Pistachio Nut Consumption Modifies Systemic Hemodynamics, Increases Heart Rate Variability, and Reduces Ambulatory Blood Pressure in Well‐Controlled Type 2 Diabetes: a Randomized Trial

BACKGROUND Managing cardiovascular risk factors is important for reducing vascular complications in type 2 diabetes, even in individuals who have achieved glycemic control. Nut consumption is associated with reduced cardiovascular risk; however, there is mixed evidence about the effect of nuts on blood pressure (BP), and limited research on the underlying hemodynamics. This study assessed the effect of pistachio consumption on BP, systemic hemodynamics, and heart rate variability in adults with well-controlled type 2 diabetes. METHODS AND RESULTS We enrolled 30 adults (40 to 74 years) with type 2 diabetes in a randomized, crossover, controlled feeding study. After a 2-week run-in period, participants consumed a low-fat control diet (27% fat) containing low-fat/high-carbohydrate snacks and a moderate-fat diet (33% fat) containing pistachios (20% of total energy) for 4 weeks each, separated by a 2-week washout. Following each diet period, we assessed BP, systemic hemodynamics, and heart rate variability at rest and during acute mental stress, and, in a subset of participants (n=21), 24-hour ambulatory BP. BP at rest and during stress did not differ between treatments. The pistachio diet significantly reduced total peripheral resistance (-3.7±2.9%, P=0.004), increased cardiac output (3.1±2.3%, P=0.002), and improved some measures of heart rate variability (all P<0.05). Systolic ambulatory BP was significantly reduced by 3.5±2.2 mm Hg (P=0.046) following the pistachio diet, with the greatest reduction observed during sleep (-5.7±2.6 mm Hg, P=0.052). CONCLUSIONS A moderate-fat diet containing pistachios modestly improves some cardiovascular risk factors in adults with well-controlled type 2 diabetes. CLINICAL TRIAL REGISTRATION URL www.clinicaltrials.gov. Unique identifier: NCT00956735.