Omega‐3 Polyunsaturated Fatty Acids Intake and Blood Pressure: A Dose‐Response Meta‐Analysis of Randomized Controlled Trials

BACKGROUND: Current evidence might support the use of omega‐3 fatty acids (preferably docosahexaenoic acid and eicosapentaenoic acid) for lowering blood pressure (BP), but the strength and shape of the dose‐response relationship remains unclear. METHODS AND RESULTS: This study included randomized controlled trials published before May 7, 2021, that involved participants aged ≥18 years, and examined an association between omega‐3 fatty acids (docosahexaenoic acid, eicosapentaenoic acid, or both) and BP. A random‐effects 1‐stage cubic spline regression model was used to predict the average dose‐response association between daily omega‐3 fatty acid intake and changes in BP. We also conducted stratified analyses to examine differences by prespecified subgroups. Seventy‐one trials were included, involving 4973 individuals with a combined docosahexaenoic acid+eicosapentaenoic acid dose of 2.8 g/d (interquartile range, 1.3 g/d to 3.6 g/d). A nonlinear association was found overall or in most subgroups, depicted as J‐shaped dose‐response curves. The optimal intake in both systolic BP and diastolic BP reductions (mm Hg) were obtained by moderate doses between 2 g/d (systolic BP, −2.61 [95% CI, −3.57 to −1.65]; diastolic BP, −1.64 [95% CI, −2.29 to −0.99]) and 3 g/d (systolic BP, −2.61 [95% CI, −3.52 to −1.69]; diastolic BP, −1.80 [95% CI, −2.38 to −1.23]). Subgroup studies revealed stronger and approximately linear dose‐response relations among hypertensive, hyperlipidemic, and older populations. CONCLUSIONS: This dose‐response meta‐analysis demonstrates that the optimal combined intake of omega‐3 fatty acids for BP lowering is likely between 2 g/d and 3 g/d. Doses of omega‐3 fatty acid intake above the recommended 3 g/d may be associated with additional benefits in lowering BP among groups at high risk for cardiovascular diseases.