Article

The Mediterranean Diet and Incidence of Hypertension: The Seguimiento Universidad de Navarra (SUN) Study

Department of Preventive Medicine and Public Health, Medical School-Clínica Universitaria, University of Navarra, Pamplona, Spain.
American journal of epidemiology (Impact Factor: 5.23). 12/2008; 169(3):339-46. DOI: 10.1093/aje/kwn335
Source: PubMed

ABSTRACT

The Mediterranean diet is receiving increasing attention in cardiovascular epidemiology. The association of adherence to the
Mediterranean diet with the incidence of hypertension was evaluated among 9,408 men and women enrolled in a dynamic Spanish
prospective cohort study during 1999–2005. Dietary intake was assessed at baseline with a validated semiquantitative food
frequency questionnaire, and a 9-point Mediterranean diet score was constructed. During a median follow-up period of 4.2 years
(range, 1.9–7.9), 501 incident cases of hypertension were identified. After adjustment for major hypertension risk factors
and nutritional covariates, adherence to the Mediterranean diet was not associated with hypertension (the hazard ratio was
1.10 (95% confidence interval (CI): 0.81, 1.41) for moderate adherence and 1.12 (95% CI: 0.79, 1.60) for high adherence).
However, it was associated with reduced changes in mean levels of systolic blood pressure (moderate adherence, −2.4 mm Hg
(95% CI: −4.0, −0.8); high adherence, −3.1 mm Hg (95% CI: −5.4, −0.8)) and diastolic blood pressure (moderate adherence, −1.3
mm Hg (95% CI: −2.5, −0.1); high adherence, −1.9 mm Hg (95% CI: −3.6, −0.1)) after 6 years of follow-up. These results suggest
that adhering to a Mediterranean-type diet could contribute to the prevention of age-related changes in blood pressure.

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    • "Regarding the intervention groups, the traditional MD is also rich in fruits and vegetables, has low content of saturated fat and dietary cholesterol, and is rich in magnesium and potassium [24], thus, in spite of its high total fat content, the MD could enhance BP control. Even though greater adherence to the MD has shown no association with incident hypertension in some large cohorts [25], a meta-analysis of trials with the MD on the components of metabolic syndrome found beneficial effects on average systolic and diastolic BP levels [9]. Similarly, we found a significant decrease in systolic and diastolic BP in both MD groups. "
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    ABSTRACT: Hypertension can be prevented by adopting healthy dietary patterns. Our aim was to assess the 4-year effect on blood pressure (BP) control of a randomized feeding trial promoting the traditional Mediterranean dietary pattern. The PREDIMED primary prevention trial is a randomized, single-blinded, controlled trial conducted in Spanish primary healthcare centers. We recruited 7,447 men (aged 55 to 80 years) and women (aged 60 to 80 years) who had high risk for cardiovascular disease. Participants were assigned to a control group or to one of two Mediterranean diets. The control group received education on following a low-fat diet, while the groups on Mediterranean diets received nutritional education and also free foods; either extra virgin olive oil, or nuts. Trained personnel measured participants' BP at baseline and once yearly during a 4-year follow-up. We used generalized estimating equations to assess the differences between groups during the follow-up. The percentage of participants with controlled BP increased in all three intervention groups (P-value for within-group changes: P<0.001). Participants allocated to either of the two Mediterranean diet groups had significantly lower diastolic BP than the participants in the control group (-1.53 mmHg (95% confidence interval (CI) -2.01 to -1.04) for the Mediterranean diet supplemented with extra virgin olive oil, and -0.65 mmHg (95% CI -1.15 to -0.15) mmHg for the Mediterranean diet supplemented with nuts). No between-group differences in changes of systolic BP were seen. Both the traditional Mediterranean diet and a low-fat diet exerted beneficial effects on BP and could be part of advice to patients for controlling BP. However, we found lower values of diastolic BP in the two groups promoting the Mediterranean diet with extra virgin olive oil or with nuts than in the control group.Trial registration: Current Controlled Trials ISRCTN35739639.
    Full-text · Article · Sep 2013 · BMC Medicine
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    • "Recently, in the SUN study [36] adherence to the Mediterranean diet was not associated with hypertension. "
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    ABSTRACT: Background and aims: Dietary factors are critical for the prevention and treatment of hypertension, but data on the effects of specific nutrients on blood pressure (BP) are scarce. The aim of this study was to assess the relationship between total polyphenol excretion (TPE) in urine, as an objective measurement of total polyphenol intake and BP in an elderly population at high cardiovascular risk. Methods and results: Cross-sectional substudy of 589 high-risk participants entering in the PREDIMED trial. BP was measured and TPE was determined in urine by FolineCiocalteu assay. A significant positive association was observed between TPE in urine and daily intake of fruit and vegetables (F&V), coffee or wine after adjusting for potential confounders. The intake of 100 g of F&V (BetaZ0.150;P < 0.001) had a greater contribution to TPE than 100 mL of coffee (BetaZ0.141;PZ0.001), and the latter two foods contributed more than the consumption of 100 mL of wine (BetaZ0.120;PZ0.019). An inverse association was observed between urinary TPE and the prevalence of hypertension. Participants in the highest quartile of urinary TPE had a reduced prevalence of hypertension compared to those in the lowest quartile (Odds RatioZ0.64; 95% confidence interval 0.45 to 0.92; PZ0.015). Systolic and diastolic BP were inversely associated with urinary TPE after adjustment for potential confounders (PZ0.024 and PZ0.003, respectively). Conclusions: Polyphenol intake, assessed via TPE in urine, was negatively associated with BP levels and prevalence of hypertension in an elderly Mediterranean population at high cardiovascular risk. Participants with the highest intake of polyphenol-rich foods showed the lowest BP measurements.
    Full-text · Article · Jan 2011 · Nutrition Metabolism and Cardiovascular Diseases
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    • "Recently, in the SUN study [36] adherence to the Mediterranean diet was not associated with hypertension. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Dietary factors are critical for the prevention and treatment of hypertension, but data on the effects of specific nutrients on blood pressure (BP) are scarce. The aim of this study was to assess the relationship between total polyphenol excretion (TPE) in urine, as an objective measurement of total polyphenol intake and BP in an elderly population at high cardiovascular risk. Cross-sectional substudy of 589 high-risk participants entering in the PREDIMED trial. BP was measured and TPE was determined in urine by Folin-Ciocalteu assay. A significant positive association was observed between TPE in urine and daily intake of fruit and vegetables (F&V), coffee or wine after adjusting for potential confounders. The intake of 100 g of F&V (Beta=0.150;P<0.001) had a greater contribution to TPE than 100 mL of coffee (Beta=0.141;P=0.001), and the latter two foods contributed more than the consumption of 100 mL of wine (Beta=0.120;P=0.019). An inverse association was observed between urinary TPE and the prevalence of hypertension. Participants in the highest quartile of urinary TPE had a reduced prevalence of hypertension compared to those in the lowest quartile (Odds Ratio=0.64; 95% confidence interval 0.45 to 0.92; P=0.015). Systolic and diastolic BP were inversely associated with urinary TPE after adjustment for potential confounders (P=0.024 and P=0.003, respectively). Polyphenol intake, assessed via TPE in urine, was negatively associated with BP levels and prevalence of hypertension in an elderly Mediterranean population at high cardiovascular risk. Participants with the highest intake of polyphenol-rich foods showed the lowest BP measurements.
    Full-text · Article · Feb 2010 · Nutrition, metabolism, and cardiovascular diseases: NMCD
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