In a recent publication in the European Journal of Clinical Nutrition, investigators evaluated the enduring effects of adhering to the Mediterranean diet on the development of hypertension (HTN) over a span of 20 years among a cohort of non-hypertensive adults.
Introduction
Hypertension (HTN) significantly impacts global health, contributing to severe complications like heart disease and stroke, particularly prevalent in low and middle-income nations. Despite the efficacy of antihypertensive medications in stabilizing global blood pressure levels, approximately 30% of adults are affected by HTN, leading to increased costs and mortality associated with cardiovascular disease (CVD). Lifestyle modifications, including balanced diets, regular exercise, and smoking cessation, are crucial for managing and preventing HTN. Health guidelines recommend diets rich in plant-based foods, healthy fats, lean proteins, and low in sodium and alcohol. Although the Mediterranean diet has been recognized since the 1960s for its role in preventing chronic diseases and reducing cardiovascular mortality, there remains a lack of long-term definitive evidence regarding its effectiveness in managing blood pressure, necessitating further research.
Study Overview
The ATTICA study, conducted in accordance with the principles of the Declaration of Helsinki, is a long-term, population-based health investigation focusing on the incidence of cardiovascular disease (CVD) among Greek adults. Commencing with 4,056 individuals from the Attica region, 3,042 participants consented and have been monitored for a duration of 20 years. The initial phase of the ATTICA study, carried out between 2001 and 2002, entailed face-to-face interviews conducted at participants’ residences or workplaces. These interviews were administered by trained healthcare professionals who gathered comprehensive sociodemographic, clinical, and biochemical information utilizing a standardized protocol. Key assessments included fasting blood samples for glucose, insulin, total cholesterol (TC) levels, and high sensitivity C-reactive protein (hsCRP), among other markers. Moreover, participants underwent physical examinations to confirm the absence of CVD and to document their blood pressure readings. Lifestyle factors, including dietary habits, physical activity levels, and smoking behaviors, were meticulously documented, with dietary patterns assessed using a validated food frequency questionnaire, and adherence to the Mediterranean diet was evaluated using the MedDietScore.
Over the course of 20 years, the study maintained ongoing involvement with participants through scheduled follow-up assessments, with the most recent conducted in 2022. During this latest follow-up, 2,169 of the original participants were re-evaluated, with data collected on various health outcomes, including the incidence of hypertension (HTN), diabetes, and cardiovascular disease (CVD). Information was corroborated through familial reports and medical records for deceased participants.
Statistical software was employed to analyze the gathered data, comparing baseline and 10-year dietary patterns. Additionally, the study identified four distinct trajectories of adherence to the Mediterranean diet. Statistical analyses encompassed correlation coefficients, chi-squared tests, and logistic regression models, aiming to elucidate the association between dietary adherence and the risk of HTN. These analyses were adjusted for multiple confounding variables, such as age, sex, body mass index (BMI), lifestyle habits, and baseline health status.
Study Findings
Tracking 1,415 participants over a span of 20 years, the study investigated the correlation between adherence to the Mediterranean diet and health outcomes. At the study’s outset, the average age of participants was 41 years, with gender distribution nearly equal (44% men). The study population demonstrated moderate adherence to the Mediterranean diet, reflected by an average MedDietScore of 27.1. In terms of physical activity, 63.1% of subjects exhibited minimal activity levels, while approximately half were classified as overweight or obese. Medical assessments unveiled a prevalence of hypercholesterolemia in 35.3% of participants and diabetes in 3.9%.
The examination of baseline data revealed a distinct inverse correlation between adherence to the Mediterranean diet and both systolic and diastolic blood pressures, implying that increased adherence was linked to reduced blood pressure levels. Over the course of the two-decade follow-up, hypertension developed in 314 individuals, representing an incidence rate of 22.2%. Those who developed hypertension tended to be older, predominantly male, and exhibited higher rates of obesity, poorer cardiometabolic profiles, and increased tobacco usage compared to those who remained free of hypertension.
A comprehensive analysis revealed a direct association between a lower baseline MedDietScore and a heightened incidence of hypertension. Specifically, individuals with poor dietary adherence demonstrated notably elevated rates of developing hypertension compared to those with moderate or high adherence. Statistical scrutiny corroborated that for each incremental increase in MedDietScore at baseline, there was a corresponding 7% decrease in the risk of developing hypertension over the 20-year period. Even after accounting for variables such as age, gender, BMI, lifestyle habits, and baseline health status, the inverse correlation between dietary adherence and hypertension risk remained significant.
Further exploration of dietary adherence trajectories from baseline to the 10-year milestone unveiled various patterns. Of particular note was that participants who consistently adhered to the Mediterranean diet (exhibiting a trajectory of sustained adherence) showcased a markedly reduced incidence of hypertension compared to those whose adherence declined over time. In the fully adjusted model, this group exhibited a 46.5% lower risk, underscoring the protective influence of prolonged adherence to the Mediterranean diet against hypertension.
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