Almutairi, Sultan
(2025)
Understanding the impact of hypertension medication usage on zinc status with advancing age.
PhD thesis, University of Nottingham.
Abstract
Background
Zinc (Zn) is an essential trace element involved in various physiological functions, including enzymatic activity, cellular metabolism, gene expression regulation, and immune function. Adequate Zn status is crucial for maintaining overall health, particularly in older adults who are susceptible to age-related declines in Zn absorption and an increased risk of deficiency. Chronic hypertension, a prevalent condition in the ageing population, often requires long-term pharmacological intervention, which has been implicated in disrupting Zn homeostasis. Despite growing evidence suggesting an association between antihypertensive medication use and altered Zn status, the underlying mechanisms and potential health consequences remain unclear.
Aims
This thesis aims to investigate the impact of chronic antihypertensive medication use on Zn status in older adults by conducting a systematic review, secondary analysis of the UK National Diet and Nutrition Survey (NDNS), and comparative study involving older adult populations residing in Nottinghamshire.
Methods
In the initial phase of this research, a systematic review and meta-analysis were conducted in accordance with PRISMA guidelines to synthesise existing evidence regarding the relationship between antihypertensive medication use and Zn status. The review incorporated studies that assessed dietary Zn intake, serum Zn concentrations, and urinary Zn excretion. In addition, a secondary analysis of the NDNS dataset was performed to examine patterns of Zn intake and biochemical markers of Zn status among older adults prescribed antihypertensive medications. Furthermore, a cross-sectional comparative study was conducted to evaluate Zn status through dietary assessments and health-related parameters among older adults residing in care homes and those living independently. A total of 11 participants were recruited, comprising five care home residents and six free-living individuals.
Results
Findings from the systematic review demonstrated a significant association between the use of antihypertensive medications – particularly angiotensin-converting enzyme inhibitors and diuretics – and decreased serum Zn levels, along with increased urinary Zn losses, suggesting potential disruptions in Zn homeostasis. Analysis of NDNS data corroborated these findings, indicating lower dietary Zn intake and reduced serum concentrations in older adults undergoing prolonged antihypertensive treatment, with polypharmacy exacerbating this trend. The comparative study further supported these observations, demonstrating that care home residents on multiple antihypertensive medications exhibited lower Zn status compared to their free-living counterparts.
Conclusion
The findings of this thesis highlight the potential implications of antihypertensive medication use on Zn status in older adults, underscoring the importance of regular nutritional monitoring and tailored dietary interventions to prevent deficiencies. Given the critical role of Zn in immune function and overall health, addressing potential deficiencies in hypertensive older populations is imperative. This thesis contributes to understanding the impact of chronic antihypertensive medication use on Zn status in older adults by providing evidence-based insights into the interplay between medication use, dietary intake, and Zn status. The research emphasises the need for comprehensive nutritional strategies that address the potential micronutrient imbalances induced by long-term pharmacological treatment.
The findings underscore the importance of multidisciplinary approaches, involving healthcare professionals and dietitians, to implementing targeted interventions, such as routine nutritional screening, dietary modifications, and supplementation guidelines tailored to hypertensive older adults. Additionally, future research should focus on longitudinal studies to explore the long- term implications of antihypertensive medications on Zn homeostasis and the development of personalised nutritional recommendations to improve health outcomes in ageing populations. Furthermore, it is essential to evaluate the efficacy of Zn supplementation in mitigating the adverse effects of antihypertensive medications on Zn status.
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