The Adherence To The Mediterranean Diet And Risk Of Hypertension In China: An Observational Study And Propensity Analysis

Objectives: To examine the relationship between five categories of Mediterranean diet adherence and the risk of developing hypertension. Methods: Risk factors distribution were based on data from the China Health and Nutrition Survey 1997–2011. A matching process based on propensity-score was performed to equalize potential prognostic factors in five groups after excluding dead and missing samples. Dietary situation was assessed by 3-day dietary recalls in addition to using a 3-day food-weighed method, and a 10-point Mediterranean diet score was constructed. The relationship between five levels of Mediterranean diet adherence and the risk of developing hypertension was examined by Cox proportional hazards regression. Life behavior factors were treated as time-varying variables. Results: A final total of 5725 individuals was included. 3.90% of respondents reported having hypertension. Matched respondents who were in the group with 4 scores (P < 0.001), 5–6 scores (P < 0.001), 7–10 Mediterranean diet scores (P < 0.001) tended to have reduced risk of hypertension. Between the propensity-score matched groups, the effect size of Mediterranean diet on incidence risk were larger in the three groups with highest diet adherence (HR4 = 0.653, P3 < 0.05; HR5–6 = 0.361, P4 < 0.05; HR7–10 = 0.256, P5 < 0.01). Adjusted hazard ratios (HRs) for the effect of Mediterranean diet adherence was 0.982 (P < 0.05) for time-varying approach controlling for a set of covariates. Besides, there was a significant positive relationship between BMI and risk of hypertension (HR = 1.024, P < 0.001). Conclusion: Findings suggested that adhering to the Mediterranean dietary pattern may have a lower risk of hypertension. Besides, the magnitudes of reduced risk of hypertension were larger in higher adherers to the Mediterranean diet scores groups.