Dietary phosphorus, blood pressure, and incidence of hypertension in the atherosclerosis risk in communities study and the multi-ethnic study of atherosclerosis

Abstract

Greater phosphorus intake has been associated with lower levels of blood pressure in cross-sectional studies. This association, however, has not been assessed prospectively. We studied 13 444 participants from the Atherosclerosis Risk in Communities cohort and the Multi-Ethnic Study of Atherosclerosis, with diet assessed at baseline using validated food frequency questionnaires. Blood pressure and use of antihypertensive medication were determined at baseline and during follow-up visits. Compared with individuals in the lowest quintile of phosphorus intake at baseline, those in the highest quintile had lower baseline systolic and diastolic blood pressures after adjustment for dietary and nondietary confounders (-2.0 mm Hg [95% CI: -3.6 to -0.5], P for trend=0.01; and -0.6 [95% CI: -1.6 to +0.3], P for trend=0.20, respectively). During an average 6.2 years of follow-up, 3345 cases of hypertension were identified. Phosphorus intake was associated with the risk of hypertension (hazard ratio: 0.80 [95% CI: 0.80 to 1.00], comparing extreme quintiles; P for trend=0.02) after adjustment for nondietary factors but not after additional adjustment for dietary variables (hazard ratio: 1.01 [95% CI: 0.82 to 1.23], P for trend=0.88). Phosphorus from dairy products but not from other sources was associated with lower baseline blood pressure and reduced risk of incident hypertension. Hazard ratios (95% CIs) comparing extreme quintiles were 0.86 (0.76 to 0.97; P for trend=0.01) for phosphorus from dairy foods and 1.04 (0.93 to 1.17; P for trend=0.48) for phosphorus from other foods. These findings could indicate an effect of phosphorus in conjunction with other dairy constituents or of dairy itself without involvement of phosphorus.

Figure 1

Participation flow diagram, ARIC and MESA.

Figure 2

Cross-sectional difference in systolic BP (SBP) levels (and 95% confidence intervals) by quintiles of phosphorus from dairy products (black squares) and phosphorus from non-dairy foods (dark grey circles). Pooled results from ARIC and MESA. Linear regression model adjusted for age, race, sex, body mass index, waist circumference, eGFR, education, income, physical activity, cigarette smoking, study site, alcohol intake, and energy intake.

Figure 3

Hazard ratios (HR) and 95% confidence intervals (CI) of hypertension by quintiles of phosphorus from dairy products (black squares) and phosphorus from non-dairy foods (dark grey circles). Pooled results from ARIC and MESA. Cox proportional hazard model adjusted for age, race, sex, body mass index, waist circumference, eGFR, education, income, physical activity, cigarette smoking, study site, alcohol intake, and energy intake.