不同膳食因素与轻中度高血压患者血压水平的关系

Associations of blood pressure change with change in foods′intake among adults with mild to moderate hypertension

目的分析轻中度高血压患者各类食物摄入量及其变化与血压水平及其变化的关系。方法研究对象来自DECIDE-Diet研究,该研究是一项多中心、随机对照试验。入选DECIDE-Diet研究中基线和结局数据均完整的轻中度高血压患者。收集入选患者7 d导入期(基线)和28 d试验期的膳食记录和血压测量数据。血压变化定义为试验结束时血压与基线血压的差值。各类食物基线摄入量为导入期每日摄入量的平均值,摄入量的增量定义为试验期平均摄入量与导入期平均摄入量的差值。调整年龄、性别、研究中心、干预分组情况、基线体重指数、是否服用降压药物及基线总热量摄入量,采用线性回归模型分析各类食物摄入量及其增量与血压水平及其变化的关系。结果共纳入258例轻中度高血压患者,其中男性133例,年龄(56.5±9.9)岁。(1)控制混杂因素后,各类食物的基线摄入量与基线收缩压和舒张压均无显著相关性(P均>0.05),但薯类、蔬菜、植物油的基线摄入量与收缩压、舒张压变化均呈负相关,而畜禽肉的基线摄入量与收缩压、舒张压变化均呈正相关;全谷物和鱼类的摄入量增量与收缩压、舒张压变化均呈负相关(P均<0.05)。(2)多元线性回归分析结果显示,蔬菜(β=-0.021,P=0.004)、植物油(β=-0.260,P=0.002)基线摄入量及鱼类摄入量增量(β=-0.128,P=0.026)均与收缩压变化相关;蔬菜(β=-0.017,P=0.002)、植物油(β=-0.182,P=0.001)、奶类(β=0.021,P=0.022)基线摄入量及鱼类摄入量增量(β=-0.092,P=0.010)均与舒张压变化相关。结论在轻中度高血压患者中,增加全谷物、蔬菜、植物油、鱼类摄入,减少畜禽肉摄入可能有利于患者血压的控制。

Objective To explore the association between the intake and changes in various types of food and the changes in blood pressure in patients with mild to moderate hypertension.Methods Mild to moderate hypertension participants with complete baseline and outcome data were included from DECIDE-Diet study,a multicenter,randomized controlled trial.Dietary records and blood pressure measurements at both 7-day run-in(baseline)and 28-day intervention phases were collected for enrolled participants.Blood pressure change was defined as the difference between blood pressure at the end of trial and the baseline blood pressure.Baseline intake of food was the average daily intake during the run-in period,and the intake increment was defined as the difference between the average intake during the trial period and the average intake during the run-in period.After adjusting for age,sex,study center,intervention groups,baseline body mass index(kg/m^(2)),antihypertension medication use,and baseline total calorie intake,a linear regression model was used to analyze the associations of the before-after-intervention change in blood pressure with baseline intake and intake increment of foods.Results A total of 258 patients with mild to moderate hypertension were included,including 133 males,aged(56.5±9.9)years.(1)After adjusting for confounding factors,there was no significant association between baseline intake of food and baseline blood pressure(all P>0.05).The blood pressure change was negatively associated with baseline intakes of tubers,vegetables,and vegetable oils but positively with baseline intake of meats;and was negatively associated with intake increment of whole grains and fish(all P<0.05).(2)The multiple linear regression analysis showed that baseline intake of vegetables(β=-0.021,P=0.004),vegetable oils(β=-0.260,P=0.002),and increment in intake of fish(β=-0.128,P=0.026)were all significantly associated with changes in systolic blood pressure;baseline intake of vegetables(β=-0.017,P=0.002),vegetable oils(β=-0.182,P=0.001),dairy products(β=0.021,P=0.022),and increment in intake of fish(β=-0.092,P=0.010)were all significantly associated with changes in diastolic blood pressure.Conclusion Increasing the intake of whole grains,vegetables,vegetable oils,and fish and decreasing the intake of meat may be beneficial for blood pressure control in patients with mild to moderate hypertension.