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The association of dietary phosphorus with blood pressure: results from a secondary analysis of the PREMIER trial

Journal of Human Hypertension volume 34, pages 132–142 (2020)Cite this article

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Abstract

Inconsistent findings exist for the association between dietary phosphorus intake and blood pressure (BP). We examined the longitudinal association between urinary excretion and dietary intake of phosphorus (total, plant, animal, and added) with BP. This is a secondary analysis of PREMIER, a randomized behavioral intervention study in adults (25–79 years) with BP, measured at 6 months, as the primary outcome. We classified total phosphorus intake from dietary recalls into plant, animal, and added phosphorus. We modeled 6-month change of phosphorus intake (from 24 h dietary recalls, N = 622) and excretion (from 24 h urine collection, N = 564) on BP, using linear regression crude and adjusted for intervention, age, race, sex, income, education, study site, and change in energy intake (kcal/day), sodium intake (mg/day), fitness (heart rate, bpm), and DASH diet index. Baseline phosphorus intake was 1154 mg/day (95% CI 1126, 1182) with 38%, 53%, and 10% from plant, animal, and added phosphorus, respectively. Total phosphorus intake was not associated with significant changes in BP. Increased urinary phosphorus excretion was associated with a significant increase in DBP [0.14 mmHg/100 mg (0.01, 0.28), adjusted]. In several analyses, phosphorus type (plant, animal, or added) significantly modified the association between phosphorus intake and BP. For example, added phosphorus (but not plant or animal) was associated with increases in SBP and DBP, 1.24 mmHg/100 mg (0.36, 2.12) and 0.83 mmHg/100 mg (0.22, 1.44), respectively, crude. These findings suggest that the type of phosphorus may modify the association between phosphorus intake and BP. Trial registration NCT00000616 (clinicaltrials.gov).

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Acknowledgements

STM was supported by the NIH/National Heart, Lung, and Blood Institute grant T32 HL007024. CMR was supported by a Mentored Research Scientist Development Award from the National Institute of Diabetes and Digestive and Kidney Diseases (K01 DK107782). ES was supported by NIH/NIDDK grants K24DK106414 and R01DK089174.

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Authors and Affiliations

  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Scott T. McClure, Casey M. Rebholz, Elizabeth Selvin & Lawrence J. Appel

  2. Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA

    Scott T. McClure, Casey M. Rebholz, Elizabeth Selvin & Lawrence J. Appel

  3. Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA

    Diane C. Mitchell

  4. Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Elizabeth Selvin & Lawrence J. Appel

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Correspondence to Scott T. McClure.

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McClure, S.T., Rebholz, C.M., Mitchell, D.C. et al. The association of dietary phosphorus with blood pressure: results from a secondary analysis of the PREMIER trial. J Hum Hypertens 34, 132–142 (2020). https://doi.org/10.1038/s41371-019-0231-x

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