Abstract-Raised blood pressure is a leading cause of morbidity and mortality worldwide; improved nutritional approaches to population-wide prevention are required. Few data are available on dietary phosphorus and blood pressure and none are available on possible combined effects of phosphorus, magnesium, and calcium on blood pressure. The International Study of Macro-and Micro-Nutrients and Blood Pressure is a cross-sectional epidemiologic study of 4680 men and women ages 40 to 59 from 17 population samples in Japan, China, United Kingdom, and United States. Blood pressure was measured 8 times at 4 visits. Dietary intakes were obtained from four 24-hour recalls plus data on supplement use. Dietary phosphorus was inversely associated with blood pressure in a series of predefined multiple regression models, with the successive addition of potential confounders, both nondietary and dietary. Estimated blood pressure differences per 232 mg/1000 kcal (2 SD) of higher dietary phosphorus were Ϫ1.1 to Ϫ2.3 mm Hg systolic/Ϫ0.6 to Ϫ1.5 mm Hg diastolic (nϭ4680) and Ϫ1.6 to Ϫ3.5 mm Hg systolic/Ϫ0.8 to Ϫ1.8 mm Hg diastolic for 2238 "nonintervened" individuals, ie, those without special diet/nutritional supplements or diagnosis/treatment for cardiovascular disease or diabetes. Dietary calcium and magnesium, correlated with phosphorus (partial rϭ0.71 and rϭ0.68), were inversely associated with blood pressure. Blood pressures were lower by 1.9 to 4.2 mm Hg systolic/1.2 to 2.4 mm Hg diastolic for people with intakes above versus below country-specific medians for all 3 of the minerals. These results indicate the potential for increased phosphorus/mineral intake to lower blood pressure as part of the recommendations for healthier eating patterns for the prevention and control of prehypertension and hypertension. (Hypertension. 2008;51:669-675.)Key Words: blood pressure Ⅲ dietary phosphorus Ⅲ calcium Ⅲ magnesium Ⅲ population study Ⅲ primary prevention R aised blood pressure (BP) commonly affects middle-and older-aged adults and is a major contributor to the high rates of coronary heart disease and stroke worldwide. 1 Data from epidemiological studies 2,3 ; randomized, controlled trials 4 -13 ; and studies of migrants 14,15 show the importance of dietary factors in the primary prevention and control of high BP. Mineral intakes are important, especially sodium and potassium, 2-9 possibly also calcium and magnesium, 10 -13 but little attention has been paid to the possible effects of phosphorus intake on BP, 16 -18 despite its role in cellular structure and function, 19 calcium turnover, and regulation. 20 We report here multivariate data from the International Study of Macroand Micro-Nutrients and Blood Pressure (INTERMAP Study) on the independent relationship of dietary phosphorus to BP and on estimated combined influences of higher versus lower intakes of phosphorus, calcium, and magnesium.
MethodsThe INTERMAP Study includes men and women ages 40 to 59 years, from 17 diverse population samples in Japan (4 samples), People's Republi...