1. ¹Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
2. ²Department of Epidemiology and Public Health, Faculty of Medicine, St Mary's Campus, Imperial College, London, UK
3. ³Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina, Chapel Hill, NC, USA
4. ⁴Central Laboratory, Akademisch Ziekenhuis St Rafael, Leuven, Belgium
5. ⁵Department of Health Science, Shiga University of Medical Science, Otsu, Japan
6. ⁶Department of Epidemiology, Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, People's Republic of China

Correspondence: Dr J Stamler, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Suite 1102(D335), 680 North Lake Shore Drive, Chicago, IL, USA. E-mail: jstamler@northwestern.edu

^*Member, INTERMAP Steering and Editorial Committee.

Abstract

Blood pressure (BP) above optimal (120/80 mmHg) is established as a major cardiovascular disease (CVD) risk factor. Prevalence of adverse BP is high in most adult populations; until recently research has been sparse on reasons for this. Since the 1980s, epidemiologic studies confirmed that salt, alcohol intake, and body mass relate directly to BP; dietary potassium, inversely. Several other nutrients also probably influence BP. The DASH feeding trials demonstrated that with the multiple modifications in the DASH combination diet, SBP/DBP (SBP: systolic blood pressure, DBP: diastolic blood pressure) was sizably reduced, independent of calorie balance, alcohol intake, and BP reduction with decreased dietary salt. A key challenge for research is to elucidate specific nutrients accounting for this effect. The general aim of the study was to clarify influences of multiple nutrients on SBP/DBP of individuals over and above effects of Na, K, alcohol, and body mass. Specific aims were, in a cross-sectional epidemiologic study of 4680 men and women aged 40–59 years from 17 diverse population samples in China, Japan, UK, and USA, test 10 prior hypotheses on relations of macronutrients to SBP/DBP and on role of dietary factors in inverse associations of education with BP; test four related subgroup hypotheses; explore associations with SBP/DBP of multiple other nutrients, urinary metabolites, and foods. For these purposes, for all 4680 participants, with standardized high-quality methods, assess individual intake of 76 nutrients from four 24-h dietary recalls/person; measure in two timed 24-h urine collections/person 24-h excretion of Na, K, Ca, Mg, creatinine, amino acids; microalbuminuria; multiple nutrients and metabolites by nuclear magnetic resonance and high-pressure liquid chromatography. Based on eight SBP/DBP measurements/person, and data on multiple possible confounders, utilize mainly multiple linear regression and quantile analyses to test prior hypotheses and explore relations of multiple dietary and urinary variables to SBP/DBP of individuals.

The 4680 INTERMAP participants are equally divided across four age/gender strata: diverse in ethnicity, education, occupation, physical activity; use of cigarettes, alcohol; diagnosed high BP, CVD, diabetes; CVD family history; women vary in parity, use of contraceptive medication and hormone replacement therapy.