Total polyphenol excretion and blood pressure in subjects at high cardiovascular risk
Abstract
Background and aims Dietary factors are critical for the prevention and treatment of hypertension, but data on the effects of specific nutrients on blood pressure (BP) are scarce. The aim of this study was to assess the relationship between total polyphenol excretion (TPE) in urine, as an objective measurement of total polyphenol intake and BP in an elderly population at high cardiovascular risk.Methods and results Cross-sectional substudy of 589 high-risk participants entering in the PREDIMED trial. BP was measured and TPE was determined in urine by Folin-Ciocalteu assay. A significant positive association was observed between TPE in urine and daily intake of fruit and vegetables (F&V), coffee or wine after adjusting for potential confounders. The intake of 100 g of F&V (Beta=0.150;P<0.001) had a greater contribution to TPE than 100 mL of coffee (Beta=0.141;P=0.001), and the latter two foods contributed more than the consumption of 100 mL of wine (Beta=0.120;P=0.019). An inverse association was observed between urinary TPE and the prevalence of hypertension. Participants in the highest quartile of urinary TPE had a reduced prevalence of hypertension compared to those in the lowest quartile (Odds Ratio=0.64; 95% confidence interval 0.45 to 0.92; P=0.015). Systolic and diastolic BP were inversely associated with urinary TPE after adjustment for potential confounders (P=0.024 and P=0.003, respectively).Conclusions Polyphenol intake, assessed via TPE in urine, was negatively associated with BP levels and prevalence of hypertension in an elderly Mediterranean population at high cardiovascular risk. Participants with the highest intake of polyphenol-rich foods showed the lowest BP measurements.
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The Folin assay, commonly used to estimate total polyphenols in foods, has been applied to urine to compare polyphenol intake, but such use may be inappropriate because of interfering reducing metabolites.
“The Folin assay, commonly used to estimate total polyphenols in foods (46), has also been applied to urine samples to compare polyphenol intake (47), but such use may be inappropriate because of the presence of interfering reducing metabolites in such complex biological matrices (46).”
From The food metabolome: a window over dietary exposure (2014) · cites this paper as [47]
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BackgroundChanges in Phenolic Content of Tomato Products during Storage
Vallverdú‐Queralt, A., Arranz, S., Medina‐Remón, A., Casals, I., & Lamuela-Raventós, R. M. (2011) · Journal of Agricultural and Food Chemistry · doi:10.1021/jf202140j · Cited by 57 · see citing works
Onakpoya, I., O’Sullivan, J. W., & Heneghan, C. J. (2014) · Nutrition · doi:10.1016/j.nut.2014.11.015 · Cited by 57 · see citing works
Sharma, R., & Padwad, Y. S. (2020) · Trends in Food Science & Technology · doi:10.1016/j.tifs.2020.02.004 · Cited by 55 · see citing works
Calderón-Pérez, L., Llauradó, E., Companys, J., Pla‐Pagà, L., Pedret, A., Rubió, L., Gosalbes, M. J., Yuste, S., Solà, R., & Valls, R. M. (2020) · Food Chemistry · doi:10.1016/j.foodchem.2020.128567 · Cited by 48 · see citing works
Verde, M., Mulè, S., Zappalà, G., Privitera, G. P., Maugeri, G., Pecora, F., & Marranzano, M. (2017) · International Journal of Food Sciences and Nutrition · doi:10.1080/09637486.2017.1350941 · Cited by 47 · see citing works
Romero‐Prado, M. M. D. J., Curiel‐Beltrán, J. A., Miramontes‐Espino, M. V., Cardona-Muñóz, E. G., Rios‐Arellano, A., & Balam‐Salazar, L. (2014) · Basic & Clinical Pharmacology & Toxicology · doi:10.1111/bcpt.12360 · Cited by 36 · see citing works
Pedret, A., Valls, R. M., Fernández‐Castillejo, S., Catalán, Ú., Romeu, M., Giralt, M., Lamuela-Raventós, R. M., Medina‐Remón, A., Arija, V., Aranda, N., et al. (2012) · Molecular Nutrition & Food Research · doi:10.1002/mnfr.201100676 · Cited by 33 · see citing works
“TPI is documented as being higher than any other known dietary antioxidant, including dietary vitamin C, vitamin E, and carotenoid intake [36].”
BackgroundMedina‐Remón, A., Vallverdú‐Queralt, A., Arranz, S., Ros, E., Martínez‐González, M. Á., Sacanella, E., Covas, M. I., Corella, D., Salas‐Salvadó, J., Gómez‐Gracia, E., et al. (2012) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2012.07.008 · Cited by 25 · see citing works
Polyphenols Excreted in Urine as Biomarkers of Total Polyphenol Intake
Medina‐Remón, A., Tresserra‐Rimbau, A., Arranz, S., Estruch, R., & Lamuela-Raventós, R. M. (2012) · Bioanalysis · doi:10.4155/bio.12.249 · Cited by 24 · see citing works
Urinary Isoxanthohumol Is a Specific and Accurate Biomarker of Beer Consumptionce
Quifer‐Rada, P., Martínez‐Huélamo, M., Chiva‐Blanch, G., Jáuregui, O., Estruch, R., & Lamuela-Raventós, R. M. (2014) · Journal of Nutrition · doi:10.3945/jn.113.185199 · Cited by 23 · see citing works
de Figueiredo, E. A., Alves, N. F. B., Monteiro, M. M. D. O., Cavalcanti, C. D. O., Silva, T. M. S., da Silva, T. M. G., Braga, V. A., & Oliveira, E. D. J. (2017) · Nutrients · doi:10.3390/nu9060574 · Cited by 20 · see citing works
Phytochemicals and Hypertension
Kooshki, A., & Hoseini, B. L. (2014) · Shiraz E-Medical Journal · doi:10.17795/semj19738 · Cited by 19 · see citing works
“Several polyphenol-rich sources such as grape-derived products, cocoa, tea, soy, pomegranate and tomatoes have been shown to decrease blood pressure in hypertensive patients (6, 19-24).”
BackgroundStettner, M., Wolffram, K., Mausberg, A. K., Albrecht, P., Derksen, A., Methner, A., Dehmel, T., Hartung, H., Dietrich, H., & Kieseier, B. C. (2013) · PLoS ONE · doi:10.1371/journal.pone.0066079 · Cited by 18 · see citing works
“In various clinical studies moderate wine consumption has been suggested to exert beneficial effects in a broad range of disorders [5,6,7,8,9,10,11,12,13,14,15,16,17].”
Background(Poly)phenol intake, plant-rich dietary patterns and cardiometabolic health: a cross-sectional study
Li, Y., Xu, Y., Ma, X., Sayec, M. L., Wu, H., Dazzan, P., Nosarti, C., Heiß, C., Gibson, R., & Rodriguez‐Mateos, A. (2023) · Food & Function · doi:10.1039/d3fo00019b · Cited by 17 · see citing works
Antioxidant Capacity and Phenolic Content of Some Nepalese Medicinal Plants
Maharjan, B. L., & Baral, B. (2013) · American Journal of Plant Sciences · doi:10.4236/ajps.2013.48200 · Cited by 17 · see citing works
“The total phenolic content in the sample solutions was considered the slope of the linear curve derived from the constructed calibration graph and expressed in GAE/100 g dry mass [12].”
MethodWaśkiewicz, A., Zujko, M. E., Szcześniewska, D., Tykarski, A., Kwaśniewska, M., Drygas, W., & Witkowska, A. M. (2019) · Advances in Clinical and Experimental Medicine · doi:10.17219/acem/91487 · Cited by 16 · see citing works
Daily polyphenol intake from fresh fruits in Portugal: contribution from berry fruits
Pinto, P., Cardoso, S. M., Pimpão, R. C., Tavares, L., Ferreira, R. B., & dos Santos, C. N. (2013) · International Journal of Food Sciences and Nutrition · doi:10.3109/09637486.2013.816938 · Cited by 14 · see citing works
“Consumption of fresh fruits and vegetables is related to lower risk of developing non-communicable diseases such as cardiovascular diseases and cancer (Crowe et al., 2011; Medina-Remón et al., 2011; Soerjomataram et al., 2010).”
BackgroundMonori-Kiss, A., Monos, E., & Nádasy, G. L. (2014) · PLoS ONE · doi:10.1371/journal.pone.0105587 · Cited by 11 · see citing works
Santos, E. P. L., Parilli‐Moser, I., Ramírez-Garza, S. L., Tresserra‐Rimbau, A., Storniolo, C. E., Ruiz-León, A. M., Estruch, R., Bodega, P., de Miguel, M., de Cos-Gandoy, A., et al. (2020) · Antioxidants · doi:10.3390/antiox9100910 · Cited by 9 · see citing works
“A cross-sectional study found an inverse association between TPE and BP in subjects at high cardiovascular risk [33].”
BackgroundAnimal-based organic nutrition can substitute inorganic fertigation in soilless-grown grape tomato
Guajardo-Ríos, O., Cavazos, C. J. L., Valdéz-Aguilar, L. A., Benavides‐Mendoza, A., Ibarra-Jiménez, L., Ascacio-Valdés, J. A., & Aguilar, C. N. (2017) · Acta Agriculturae Scandinavica Section B - Soil & Plant Science · doi:10.1080/09064710.2017.1367030 · Cited by 9 · see citing works
“…organically or conventionally remain scarce in the literature as these compounds have only recently been considered to be interesting functional microconstituents due to their potential role in the prevention of cardiovascular diseases, degenerative diseases, and cancer (Medina-Remón et al. 2011).”
BackgroundDiet and Oxidative Status. The Dietary Pattern and Urinary 8-Isoprostane in Healthy Spanish Women
Ruiz, N. G., Segarra, A. B., Lara, L., Ramírez‐Sánchez, M., & Prieto, I. (2019) · Antioxidants · doi:10.3390/antiox8080271 · Cited by 9 · see citing works
“Absorbance was measured at 765 nm in Ultraviolet/Visible (UV/VIS) Optima Fluostar spectrophotometer (BMG LabTech, Ortenberg, Germany) [15,22].”
MethodBaseline diet modifies the effects of dietary change
Pickering, R. T., Bradlee, M. L., Singer, M. R., & Moore, L. L. (2020) · British Journal Of Nutrition · doi:10.1017/s0007114520000112 · Cited by 8 · see citing works
“These mechanisms have been linked with beneficial effects on BP regulation and downstream effects on cardiovascular health(23,24).”
BackgroundDiet to Stop Hypertension: Should Fats be Included?
Nestel, P. J., & Mori, T. A. (2024) · Current Hypertension Reports · doi:10.1007/s11906-024-01310-7 · Cited by 7 · see citing works
Wine Consumption in the Mediterranean Diet: Old Concepts in a New Sight
Carollo, C., & Caimi, G. (2012) · Food and Nutrition Sciences · doi:10.4236/fns.2012.312226 · Cited by 7 · see citing works
“In the Predimed Study [42], a clinical, multicentric randomized, controlled trial total polyphenol urinary excretion, as biomarker of the total polyphenol intake, was measured in more than 500 subjects.”
BackgroundPolyphenol Consumption and Blood Pressure
Medina‐Remón, A., Tresserra‐Rimbau, A., Valderas-Martínez, P., Estruch, R., & Lamuela-Raventós, R. M. (2013) · Polyphenols in Human Health and Disease · doi:10.1016/b978-0-12-398456-2.00075-x · Cited by 7 · see citing works
Biomarkers of (poly)phenol intake: a systematic review
Li, Y., Xu, Y., Nash, M., Yue, Q., Sevim, M., Manach, C., Gibson, R., & Rodriguez‐Mateos, A. (2025) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2025.2469770 · Cited by 6 · see citing works
“To address this limitation, a modified Folin-Ciocalteu method using micro-solid phase extraction (μ-SPE) has been proposed for assessing total (poly)phenol excretion in urine, which potentially reflects total (poly)phenol intake (Medina-Remon et al. 2011).”
Common Applications of Black Cumin Seed (Nigella sativa) Oil in Folk Medicine
Hosni, R., Haffez, H., & Elkordy, H. (2023) · Journal of Advanced Pharmacy Research · doi:10.21608/aprh.2022.166251.1196 · Cited by 6 · see citing works
Grape Polyphenols in the Prevention of Cardiovascular Disease
Gross, M. D. (2016) · Springer eBooks · doi:10.1007/978-3-319-28995-3_3 · Cited by 6 · see citing works
Stettner, M., Wolffram, K., Mausberg, A. K., Albrecht, P., Derksen, A., Methner, A., Dehmel, T., Hartung, H., Dietrich, H., & Kieseier, B. C. (2013) · PLoS ONE · doi:10.1371/annotation/a9d91925-7bb9-48a6-b261-40429a319bae · Cited by 6 · see citing works
Ismail, M. S., & NM, E. A. A. Q. (2015) · Medicinal & Aromatic Plants · doi:10.4172/2167-0412.1000203 · Cited by 5 · see citing works
“Caffeine and chlorogenic acids have been extensively studied because they may reduce the risk of insulin resistance [13,14], and development and progression of atherosclerosis [15] and they might decrease blood pressure (BP) [16,17].”
BackgroundThe Effect of Consuming Coffee from Different Preparation Methods on Body Lipids Profile
Shnaigat, S. A., & Obeidat, H. J. (2022) · Jordan Journal of Agricultural Sciences · doi:10.35516/jjas.v18i3.462 · Cited by 3 · see citing works
Kang, N. (2012) · TSpace (University of Toronto) · Cited by 3 · see citing works
Enhancing nutritional value in fruit crops through biofortification: A comprehensive review
SHARMA, R., Bakshi, P., Kumar, R., SHARMA, A., Maanik, M., Thakur, N., Kumar, V., & Gheware, K. M. (2023) · The Indian Journal of Agricultural Sciences · doi:10.56093/ijas.v93i11.140995 · Cited by 2 · see citing works
Martín, B. (2010) · Clínica e Investigación en Arteriosclerosis · doi:10.1016/j.arteri.2010.03.002 · Cited by 2 · see citing works
Dietary Antioxidants in Mitigating Oxidative Stress in Cardiovascular Diseases
Ghose, S., Varshney, S., Chakraborty, R., & Sengupta, S. (2019) · Springer eBooks · doi:10.1007/978-981-13-8273-4_5 · Cited by 2 · see citing works
Dissanayake, L., Herath, K. B., Opatha, J., Jabir, S., Siriwardana, R., Sirisena, K. A., Wickramasinghe, M. A., Wimalasekera, M., Liyanage, R., Guruge, G. N. D., et al. (2024) · Behavior Genetics · doi:10.1007/s10519-023-10171-w · Cited by 1 · see citing works
“These compounds function as natural antioxidants within the human body, playing a crucial role in preventing various non-communicable diseases that many Sri Lankans suffer from due to poor dietary habits (Mennen et al. 2006; Medina-Remón et al. 2011).”
BackgroundBioanalysis Young Investigator: Alexander Medina-Remón
Medina‐Remón, A., & Lamuela-Raventós, R. M. (2011) · Bioanalysis · doi:10.4155/bio.11.143 · Cited by 1 · see citing works
Red Wine Polyphenols and Vascular Function
Botden, I. P. G. (2012) · EUR Research Repository (Erasmus University Rotterdam)
Carbohydrate Intake in Non-communicable Disease Prevention and Treatment
Venn, B. J. (2019) · MDPI eBooks · doi:10.3390/books978-3-03897-819-0
Polyphenols and their effects on metabolic syndromes and other CVD risk factors
Duttaroy, A. K. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-822405-2.00001-3
Li, Y., Sayec, M. L., Xu, Y., Bergland, A. K., Khalifa, K. N., de Lucia, C., Aarsland, D., Gibson, R., & Rodriguez‐Mateos, A. (2026) · The Journal of Nutritional Biochemistry · doi:10.1016/j.jnutbio.2026.110300
- Authors
- Medina-Remón, A., Zamora-Ros, R., Rotchés-Ribalta, M., Andres-Lacueva, C., Martínez-González, M. A., Covas, M. I., Corella, D., Salas-Salvadó, J., Gómez-Gracia, E., Ruiz-Gutiérrez, V., García de la Corte, F. J., Fiol, M., Pena, M. A., Saez, G. T., Ros, E., Serra-Majem, L., Pinto, X., Warnberg, J., Estruch, R., & Lamuela-Raventos, R. M.
- Affiliations
- Universitat de Barcelona (ES)
- Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition (ES)
- Universitat de València (ES)
- Instituto de Salud Carlos III (ES)
- Venue
- Nutrition Metabolism and Cardiovascular Diseases
- Publisher
- Elsevier BV
- Published
- 2011-05
- Volume
- 21
- Issue
- 5
- Pages
- 323-331
- ISSN
- 0939-4753 (ISSN-L)
- OpenAlex
- W2154767672
- Cited by
- 80
- References
- 39
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 5 · 2022: 2 · 2021: 2 · 2020: 5 · 2019: 9 · 2018: 2 · 2017: 7 · 2016: 4 · 2015: 3 · 2014: 10 · 2013: 9 · 2012: 11
- FWCI
- 5.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nutrition Metabolism and Cardiovascular Diseases (publishedVersion)
- PubMed (publishedVersion)
- DIGITAL.CSIC (Spanish National Research Council (CSIC)) (submittedVersion)
- TECNALIA Publications (Fundación TECNALIA Research & Innovation) (submittedVersion, public-domain)
- Topics
- Health Sciences › Medicine › Biochemistry › Phytochemicals and Antioxidant Activities
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- blood pressure, hypertension, polyphenol intake, fruit and vegetable intake, coffee consumption, wine consumption, older adults, high cardiovascular risk, PREDIMED trial, Mediterranean diet
- MeSH terms
- Aged, Blood Pressure, Coffee, Cross-Sectional Studies, Diet, Female, Flavonoids, Fruit, Humans, Hypertension, Male, Middle Aged, Phenols, Surveys and Questionnaires, Risk Factors, Vegetables, Wine, Prevalence, Multivariate Analysis, Linear Models, Odds Ratio, Randomized Controlled Trials as Topic, Mediterranean Region, Polyphenols
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