   These data showed that oral magnesium supplementation may reduce the blood pressure, which can be partially explained by the decrease in intracellular sodium and augment in intracellular magnesium.
2. Reduction in blood pressure with a low sodium, high potassium, high magnesium salt in older subjects with mild to moderate hypert
   Replacing common sodium salt by a low sodium, high potassium, high magnesium mineral salt could offer a valuable non-pharmacological approach to lowering blood pressure in older people with mild to moderate hypertension
3. Nutritional dose of magnesium in hypertensive patients on beta blockers lowers systolic blood pressure: a double-blind, cross-over study
   This study showed that 15 mmol magnesium day-1 given to mild to moderate hypertensive patients treated with beta blockers could be the cause of a significant decrease in supine and standing systolic blood pressure
4. Reduction of blood pressure with oral magnesium supplementation in women with mild to moderate hypertension
   The findings suggest that oral supplementation with magnesium aspartate-HCl may lower blood pressure in subjects with mild to moderate hypertension
5. The dose-dependent reduction in blood pressure through administration of magnesium. A double blind placebo controlled cross-over study
   Seventeen patients with a diastolic blood pressure over 90 mm Hg were recruited from a running health screening program to participate in a double blind cross-over study of magnesium supplementation (15 mmol Mg2+/day (Emgesan, Kabi Pharmacia) for 3 weeks, followed by 30 mmol Mg2+/day for another 3 weeks, finishing with 40 mmol Mg2+/day for a final 3 weeks). A significant decrease in the mean systolic blood pressure was recorded from 154.0 +/- 10.7 mm Hg to 146.1 +/- 16.9 mm Hg (P = .031) while the mean diastolic blood pressure decreased from 100.2 +/- 4.2 mm Hg to 92.0 +/- 6.6 mm Hg (P = .0001).
6. Magnesium and hypertension
   Magnesium status has a direct effect upon the relaxation capability of vascular smooth muscle cells and the regulation of the cellular placement of other cations important to blood pressure - cellular sodium:potassium (Na:K) ratio and intracellular calcium (iCa(2+)). As a result, nutritional magnesium has both direct and indirect impacts on the regulation of blood pressure and therefore on the occurrence of hypertension.

Het gebruik van kalium bij de behandeling van hoge bloeddruk (hypertensie)

1. Efficacy of potassium and magnesium in essential hypertension: a double-blind, placebo controlled, crossover study
   Potassium 60 mmol/day lowers arterial blood pressure in patients with mild hypertension. Giving magnesium as well has no added advantage.
2. Long-term potassium supplementation lowers blood pressure in elderly hypertensive subjects
   Modest increases in dietary potassium intake could have significant effects on lowering BP in the large proportion of elderly subjects with hypertension.
3. Why and how to implement sodium, potassium, calcium, and magnesium changes in food items and diets?
   The present average sodium intakes, approximately 3000-4500 mg/day in various industrialised populations, are very high, that is, 2-3-fold in comparison with the current Dietary Reference Intake (DRI) of 1500 mg. The sodium intakes markedly exceed even the level of 2500 mg, which has been recently given as the maximum level of daily intake that is likely to pose no risk of adverse effects on blood pressure or otherwise. By contrast, the present average potassium, calcium, and magnesium intakes are remarkably lower than the recommended intake levels (DRI).
4. Potassium, magnesium, and electrolyte imbalance and complications in disease management
   Electrolyte balance is a critical issue in managing comorbid conditions in both diseased and elderly patients. Patients with hypertension and diabetes need careful regulation of their calcium and magnesium levels, whereas in patients with congestive heart failure, sodium and potassium levels also are critical.
5. The cardiovascular implications of hypokalemia
   The role of potassium in the progression of cardiovascular disease is complex and controversial. Animal and human data suggest that increases in dietary potassium, decreases in urinary potassium loss, or increases in serum potassium levels through other mechanisms have benefits in several disease states. These include the treatment of hypertension, stroke prevention, arrhythmia prevention, and treatment of congestive heart failure.

Het gebruik van Q10 bij de behandeling van hoge bloeddruk (hypertensie)

1. Overview of the use of CoQ10 in cardiovascular disease
   Supplemental CoQ10 alters the natural history of cardiovascular illnesses and has the potential for prevention of cardiovascular disease through the inhibition of LDL cholesterol oxidation and by the maintenance of optimal cellular and mitochondrial function throughout the ravages of time and internal and external stresses.
2. Randomized, double-blind, placebo-controlled trial of coenzyme Q10 in isolated systolic hypertension
   Our results suggest CoQ may be safely offered to hypertensive patients as an alternative treatment option.
3. Can coenzyme Q10 improve vascular function and blood pressure? Potential for effective therapeutic reduction in vascular oxidative stress
   The limited data available from studies in animal models and from human intervention studies are generally consistent with a benefit of CoQ on vascular function and blood pressure. The observed effects of CoQ on these endpoints are potentially important therapeutically.
4. Co-enzyme Q10: a new drug for cardiovascular disease
   Co-enzyme Q10 (ubiquinone) is a naturally occurring substance which has properties potentially beneficial for preventing cellular damage during myocardial ischemia and reperfusion. It plays a role in oxidative phosphorylation and has membrane stabilizing activity. The substance has been used in oral form to treat various cardiovascular disorders including angina pectoris, hypertension, and congestive heart failure. Its clinical importance is now being established in clinical trails worldwide.
5. Overview of the use of CoQ10 in cardiovascular disease
   The clinical experience in cardiology with CoQ10 includes studies on congestive heart failure, ischemic heart disease, hypertensive heart disease, diastolic dysfunction of the left ventricle, and reperfusion injury as it relates to coronary artery bypass graft surgery.

Het gebruik van calcium bij de behandeling van hoge bloeddruk (hypertensie)

1. Calcium plus linoleic acid therapy for pregnancy-induced hypertension
   In pregnant women at high risk for PIH, calcium-CLA supplementation decreases the incidence of PIH and improves endothelial function.
2. Clinical observation of treatment of hypertension with calcium
   While the mechanism by which increased calcium intake lowers blood pressure in hypertension is still undetermined, these data support an underlying relationship between hypertension and calcium and possibly sodium metabolism.
3. Long-term oral calcium supplementation reduces diastolic blood pressure in end stage renal disease. A randomized, double-blind, placebo controlled study
   In conclusion, the treatment of secondary hyperparathyroidism with oral calcium gives good benefits in the regulation of diastolic blood pressure. A well controlled phosphate homeostasis may also be of importance for the control of blood pressure in haemodialysis patients.
4. Effect of an oral calcium supplement in the treatment of slight-to- moderate essential arterial hypertension
   During the administration of the oral calcium supplement, the BP decreased in an inverse proportion to the plasmatic renin and seric level of PTH.
5. Effect of oral calcium on blood pressure response in salt-loaded borderline hypertensive patients
   The results suggest that oral calcium supplementation may prevent a rise in blood pressure in patients on a high salt, low calcium diet by attenuating the sodium retention

Het gebruik van omega-3 vetzuren bij de behandeling van hoge bloeddruk (hypertensie)

1. A polyunsaturated fatty acid diet lowers blood pressure and improves antioxidant status in spontaneously hypertensive rats
   In hypertensive rats, GLA + EPA + DHA supplementation lowers blood pressure, enhances total anti-oxidant status and resistance to lipid peroxidation, diminishes platelet aggregation speed and lowers plasma lipid concentrations. Thus, it enhances protection against cardiovascular diseases. Therefore, nutritional recommendations for cardiovascular disease prevention should take into account the pharmacologic properties of GLA, EPA and DHA.
2. Effects of n-3 polyunsaturated fatty acids on glucose homeostasis and blood pressure in essential hypertension. A randomized, controlled trial
   Fish oil, in doses that reduce blood pressure and lipid levels in hypertensive persons, does not adversely affect glucose metabolism.

Het gebruik van vitamine C bij de behandeling van hoge bloeddruk (hypertensie)

1. Ascorbic acid improves the intrahepatic endothelial dysfunction of patients with cirrhosis and portal hypertension
   Ascorbic acid improved intrahepatic endothelial dysfunction, blunting the postprandial increase in portal pressure. These results encourage the performance of further studies testing antioxidants as adjunctive therapy in the treatment of portal hypertension.
2. Effect of vitamin C on ambulatory blood pressure and plasma lipids in older persons
   In older adults high intakes of ascorbic acid have modest effects on lowering high systolic blood pressure, which could contribute to the reported association between higher vitamin C intake and lower risk of cardiovascular disease and stroke.
3. Treatment of hypertension with ascorbic acid
   In a randomised, double-blind, placebo-controlled study we showed that treatment of hypertensive patients with ascorbic acid lowers blood pressure. Further studies of ascorbic acid to treat hypertension, with clinical endpoints, are warranted.
4. Vitamin C improves endothelial function of epicardial coronary arteries in patients with hypercholesterolaemia or essential hypertension--assessed by cold pressor testing
   The antioxidant vitamin C reverses cold pressor test-induced vasoconstriction of epicardial coronary arteries in patients with hypertension or hypercholesterolaemia. Our data suggest that enhanced oxidative stress contributes to impaired endothelial function in this patient population.
5. Vitamin C improves endothelial dysfunction of epicardial coronary arteries in hypertensive patients
   Vitamin C improves the endothelium-dependent vasomotor capacity of coronary arteries in patients with hypertension and patent coronary arteries. These findings suggest that increased oxidative stress contributes to endothelial dysfunction in hypertensive patients.
6. Combination oral antioxidant supplementation reduces blood pressure
   Short-term oral high-dose combination antioxidant therapy reduces blood pressure, possibly via increased availability of nitric oxide. This study may have implications for the innovative use of antioxidants as an adjunct to anti-hypertensive therapy.
7. Vitamin C improves endothelium-dependent vasodilation by restoring nitric oxide activity in essential hypertension
   In essential hypertensive patients, impaired endothelial vasodilation can be improved by the antioxidant vitamin C, an effect that can be reversed by the nitric oxide synthase inhibitor N(G)-monomethyl-L-arginine. These findings support the hypothesis that nitric oxide inactivation by oxygen free radicals contributes to endothelial dysfunction in essential hypertension.

Het gebruik van vitamine E bij de behandeling van hoge bloeddruk (hypertensie)

1. Vitamin E can reduce blood pressure in mild hypertensives
   It is concluded that a vitamin E supplement of 200 IU/day can be effective in mild hypertensive patients in the long term, probably due to nitric oxide, and improve their blood pressure status. Therefore, vitamin E supplement could be recommended to such patients.
2. Effect of vitamin E on resistance vessel endothelial dysfunction induced by methionine
   Experimentally increasing plasma homocysteine concentrations by oral methionine rapidly impairs resistance vessel endothelial function in healthy humans and this effect is reversed with administration of the fat-soluble antioxidant, vitamin E.
3. Baseline characteristics of participants in the Women's Health Study
   With adequate duration of treatment and follow-up, this trial will provide important and relevant information on the balance of benefits and risks of aspirin and vitamin E supplementation in the primary prevention of cardiovascular disease and cancer in women.
4. Are free radicals involved in the pathobiology of human essential hypertension?
   These results suggest that an increase in free radical generation and a simultaneous decrease in the production of nitric oxide and anti-oxidants such as SOD and vitamin E occurs in essential hypertension. This increase in free radical generation can inactivate prostacyclin and nitric oxide and decrease their half life which can lead to an increase in peripheral vascular resistance and hypertension.

Het gebruik van L-arginine bij de behandeling van hoge bloeddruk (hypertensie)

1. Oral L-arginine improves endothelial dysfunction in patients with essential hypertension
   Oral administration of L-arginine acutely improves endothelium-dependent, flow-mediated dilatation of the brachial artery in patients with essential hypertension. The long-term effects of L-arginine in these patients require further investigation.
2. Short-term oral administration of L-arginine improves hemodynamics and exercise capacity in patients with precapillary pulmonary hypertension
   These results suggest that oral supplementation of L-arginine may have beneficial effects on hemodynamics and exercise capacity in patients with precapillary pulmonary hypertension.
3. Prolonged L-arginine on cardiovascular mass and myocardial hemodynamics and collagen in aged spontaneously hypertensive rats and normal rats
   These findings demonstrated that L-arginine ameliorated adverse cardiovascular effects of hypertension in aged SHRs, as demonstrated by reduced arterial pressure and total peripheral resistance, diminished left ventricular mass and collagen content, and improved coronary hemodynamics. There were no important effects in the old WKYs.
4. Correction of endothelial dysfunction in chronic heart failure: additional effects of exercise training and oral L-arginine supplementation
   Dietary supplementation of L-arg. as well as regular physical exercise improved agonist-mediated, endothelium-dependent vasodilation to a similar extent. Both interventions together seem to produce additive effects with respect to endothelium-dependent vasodilation.
5. Exploring vascular benefits of endothelium-derived nitric oxide
   Because endothelial dysfunction and arterial stiffness play an integral part in the early atherosclerotic process and are associated with poor outcomes and increased mortality, independent of blood pressure, the ability of nebivolol to enhance release of endothelium-derived NO may have significant clinical implications for the use of this agent in the treatment of hypertension and CVD

Zout restictie bij de behandeling van hoge bloeddruk (hypertensie)

1. A further subgroup analysis of the effects of the DASH diet and three dietary sodium levels on blood pressure: results of the DASH-Sodium Trial
   Reduced sodium intake and the DASH diet should be advocated for the prevention and treatment of high BP, particularly because the benefits to BP strengthen as subjects enter middle age, when the rate of cardiovascular disease increases sharply.
2. Individual blood pressure responses to changes in salt intake: results from the DASH-Sodium trial
   These results show low-order consistency of response and confirm that identifying individuals as sodium responders is difficult. They support current recommendations for lower salt intake directed at the general public rather than "susceptible" individuals as one of several strategies to prevent and control adverse blood pressures widely prevalent in the adult population.
3. Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial
   The DASH diet plus reduced sodium intake is recommended to control blood pressure in diverse subgroups.
4. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group
   The reduction of sodium intake to levels below the current recommendation of 100 mmol per day and the DASH diet both lower blood pressure substantially, with greater effects in combination than singly. Long-term health benefits will depend on the ability of people to make long-lasting dietary changes and the increased availability of lower-sodium foods.

Life style changes bij de behandeling van hoge bloeddruk (hypertensie)

1. Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials
   Patients with elevated blood pressure should follow a weight-reducing diet, take regular exercise, and restrict alcohol and salt intake. Available evidence does not support relaxation therapies, calcium, magnesium or potassium supplements to reduce blood pressure.
2. Diet, blood pressure and hypertension
   Thus the Dietary Approaches to Stop Hypertension (DASH) demonstrates that a diet rich in fruits, vegetables, low-fat dairy products, fibre and minerals (calcium, potassium and magnesium) produces a potent antihypertensive effect. Such a diet is not very restrictive and should not produce compliance problems.

Vermindering van overgewicht bij de behandeling van hoge bloeddruk (hypertensie)

1. Obesity and cardiovascular disease: pathogenic mechanisms and potential benefits of weight reduction
   The prevalence of obesity in industrialized countries has reached epidemic proportions, with about one in three people being obese and another one in three people being overweight and at risk of developing obesity. In recent years, obesity has gained the traditional tetrad of cardiovascular risk factors of smoking: hypertension, dyslipidemia, and dysglycemia.
2. Emerging concepts in the pathophysiology and treatment of obesity-associated hypertension
   Although understanding of the pathophysiology of obesity-associated hypertension has made substantial progress during the past years, treatment of obese hypertensives remains largely empirical and clearly deserves to be addressed in larger randomized, controlled trials.
3. Obesity and hypertension: epidemiological and clinical issues
   Overall, the results of the trials indicate that weight reduction lowers blood pressure over intervals of up to one year. The magnitude of the blood pressure response appears to be directly proportional to the amount of weight loss achieved.
4. Obstructive sleep apnea: implications for cardiac and vascular disease
   Obstructive sleep apnea is common, readily diagnosed, and usually treatable. It frequently coexists undiagnosed in patients with cardiovascular disease, activates disease mechanisms known to elicit cardiac and vascular damage, and may be implicated in progression of cardiovascular disease and resistance to conventional therapeutic strategies. In the absence of definitive evidence from large-scale trials and a better understanding of potential cost-effectiveness, the likely benefits of diagnosis and treatment of OSA are presently best appraised on an individualized patient basis

De behandeling van hoge bloeddruk (hypertensie) gedurende zwangerschap

Calcium

1. Calcium supplementation to prevent pre-eclampsia--a systematic review
   Calcium supplementation appears to be beneficial for women at high risk of gestational hypertension and in communities with low dietary calcium intake. These benefits were confined to several rather small trials, and were not found in the largest trial to date, conducted in a low-risk population. Further research is required.
2. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems
   Calcium supplementation appears to be beneficial for women at high risk of gestational hypertension and in communities with low dietary calcium intake. Optimum dosage requires further investigation.
3. Calcium supplementation in nulliparous women for the prevention of pregnancy-induced hypertension, preeclampsia and preterm birth: an Australian randomized trial. FRACOG and the ACT Study Group
   Calcium supplementation during pregnancy reduced the risk of preeclampsia and preterm birth in this nulliparous population. The available evidence for systematic review of all the randomized trials of calcium supplementation shows benefit in reducing the risk of hypertension and preeclampsia.
4. Effect of calcium supplementation on pregnancy-induced hypertension and preeclampsia: a meta-analysis of randomized controlled trials
   Calcium supplementation during pregnancy leads to an important reduction in systolic and diastolic blood pressure and preeclampsia. While pregnant women at risk of preeclampsia should consider taking calcium, many more patient events are needed to confirm calcium's impact on maternal and fetal morbidity
5. Preliminary evidence of the effect of calcium supplementation on blood pressure in normal pregnant women
   The supplemented groups had significantly lower diastolic blood pressure than the control subjects between the twentieth and twenty-fourth weeks of gestation. Thereafter, an increase in the control group and the group receiving 1 gm of calcium was observed, but levels were similar at term. On the contrary, patients receiving 2 gm of calcium had blood pressure values that remained significantly lower throughout the third trimester. No differences or clear patterns were observed in the blood levels of calcium, magnesium, phosphorus, and proteins between and within groups during gestation. A possible explanation involving parathyroid hormone is attempted.

Knoflook

1. Garlic increases IL-10 and inhibits TNFalpha and IL-6 production in endotoxin-stimulated human placental explants
   Garlic resulted in an increase in IL-10 production at lower doses (normal explants only) and inhibition of the production of IL-10 at higher doses (normal and preeclamptic explants). Garlic also resulted in a dose-dependent reduction of IL-6 and TNFalpha. Initially there was no change in sTRAIL production; however, at the highest garlic concentrations there was a significant increase in production. We thus conclude that garlic may have an immunomodulatory effect on normal and preeclamptic placentas
2. The effect of garlic tablet on plasma lipids and platelet aggregation in nulliparous pregnants at high risk of preeclampsia.
   The administration of 800mg/day of Garlet during the third trimester of pregnancy was effective in reducing the occurrence of hypertension alone, but it was no effective in preventing of preeclampsia.

Magnesium

1. Oral low-dose magnesium gluconate preventing pregnancy induced hypertension
   Low-dose magnesium gluconate may efficiently prevent PIH in high risk women. The mechanism of action of magnesium gluconate probably involves to keep the balance of PGI2 and TXA2, but not associates with serum magnesium level.
2. The effect of magnesium on maternal blood pressure in pregnancy-induced hypertension. A randomized double-blind placebo-controlled trial
   Unbalanced analyses of variance suggested an influence of magnesium supplement on birth weight. The infants in the magnesium supplemented group spent fewer days in the neonatal intensive care unit. There were no perinatal deaths. Magnesium appeared to be beneficial in the management of pregnancy-induced hypertension. The better outcome associated with magnesium supplementation may not have been due to reduction of MAP and further studies are needed to clarify whether magnesium influences birth weight.
3. Magnesium supplement in pregnancy-induced hypertension. A clinicopathological study
   The present study suggests that magnesium supplement has a beneficial effect on fetal growth in pregnancy-induced hypertension. With regard to the light and electron microscopic changes we were unable to demonstrate any significant difference between the magnesium, placebo and control groups.

Vitamine C en E

1. Dietary intake of vitamin C and vitamin E and the development of hypertensive disorders of pregnancy
   Little support was found for a relationship between dietary intake of vitamin C and the development of hypertensive disorders of pregnancy. Low vitamin E intake was associated with a significant increase in the risk of hypertensive disorders of pregnancy, even after adjustments were made for confounding factors. Further research is required to investigate whether supplementation above dietary intake of antioxidant vitamins influences the risk of hypertensive disorders of pregnancy.
2. Increased oxidative stress in women with pregnancy-induced hypertension
   The findings in the present research suggest that pregnancy-induced hypertension can increase oxidative stress and potential free radical damage in women with pregnancy-induced hypertension.
3. Vitamin C and E supplementation in women at high risk for preeclampsia: a double-blind, placebo-controlled trial
   The potential benefit of vitamin C and E supplementation to prevent preeclampsia in women with clinical risk factors is smaller than we estimated. Future studies of antioxidant vitamin supplementation in this population will require more than 500 women in each arm.
4. Effect of antioxidants on the occurrence of pre-eclampsia in women at increased risk: a randomised trial
   Supplementation with vitamins C and E may be beneficial in the prevention of pre-eclampsia in women at increased risk of the disease. Multicentre trials are needed to show whether vitamin supplementation affects the occurrence of pre-eclampsia in low-risk women and to confirm our results in larger groups of high-risk women from different populations.
5. Vitamin C and E supplementation in women at risk of preeclampsia is associated with changes in indices of oxidative stress and placental function
   Antioxidant supplementation in women who were at risk of preeclampsia was associated with improvement in biochemical indices of the disease.
6. Effect of antioxidants on the occurrence of pre-eclampsia in women at increased risk: a randomised trial
   Supplementation with vitamins C and E may be beneficial in the prevention of pre-eclampsia in women at increased risk of the disease. Multicentre trials are needed to show whether vitamin supplementation affects the occurrence of pre-eclampsia in low-risk women and to confirm our results in larger groups of high-risk women from different populations.

Omega-3

1. Long-chain polyunsaturated fatty acid requirements during pregnancy and lactation
   From a functional standpoint, the results of randomized clinical studies suggest that n-3 LCPUFA supplementation during pregnancy does not affect the incidences of pregnancy-induced hypertension and preeclampsia without edema. However, n-3 LCPUFA supplementation may cause modest increases in the duration of gestation, birth weight, or both. To date, there is little evidence of harm as a result of n-3 LCPUFA supplementation during either pregnancy or lactation.
2. Women and omega-3 Fatty acids
   Supplementation with omega-3 FA during pregnancy lowers the risk of premature birth and can increase the length of pregnancy and birth weight by altering the balance of eicosanoids involved in labor and promote fetal growth by improving placental blood flow. Intake of omega-3 FA during pregnancy and breast feeding may facilitate the child's brain development. There is also some evidence that supplementation with omega-3 FA might help to prevent preeclampsia, postpartum depression, menopausal problems, postmenopausal osteoporosis, and breast cancer.
3. Long chain polyunsaturated fatty acids improve cognitive development
   Docosahexaenoic acid (DHA, an Omega-3 fatty acid) and arachindonic acid (AA, an Omega-6 fatty acid) are long-chain polyunsaturated fatty acids (LCPs) that are important for cognitive development. Research has shown that LCPs are associated with improved visual and cognitive development: breast-fed children had higher IQ scores compared with children who received an infant formula that did not contain LCPs. Because breast milk contains LCPs and the formulae in these studies did not, it is possible that LCPs may contribute to improved cognitive development.

Algemeen

1. Diagnosis, prevention, and management of eclampsia
   Magnesium sulfate is the drug of choice for reducing the rate of eclampsia developing intrapartum and immediately postpartum. There are 4 large randomized trials comparing magnesium sulfate with no treatment or placebo in patients with severe preeclampsia. The rate of eclampsia was significantly lower in those assigned to magnesium sulfate (0.6% versus 2.0%, relative risk 0.39, 95% confidence interval 0.28-0.55).
2. Nutritional interventions for the prevention of maternal morbidity
   Calcium supplementation in women at high risk of pregnancy hypertension reduced the incidence of high blood pressure (RR, 0.35; 95% CI, 0.21-0.57) and pre-eclampsia (RR, 0.22; 95% CI, 0.11-0.43).