Hypothesis-oriented food patterns and incidence of hypertension: 6-year follow-up of the SUN (Seguimiento Universidad de Navarra) prospective cohort

Abstract

Objective: To study the association between adherence to several a priori-defined healthy food patterns and the risk of hypertension. Design: Prospective, multipurpose, dynamic cohort study (recruitment permanently open). We followed up 10 800 men and women (all of them university graduates), who were initially free of hypertension, for a variable period (range 2-6 years, median 4?6 years). During follow-up, 640 participants reported a new medical diagnosis of hypertension. Baseline diet was assessed using a validated 136-item FFQ. Validated information about non-dietary potential confounders was also gathered. We calculated adherence to fifteen different hypothesisoriented food patterns and assessed the association between each of them and incident hypertension using multivariable Cox models. Setting: The SUN (Seguimiento Universidad de Navarra -University of Navarra Follow-up) Project, Spain. Subjects: Participants recruited to the SUN cohort before October 2005 were eligible for inclusion; after excluding those with self-reported hypertension or CVD at baseline, or with extreme total energy intake, data of 10 800 were analysed. Results: Higher adherence to the DASH (Dietary Approaches to Stop Hypertension) diet (range of the score: 0 to 5) was significantly associated with a lower risk for developing hypertension (P for trend 5 0?02). The other food patterns showed no significant association with incident hypertension. Conclusions: Our results support a long-term protection of the DASH diet against the incidence of hypertension, but we found no evidence of a similar inverse association with hypertension for any other a priori-defined healthy food pattern.

Concordance with DASH diet and blood pressure change

“…A European cohort also found no dose-response relationship between diet score and hypertension, although the DASH score in that study was derived from only three food components (vegetables, fruits, and milk products) [11]. Another European cohort (SUN (Seguimiento Universidad deNavarra) prospective cohort) showed that higher adherence to DASH diet (assessed from six food components) was associated with lower risk of developing hypertension (P for trend ¼ 0.02) [12]. On the contrary, one study [12] showed some evidence that DASH diet influences longterm hypertension rates.…”

“…The relation of demographic variables or DASH score to BP change was estimated by using the coefficient of the cross product (interaction term) between these variables and time (years since exam 5 at the time of BP measurement). For potential confounders, we first adjusted for age (years) (model 1), then additionally adjusted for sex, smoking status (current, not current), alcohol intake (oz/week), history of diabetes (yes, no), BMI, and PAI (model 2) since these variables were considered to be associated with both diet intake and BP change, on the basis of the literature [10,12]. Furthermore, we conducted sensitivity analysis with additional adjustment for total energy intake, high-fat dairy intake, or both.…”

“…Another European cohort (SUN (Seguimiento Universidad deNavarra) prospective cohort) showed that higher adherence to DASH diet (assessed from six food components) was associated with lower risk of developing hypertension (P for trend ¼ 0.02) [12]. On the contrary, one study [12] showed some evidence that DASH diet influences longterm hypertension rates. Cumulative evidence, including our study, are not supportive of this relationship [10].…”

“…Despite success in interventions and an understanding of possible mechanisms of how diet or nutrients may influence BP through anti-inflammatory pathways or endothelial function [8], epidemiological evidence regarding the long-term effects of a DASH-type diet on the prevention of high BP is inconsistent [9][10][11][12]. Most studies investigated associations of diet with the incidence of hypertension [10][11][12], whereas DASH diet and longitudinal change in BP have been investigated less.…”

“…Most studies investigated associations of diet with the incidence of hypertension [10][11][12], whereas DASH diet and longitudinal change in BP have been investigated less. Two longitudinal studies in the knowledge, there have been no large studies of association between DASH diet concordance and long-term BP change.…”