| Background and Objective Hypertension is the primary risk factor of the disease burden,and has become a major public health problem in China.The prevalence of hypertension displays a steep rise,however,the rates of awareness,treatment and control remain at a relatively low level,especially in rural residents,implying a huge burden of future cardiovascular diseases in rural China.Besides excessive dietary sodium intake,unhealthy diet is another major risk factor of hypertension.Studies have shown that a diet rich in fruit and vegetable could help to prevent and control hypertension,but related epidemiological evidences were inconsistent in the association of fruit and vegetable intake with incident hypertension.This study aimed to investigate the associations of fruit and vegetable consumption with the risk of incident hypertension,and blood pressure(BP)progression among rural hypertensive patients,and provide theoretical basis for the prevention and management of hypertension in China.Methods Based on the Prediction for Atherosclerotic Cardiovascular Disease Risk in China(China-PAR)project,this study collected information on diet consumption and behavioral lifestyle,disease history,family history,blood pressure(BP)and so on at baseline,and hypertension incidence during the follow-up.Information on diet consumption were aquired through food frequency questionnaires.The analyses of association between fruit and vegetable intake and the risk of hypertension incidence included three cohorts with dietary records from the China-PAR project.A total of 55 542 participants without hypertension aged?18 years at baseline were included in our analyses.Participants were classified into five groups according to quintiles(Q1-Q5)of total fruit and vegetable(TFV),fruit,and vegetable consumption,respectively.Hypertension was defined as systolic BP(SBP)?140 mmHg and/or diastolic BP(DBP)?90 mmHg and/or taking antihypertensive medications within the past two weeks.Cox proportional hazard models were performed to estimate hazard ratios(HR)and 95%confidence intervals(CI)for incident hypertension with intakes of fruit and vegetable.Multivariable linear regression models were used to assess the relationship of changes of fruit and vegetable consumption from baseline to the first follow-up with BP level at the second follow-up.The analyses of association between fruit and vegetable intake and BP progression in rural China included the Community Intervention of Metabolic Syndrome in China&Chinese Family Health Study(CIMIC)from the China-PAR project.A total of 25 080 hypertensive patients were included in our analyses.Participants were divided into two groups by whether meeting the recommended levels of TFV,fruit,or vegetable intake(Yes or No),and were also classified into four groups according to their quartiles(Q1?Q4),respectively.Stages of hypertension were ascertained according to the 2018 Chinese guidelines for the management of hypertension,and BP progression was defined as an increment of?1 stage of hypertension from baseline to the follow-up visit.Multivariable logistic regression models were used to estimate the odds ratios(OR)and their corresponding 95%CI for the relationship of fruit and vegetable intake with the risk of BP progression.Results In the analyses of association between fruit and vegetable intake and the risk of incident hypertension,during a mean follow-up of 7.0 years(388 240.7 person-years),12 340 new hypertension cases were identified among 55 542 participants without hypertension at baseline,with the incidence rate of 31.8 per 1000 person-years.Compared with participants in the lowest TFV intake group(Q1),the HR(95%CI)of incident hypertension were 0.87(0.82-0.93),0.81(0.76-0.87),0.77(0.72-0.82)and 0.74(0.68-0.79)for Q2-Q5 group,respectively(Ptrend<0,001).When fruit and vegetable were analyzed separately,higher intake of vegetable(Ptrend<0.001),but not fruit(Ptrend=0.808),remained significantly associated with the reduced risk of hypertension.Further restricting to participants failed to achieve the recommended intake level(500 g/d),higher TFV intake had a protective effect on the incident hypertension even though it was below the level recommended by "Chinese guideline on healthy lifestyle to prevent cardiometabolic diseases".Compared with participants consuming less than 200 g TFV per day,those who consumed TFV of 200.0-349.9 g and 350.0-499.9 g per day had a lower risk of incident hypertension with HR(95%CI)of 0.94(0.88-1.01)and 0.85(0.79-0.91),respectively.In addition,a longitudinal increase in TFV intake was inversely associated with BP level.Each standard deviation increment in TFV was associated with a 0.56(0.06-1.07)mmHg decline in SBP and a 0.55(0.24-0.86)mmHg decline in DBP.In the analyses of association between fruit and vegetable intake and BP progression in rural China,4 112 patients had BP progression during the average follow-up of 5.8 years(145 785.2 person-years),with the progression rate of 16.4%.Hypertensive patients who met the recommended TFV intake had a 17%(OR:0.83,95%CI:0.77-0.90)reduction in the risk of BP progression compared with those who did not.Compared with the lowest group of TFV(Q1),the OR(95%CI)of BP progression were 0.86(0.78-0.95),0.77(0.690.86)and 0.69(0.61-0.77)for the Q2,Q3 and Q4 group,respectively(P trend<0.001).Analyses of separate vegetable and fruit consumption showed similar results.Furthermore,each increment of 100 g/d in TFV and vegetable intake was associated with a 4%(OR:0.96,95%CI:0.94-0.98)and 5%(OR:0.95,95%CI:0.93-0.97)lower risk of BP progression,respectively.The association of fruit with BP progression was not significant.Subgroup analyses indicated that the healthy effects of TF V were different between smoker and non-smoker.Higher TFV was significantly associated with the reduced risk of BP progression in non-smoker with hypertension,but not in smoker.There was no substantial change of the results after excluding patients taking anti-hypertensive medications.Conclusion Based on a prospective cohort with large sample size,this study quantified the associations of fruit and vegetable intakes with the risk of hypertension,and the risk of BP progression among hypertensive patients.Increasing fruit and vegetable intakes would effectively reduce the risk of hypertension,and the risk of BP progression among hypertensive patients.Even if it was lower than the recommended level,the reverse association of fruit and vegetable intake with the risk of hypertension remained significant.Therefore,it is urgently needed to advocate healthy diet and increase fruit and vegetable intake and then improve the prevention and management of hypertension in China. |
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