Association between protein intake and blood pressure: the INTERMAP Study.

BACKGROUND Findings from epidemiological studies suggest an inverse relationship between individuals' protein intake and their blood pressure. METHODS Cross-sectional epidemiological study of 4680 persons, aged 40 to 59 years, from 4 countries. Systolic and diastolic blood pressure was measured 8 times at 4 visits. Dietary intake based on 24-hour dietary recalls was recorded 4 times. Information on dietary supplements was noted. Two 24-hour urine samples were obtained per person. RESULTS There was a significant inverse relationship between vegetable protein intake and blood pressure. After adjusting for confounders, blood pressure differences associated with higher vegetable protein intake of 2.8% kilocalories were -2.14 mm Hg systolic and -1.35 mm Hg diastolic (P<.001 for both); after further adjustment for height and weight, these differences were -1.11 mm Hg systolic (P<.01) and -0.71 mm Hg diastolic (P<.05). For animal protein intake, significant positive blood pressure differences did not persist after adjusting for height and weight. For total protein intake (which had a significant interaction with sex), there was no significant association with blood pressure in women, nor in men after adjusting for dietary confounders. There were significant differences in the amino acid content of the diets of persons with high vegetable and low animal protein intake vs the diets of persons with low vegetable and high animal protein intake. CONCLUSIONS Vegetable protein intake was inversely related to blood pressure. This finding is consistent with recommendations that a diet high in vegetable products be part of healthy lifestyle for prevention of high blood pressure and related diseases.

[1]  Joan M Conway,et al.  Accuracy of dietary recall using the USDA five-step multiple-pass method in men: an observational validation study. , 2004, Journal of the American Dietetic Association.

[2]  P. Elliott,et al.  INTERMAP: the dietary data—process and quality control , 2003, Journal of Human Hypertension.

[3]  H Kesteloot,et al.  INTERMAP: background, aims, design, methods, and descriptive statistics (nondietary) , 2003, Journal of Human Hypertension.

[4]  Liancheng Zhao,et al.  Enhancing data on nutrient composition of foods eaten by participants in the INTERMAP study in China, Japan, the United Kingdom, and the United States. , 2003, Journal of food composition and analysis : an official publication of the United Nations University, International Network of Food Data Systems.

[5]  P. Elliott,et al.  Macronutrients, Fiber, Cholesterol, and Dietary Patterns , 2003 .

[6]  Jiang He,et al.  Lifestyle modification for the prevention and treatment of hypertension , 2003 .

[7]  Jiang He,et al.  Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. , 2002, JAMA.

[8]  P. Greenland,et al.  Eight-Year Blood Pressure Change in Middle-Aged Men: Relationship to Multiple Nutrients , 2002, Hypertension.

[9]  M. Cirillo,et al.  Relation of urinary urea to blood pressure: interaction with urinary sodium , 2002, Journal of Human Hypertension.

[10]  Longjian Liu,et al.  Inverse relationship between urinary markers of animal protein intake and blood pressure in Chinese: results from the WHO Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study. , 2002, International journal of epidemiology.

[11]  J. Hodgson,et al.  Dietary Protein and Soluble Fiber Reduce Ambulatory Blood Pressure in Treated Hypertensives , 2001, Hypertension.

[12]  B. Sibai,et al.  Nutrient intake and hypertensive disorders of pregnancy: Evidence from a large prospective cohort. , 2001, American journal of obstetrics and gynecology.

[13]  G. Bray,et al.  Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet , 2001 .

[14]  T. Tsuchihashi,et al.  [Dietary protein and blood pressure]. , 2000, Nihon rinsho. Japanese journal of clinical medicine.

[15]  Orton,et al.  EFFECTS ON BLOOD PRESSURE OF REDUCED DIETARY SODIUM AND THE DIETARY APPROACHES TO STOP HYPERTENSION ( DASH ) DIET , 2000 .

[16]  Mark A Pereira,et al.  Dietary fiber, weight gain, and cardiovascular disease risk factors in young adults. , 1999, JAMA.

[17]  W. Willett Implications of Total Energy Intake for Epidemiologic Analyses , 1998 .

[18]  P. Elliott,et al.  Dietary magnesium intake and blood pressure: a qualitative overview of the observational studies , 1998, Journal of Human Hypertension.

[19]  G. Bray,et al.  A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. , 1997, The New England journal of medicine.

[20]  A. Caggiula,et al.  Relation of body mass and alcohol, nutrient, fiber, and caffeine intakes to blood pressure in the special intervention and usual care groups in the Multiple Risk Factor Intervention Trial. , 1997, The American journal of clinical nutrition.

[21]  J. Cutler,et al.  Relationship to blood pressure of combinations of dietary macronutrients. Findings of the Multiple Risk Factor Intervention Trial (MRFIT). , 1996, Circulation.

[22]  P. Elliott,et al.  Inverse relation of dietary protein markers with blood pressure. Findings for 10,020 men and women in the INTERSALT Study. INTERSALT Cooperative Research Group. INTERnational study of SALT and blood pressure. , 1996, Circulation.

[23]  P. Elliott,et al.  Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations , 1996 .

[24]  P. Elliott,et al.  Dietary calcium and blood pressure: a meta-analysis of randomized clinical trials. , 1996, Annals of internal medicine.

[25]  P. Whelton,et al.  Dietary macronutrients and blood pressure in southwestern China , 1995, Journal of hypertension.

[26]  P Whelton,et al.  Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991. , 1995, Hypertension.

[27]  L. Beilin,et al.  VEGETARIAN DIET COMPONENTS, PROTEIN AND BLOOD PRESSURE: WHICH NUTRIENTS ARE IMPORTANT? , 1995, Clinical and experimental pharmacology & physiology.

[28]  L. Zhu,et al.  The relationship of dietary animal protein and electrolytes to blood pressure: a study on three Chinese populations. , 1994, International journal of epidemiology.

[29]  J. Neaton,et al.  Blood pressure, systolic and diastolic, and cardiovascular risks. US population data. , 1993, Archives of internal medicine.

[30]  P. López-Jaramillo,et al.  The L-arginine: nitric oxide pathway. , 1993, Current opinion in nephrology and hypertension.

[31]  S. Bealer,et al.  Central nervous system histamine regulates peripheral sympathetic activity. , 1991, The American journal of physiology.

[32]  M. Wiseman,et al.  The dietary and nutritional survey of British adults. , 1990 .

[33]  P. Nestel,et al.  Cardiovascular disease risk factors in free-living men: comparison of two prudent diets, one based on lactoovovegetarianism and the other allowing lean meat. , 1989, The American journal of clinical nutrition.

[34]  B. Zhou,et al.  Dietary patterns in 10 groups and the relationship with blood pressure. Collaborative Study Group for Cardiovascular Diseases and Their Risk Factors. , 1989, Chinese medical journal.

[35]  R. Vandongen,et al.  A randomized controlled trial of the effect on blood pressure of dietary non-meat protein versus meat protein in normotensive omnivores. , 1988, Clinical science.

[36]  K. Liu,et al.  Measurement error and its impact on partial correlation and multiple linear regression analyses. , 1988, American journal of epidemiology.

[37]  D. Reed,et al.  Relationship of magnesium intake and other dietary factors to blood pressure: the Honolulu heart study. , 1987, The American journal of clinical nutrition.

[38]  R. Vandongen,et al.  Vegetarian diet in mild hypertension: a randomised controlled trial. , 1986, British medical journal.

[39]  J. R. Landis,et al.  Blood pressure and nutrition in adults. The National Health and Nutrition Examination Survey. , 1984, American journal of epidemiology.

[40]  Y. Yamori,et al.  Dietary prevention of hypertension in animal models and its applicability to human. , 1984, Annals of clinical research.

[41]  D. McGee,et al.  The results of logistic analyses when the variables are highly correlated: an empirical example using diet and CHD incidence. , 1984, Journal of chronic diseases.

[42]  R. Vandongen,et al.  BLOOD-PRESSURE-LOWERING EFFECT OF A VEGETARIAN DIET: CONTROLLED TRIAL IN NORMOTENSIVE SUBJECTS , 1983, The Lancet.

[43]  T. M. Hayes,et al.  Dietary determinants of lipoproteins, total cholesterol, viscosity, fibrinogen, and blood pressure. , 1982, The American journal of clinical nutrition.

[44]  C. V. Van Itallie,et al.  Studies on the antihypertensive action of L-tryptophan. , 1982, The Journal of pharmacology and experimental therapeutics.

[45]  F. Sacks,et al.  Effect of ingestion of meat on plasma cholesterol of vegetarians. , 1981, JAMA.

[46]  R. Wurtman,et al.  Tyrosine administration reduces blood pressure and enhances brain norepinephrine release in spontaneously hypertensive rats. , 1979, Proceedings of the National Academy of Sciences of the United States of America.

[47]  H. Coates,et al.  Blood pressure in Seventh-day Adventist vegetarians. , 1977, American journal of epidemiology.