Public Health Nutrition

Monitoring and surveillance

Hypothesis-oriented food patterns and incidence of hypertension: 6-year follow-up of the SUN (Seguimiento Universidad de Navarra) prospective cohort

Estefanía Toledoa1a2, Francisco de A Carmona-Torrea1, Alvaro Alonsoa1a3, Blanca Puchaua4, María A Zuleta4, J Alfredo Martineza4 and Miguel A Martinez-Gonzaleza1 c1

a1 Department of Preventive Medicine and Public Health, Medical School – Clinica Universidad de Navarra, University of Navarra, c/Irunlarrea, 1 Ed. Investigacion, E-31008 Pamplona (Navarra), Spain

a2 Department of Preventive Medicine and Quality Management, Hospital Virgen del Camino, c/Irunlarrea 4, E-31008 Pamplona (Navarra), Spain

a3 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA

a4 Department of Nutrition and Food Sciences, Physiology and Toxicology, University of Navarra, c/Irunlarrea, 1. Ed. Investigacíon, E-31008 Pamplona (Navarra), Spain


Objective To study the association between adherence to several a priori-defined healthy food patterns and the risk of hypertension.

Design Prospective, multipurpose, dynamic cohort study (recruitment permanently open). We followed up 10 800 men and women (all of them university graduates), who were initially free of hypertension, for a variable period (range 2–6 years, median 4·6 years). During follow-up, 640 participants reported a new medical diagnosis of hypertension. Baseline diet was assessed using a validated 136-item FFQ. Validated information about non-dietary potential confounders was also gathered. We calculated adherence to fifteen different hypothesis-oriented food patterns and assessed the association between each of them and incident hypertension using multivariable Cox models.

Setting The SUN (Seguimiento Universidad de Navarra – University of Navarra Follow-up) Project, Spain.

Subjects Participants recruited to the SUN cohort before October 2005 were eligible for inclusion; after excluding those with self-reported hypertension or CVD at baseline, or with extreme total energy intake, data of 10 800 were analysed.

Results Higher adherence to the DASH (Dietary Approaches to Stop Hypertension) diet (range of the score: 0 to 5) was significantly associated with a lower risk for developing hypertension (P for trend = 0·02). The other food patterns showed no significant association with incident hypertension.

Conclusions Our results support a long-term protection of the DASH diet against the incidence of hypertension, but we found no evidence of a similar inverse association with hypertension for any other a priori-defined healthy food pattern.

(Received October 23 2008)

(Accepted June 24 2009)

(Online publication August 06 2009)


c1 Corresponding author: Email