Relationship Between Diet Quality and Antihypertensive Medication Intensity Among Adults With Metabolic Syndrome-Associated High Blood Pressure

Abstract

Background: Management of high blood pressure (BP), a key feature of the metabolic syndrome (MetS), relies on diet and medication. Whether these modalities are used as complements has never been evaluated in real-world settings. This study assessed the relationship between diet quality and antihypertensive medication intensity among adults with MetS-associated high BP.

Methods: This cross-sectional study included 915 adults with MetS-associated high BP from the CARTaGENE cohort (Québec, Canada), of whom 677 reported using BP-lowering medication. Antihypertensive medication intensity was graded per the number of BP-lowering classes used simultaneously. Diet quality was assessed using the Dietary Approach to Stop Hypertension (DASH) score.

Results: No evidence of a relationship between antihypertensive medication intensity and diet quality was found (β for each additional antihypertensive = -0.05; 95% CI, -0.35; 0.26 DASH score points). However, among men aged < 50 years and women aged < 60 years, the DASH score was inversely associated with medication intensity (β = -0.72; 95% CI, -1.24, -0.19), whereas this relationship tended to be positive among older participants (β = 0.32; 95% CI, -0.05, 0.69). Among participants with low Framingham risk score, the DASH score was inversely associated with medication intensity (β = -0.70; 95% CI, -1.31, -0.09), but no evidence of an association was found among individuals at moderate (β = 0.00; 95% CI, -0.45, 0.45) or high (β = 0.30, 95% CI, -0.24, 0.84) risk.

Conclusions: In this cohort of adults with MetS-associated high BP, there was an overall lack of complementarity between diet quality and BP-lowering medication, especially among younger individuals and those with a lower risk for cardiovascular disease for whom diet quality was inversely associated with intensity of medication.

Figure 1

Dietary Approaches to Stop Hypertension (DASH) score according to antihypertensive medication intensity. Data are presented as mean (95% confidence interval), following adjustments for gender (men, women), age (years), annual household income (< $10,000; $10,000-$24,999; $25,000-$49,999; $50,000-$74,999; $75,000-$99,999; $100,000-$149,999; $150,000-$199,999; > $200,000), body mass index (kg/m²), smoking status (never/ever/current), physical activity level (low/moderate/high), self-reported history of high blood cholesterol (yes/no), alcohol consumption (grams per day), and energy intake (kcal per day). The number of antihypertensive medication class was treated as a categorical variable in this model (0; 1; 2; 3+). P value for between-group differences associated with the number of blood pressure-lowering medication classes = 0.86. Groups with different superscript letters are statistically different (Tukey-Kramer’s multiple comparison test, P < 0.05).

Figure 2

Systolic (A) and diastolic (B) blood pressure according to antihypertensive medication intensity. Data are presented as mean (95% confidence interval). Models were adjusted for sex (male, female), age (years), annual household income (< $10,000; $10,000-$24,999; $25,000-$49,999; $50,000-$74,999; $75,000-$99,999; $100,000-$149,999; $150,000-$199,999; > $200,000), body mass index (kg/m²), smoking status (never/ever/current), alcohol consumption (grams per day), energy intake (kcal per day), physical activity level (low/moderate/high), self-reported history of high blood cholesterol (no/yes), and DASH score. The number of antihypertensive medication classes was treated as a categorical variable in this model (0; 1; 2; 3+). Groups with different superscript letters are statistically different (Tukey-Kramer’s multiple comparison test, P < 0.05). DASH, Dietary Approaches to Stop Hypertension.