948 American Journal of Hypertension 29(8) August 2016 ORIGINAL ARTICLE Hypertension is the most prevalent chronic disease afect- ing more than 30% of adults aged ≥25 years worldwide and the number of people with the condition rose from 600 mil- lion in 1980 to 1 billion in 2008. 1 Recent data reported that raised blood pressure (BP) is to be the most important con- tributor to the global burden of disease and to global mor- tality, leading to 9.4 million deaths each year. 2 In France, hypertension estimated prevalence is 31% for adults aged 18–74 years. 3 With such an increasing prevalence, preven- tive strategies from a public health perspective are urgently needed. Literature on the relationship between nutrition and BP is abundant linking the efect of several nutrients (salt, potassium, fber…) or foods (fruits, vegetables…) on BP 4 ; but more recently, studies in the area focused on whole diet considering that dietary components may interact with each other. Indeed, global dietary pattern takes into account the potential synergistic efects of individual components of the diet. 5 Healthy diet like the Dietary Approach to Stop Hypertension (DASH) 6 and the Mediterranean diet (MD) 7 have been shown to improve BP level. Te DASH trial was a clinical randomized trial which showed a benefcial efect on BP reduction in both normotensive and hypertensive individuals when adopting a DASH dietary pattern rich in fruits, vegetables, low-fat dairy and reduced in saturated and total fat. 6 Observational studies reported that adherence to a DASH-style diet was associated with lower BP 8 but also with reduced risk of incident hypertension, 9,10 coronary heart disease, and stroke. 11 Besides the DASH dietary pat- tern which could be the better dietary style to improve BP control, the MD, traditional food pattern in Mediterranean basin, showed through a dietary intervention trial, benef- cial reduction in BP 7 and cardiovascular events. 12 To tackle the rise of BP in general population and the burden of its public health consequences, nutritional policies have been implemented in several countries for hypertension pre- vention in the general population. In France, the preven- tion of high BP through nutrition is one of the objectives of the French Nutrition and Health Program (Programme Association Between Blood Pressure and Adherence to French Dietary Guidelines Helene Lelong, 1,2 Jacques Blacher, 1,2 Mehdi Menai, 2 Pilar Galan, 2 Leopold Fezeu, 2 Serge Hercberg, 2,3 and Emmanuelle Kesse-Guyot 2 BACKGROUND Adopting a healthy diet like the Dietary Approach to Stop Hypertension (DASH) or Mediterranean diet (MD) represents a major lifestyle for blood pressure (BP) control in general population. Nutritional policies, such as the French Nutrition and Health Program (Programme National Nutrition Santé or PNNS), have been implemented in several countries with the aims of preventing chronic diseases. The objective of our study was to investigate association between BP and adherence to PNNS guidelines compared with adherence to DASH or MD. METHODS We conducted a cross-sectional study in 11,302 untreated participants from the NutriNet-Santé study, a French web-based cohort study. Three validated scores refecting adherence to PNNS guidelines, DASH diet, and MD were calculated from repeated 24-hour records. Three BP meas- urements using a standardized protocol were collected. Multivariate linear models were used to assess the associations between the dietary scores and BP. RESULTS In women, independent of age, socioeconomic status, body mass index, tobacco use, alcohol consumption, and physical activity, adher- ence to PNNS guidelines was inversely signifcantly associated with systolic BP (β = −0.63, P < 0.0001). This association was of similar ampli- tude that between BP and adherence to DASH-style diet (β = −0.66, P < 0.0001) or MD (β = −0.63, P = 0.0002). No signifcant association was found in men. CONCLUSION Adherence to French nutritional recommendations was found nega- tively associated with BP at the same magnitude as adherence to well- known dietary pattern in the prevention and treatment of hypertension. Keywords: blood pressure; dietary scores; epidemiology; hypertension; nutritional policies. doi:10.1093/ajh/hpw017 Correspondance: Helene Lelong (helene_lelong@hotmail.com). Initially submitted November 30, 2015; date of frst revision December 17, 2015; accepted for publication January 29, 2016; online publication February 22, 2016. © American Journal of Hypertension, Ltd 2016. All rights reserved. For Permissions, please email: journals.permissions@oup.com 1 Paris-Descartes University, Faculty of Medicine, Hôtel-Dieu Hospital, AP-HP, Diagnosis and Therapeutic Center, Paris, France; 2 Paris 13, Sorbonne Paris Cité University, UREN (Nutritional Epidemiology Research Unit) - U557 INSERM, U1125 INRA, CNAM, CRNH IdF, Bobigny, France; 3 Department of Public Health, Avicenne Hospital, Bobigny, France. Downloaded from https://academic.oup.com/ajh/article-abstract/29/8/948/2622250 by guest on 17 June 2020