consumo frutas y vegetales para hta

8/18/2019 Consumo Frutas Y Vegetales Para HTA

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Hypertension, a major risk factor for cardiovascular andrenal diseases, continues to represent a growing publichealth concern nationwide and worldwide. It is estimated that41% of adult Americans will have a diagnosis of hyperten-sion by the year 2030.1,2 The Dietary Approach to StoppingHypertension (DASH) diet emphasizes the importance ofi i f it d t bl ti hil d

Methods

Study PopulationParticipants consisted of the Nurses’ Health Study (NHS, N=121 700women, aged 30–55 years in 1976), the Nurses’ Health Study II(NHS II, N=116 430 women, aged 25–42 years in 1989), and theHealth Professionals Follow-up Study (HPFS, N =51 529 men, aged

Abstract—Increased fruit and vegetable intake lowers blood pressure in short-term interventional studies. However, data onthe association of long-term intake of fruits and vegetables with hypertension risk are scarce. We prospectively examinedthe independent association of whole fruit (excluding juices) and vegetable intake, as well as the change in consumptionof whole fruits and vegetables, with incident hypertension in 3 large longitudinal cohort studies: Nurses’ Health Study(n=62 175), Nurses’ Health Study II (n=88 475), and Health Professionals Follow-up Study (n=36 803). We calculatedhazard ratios and 95% confidence intervals for fruit and vegetable consumption while controlling for hypertension riskfactors. Compared with participants whose consumption was ≤4 servings/week, the pooled hazard ratios among thosewhose intake was ≥4 servings/day were 0.92(0.87–0.97) for total whole fruit intake and 0.95(0.86–1.04) for total vegetableintake. Similarly, compared with participants who did not increase their fruit or vegetable consumption, the pooledhazard ratios for those whose intake increased by ≥7 servings/week were 0.94(0.90–0.97) for total whole fruit intake and0.98(0.94–1.01) for total vegetable. Analyses of individual fruits and vegetables yielded different results. Consumptionlevels of ≥4 servings/week (as opposed to


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increasing fruit and vegetable consumption while decreas Health Professionals Follow up Study (HPFS, N 51 529 men, aged

Borgi et al Hypertension Risk With Fruit and Vegetable Intake 289

Board of Brigham and Women’s Hospital approved the study. Byvirtue of voluntarily returning their questionnaires, participants pro-vided implied consent. All procedures followed were in accordance

with institutional guidelines.

Assessment of HypertensionHypertension was self-reported on the baseline and biennial ques-tionnaires. This method of reporting a diagnosis of hypertension wasshown to be valid in the 3 cohorts.13–15 In NHS, for example, 77% of51 cases of self-reported hypertension had a BP >160/95 mm Hg.13

A participant was considered to have prevalent hypertension if sheor he reported this diagnosis on any questionnaire up to and includ-ing the 1984 (NHS), 1991 (NHS II), or 1986 (HPFS) questionnaire.Participants were determined to be cases if they reported a diagnosisof hypertension on subsequent questionnaires, with a date of diagno-sis that was after the date of the baseline questionnaire.

Assessment of Fruits and Vegetables IntakeA detailed dietary questionnaire was sent in 1984, 1986, and every 4 yearsthereafter. Similar FFQs were mailed every 4 years beginning in 1991and 1986 for NHS II and HPFS, respectively. Participants answered howoften, on average, they consumed a specific food; 9 different responsecategories could be selected, ranging from never or


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290 Hypertension February 2016

HRs were 0.92 (0.83–1.03;P trend=0.01) and 0.94(0.77–1.14;P trend


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DiscussionIn 3 prospective cohort studies of US women and men, long-term intake of total whole fruit was associated with a decreasedrisk of developing hypertension, whereas total vegetable intakewas not. The association of whole fruit intake with hyperten-sion incidence was independent of other known and potential

risk factors for hypertension. Some vegetables (ie, broccoli,carrots, tofu) and some fruits (ie, raisins or grapes and apples

or pears) were associated with a lower risk of hypertension,whereas some vegetables (ie, string beans, Brussels sprouts)and cantaloupe were associated with an increased risk of devel-oping hypertension. To our knowledge, our study is the first toprospectively analyze individual vegetables and has the longestfollow-up period of any study of diet and hypertension.

Our finding that total whole fruit but not total veg-etable intake is associated with a lower risk of developing

Table 3. Pooled Hazard Ratios (95% Confidence Intervals) of Incident Hypertension for Several

Individual Fruit and Individual Vegetable Consumption in Nurses’ Health Study Nurses’ Health

Table 2. Pooled Hazard Ratios (95% Confidence Intervals) of Incident Hypertension for Combined Total

Fruits and Total Vegetables Consumption in Nurses’ Health Study, Nurses’ Health Study II ,and Health

Professional Follow-up Study

≤1 per Day 2–3 per Day 4–5 per Day ≥6 per Day

Linear P

Trend

Total Fruits and Vegetables

NHS* 1052/31 868 11 318/339 541 13 914/396 152 9091/266 861

Adjusted hazard ratio† 1.00 (reference) 0.90 (0.84–0.95) 0.88 (0.83–0.94) 0.85 (0.80–0.91)


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292 Hypertension February 2016

hypertension is consistent with some earlier studies. The larg-est prior experience comes from the Women’s Health Study,a prospective cohort of 28 082 female US health professionals

with baseline semiquantitative FFQ and 12.9 years of follow-up.5 Those participants who consumed more dark-yellowvegetables had a lower adjusted risk of incident hypertension(HR=0.88; 95 confidence interval 0.82–0.95), whereas simi-lar comparisons for cruciferous vegetables (such as brusselsprouts) yielded an increased risk of hypertension (HR=1.14;1.06–1.23).5 Also similar to our study, greater intake of applesand raisins were associated with lower risks of developinghypertension, with HRs of 0.91 (0.85–0.99) and 0.90 (0.85–

0.96), respectively.5Other studies are considerably smaller or are cross-sectional.

In the Ohasama study, for example, 745 nonhypertensive womenand men aged≥35 years were followed for 4 years.6 Participantsin the highest compared with lowest quintile of fruit intake hada lower adjusted hypertension risk (odds ratio=0.40; 0.21–0.74,P trend=0.03).6 The mechanisms by which fruits and vegetablesmay be associated with hypertension are probably multiple.One hypothesis pertains to the high flavonoid content of sev-eral fruits and vegetables, such as berries, apples, broccoli, andothers.20 In a prospective study of the NHS I, NHS II, and theHPFS, participants in the highest quintile intake of anthocyanins(mostly from blueberries and strawberries) had an 8% lower riskof hypertension.21 Also, in a randomized controlled trial of menat risk for cardiovascular disease, a diet rich with high-flavonoidfruits and vegetables increased endothelium-dependent micro-vascular reactivity and plasma nitric oxide, as well as decreasedC-reactive protein and E-selectin.22 Furthermore, grape poly-phenols were found to potentiate vasorelaxation and decreaseBP, as well as endothelial dysfunction markers, in a small,placebo-controlled, double-blind study of 24 men with meta-bolic syndrome 23 Endothelial dysfunction inflammation and

Brassica corps group is controversial.30 In one study, for exam-ple, microwave cooking decreased broccoli’s flavonoid contentby 97%.31 In another study, however, precooking and cooking

methods did not alter the antioxidant capacities of broccoli.32There are several limitations to our study. First, the diag-

nosis of hypertension was self-reported and participants’ BPswere not directly measured. However, all participants arehealth professionals, and this method of hypertension diagno-sis in these cohorts has been validated in multiple studies.14–16 Second, our participants were mostly nonhispanic white menand women, and this analysis should be replicated in otherpopulations. Third, the FFQ is an imperfect tool for assess-

ing food intake, and therefore, random misclassification offruit and vegetable consumption may have occurred; this ran-dom error was likely to have been amplified in our analysesof change in intake over time. Yet, this type of error wouldhave the effect of moving our hazard ratios toward the null(ie, toward finding no associations). Thus, it is possible thatthe associations we report are underestimates of the true rela-tionships. Fourth, the associations that we found were mod-est; however, even these modest associations, if consideredat the population level, could have important public healthramifications. Finally, as in any observational study, we can-not exclude the possibility that our findings are the result ofresidual confounding. Food preferences could also result inresidual confounding.

However, we controlled for multiple known and potentialrisk factors for the development of hypertension in a prospec-tive fashion.

In conclusion, we found a prospective, independent asso-ciation between higher whole fruit intake, as well as a longitu-dinal increase in fruit intake, and a decreased risk of incidenthypertension. No such association was noted with higher veg-etable intake. Although our study supports the hypothesis that


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17. Hu FB, Rimm E, Smith-Warner SA, Feskanich D, Stampfer MJ,Ascherio A, Sampson L, Willett WC. Reproducibility and validity ofdietary patterns assessed with a food-frequency questionnaire. Am J Clin

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Validity of self-reported waist and hip circumferences in men and women. Epidemiology. 1990;1:466–473.

19. Wolf AM, Hunter DJ, Colditz GA, Manson JE, Stampfer MJ, Corsano KA,Rosner B, Kriska A, Willett WC. Reproducibility and validity of aself-administered physical activity questionnaire. Int J Epidemiol.1994;23:991–999.

20. Rice-Evans CA, Lester P. Flavonoids in Health and Disease. 2nd ed . NewYork, NY: Marcel Dekker; 2003.

21. Cassidy A, O’Reilly ÉJ, Kay C, Sampson L, Franz M, Forman JP, CurhanG, Rimm EB. Habitual intake of flavonoid subclasses and incidenthypertension in adults. Am J Clin Nutr . 2011;93:338–347. doi: 10.3945/ ajcn.110.006783.

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Am J Clin Nutr . 2014;99:479–489. doi: 10.3945/ajcn.113.074237. 23. Barona J, Aristizabal JC, Blesso CN, Volek JS, Fernandez ML. Grapepolyphenols reduce blood pressure and increase flow-mediated vasodi-lation in men with metabolic syndrome. J Nutr . 2012;142:1626–1632.doi: 10.3945/jn.112.162743.

24. Landmesser U, Drexler H. Endothelial function and hypertension. CurrOpin Cardiol. 2007;22:316–320. doi: 10.1097/HCO.0b013e3281ca710d.

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logical basis of hypertension. Am J Hypertens. 2014;27:1327–1337.doi: 10.1093/ajh/hpu142.

27. Egert S, Bosy-Westphal A, Seiberl J, Kürbitz C, Settler U, Plachta-Danielzik S, Wagner AE, Frank J, Schrezenmeir J, Rimbach G,Wolffram S, Müller MJ. Quercetin reduces systolic blood pressure andplasma oxidised low density lipoprotein concentrations in overweight sub


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Lea Borgi, Isao Muraki, Ambika Satija, Walter C. Willett, Eric B. Rimm and John P. FormanCohort Studies

Fruit and Vegetable Consumption and the Incidence of Hypertension in Three Prospective

Print ISSN: 0194-911X. Online ISSN: 1524-4563Copyright © 2015 American Heart Association, Inc. All rights reserved.

is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Hypertensiondoi: 10.1161/HYPERTENSIONAHA.115.06497

2016;67:288-293; originally published online December 7, 2015; Hypertension.

http://hyper.ahajournals.org/content/67/2/288

World Wide Web at:The online version of this article, along with updated information and services, is located on the

http://hyper.ahajournals.org/content/suppl/2015/12/07/HYPERTENSIONAHA.115.06497.DC1.htmlData Supplement (unedited) at:

http://hyper.ahajournals.org/content/67/2/288http://hyper.ahajournals.org/content/suppl/2015/12/07/HYPERTENSIONAHA.115.06497.DC1.htmlhttp://hyper.ahajournals.org/content/suppl/2015/12/07/HYPERTENSIONAHA.115.06497.DC1.htmlhttp://hyper.ahajournals.org/content/suppl/2015/12/07/HYPERTENSIONAHA.115.06497.DC1.htmlhttp://hyper.ahajournals.org/content/suppl/2015/12/07/HYPERTENSIONAHA.115.06497.DC1.htmlhttp://hyper.ahajournals.org/content/67/2/288


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FRUIT AND VEGETABLE CONSUMPTION AND THE INCIDENCE OF HYPERTENSION IN THREE PROSPECTIVE COHORT STUDIES

Lea Borgi MD, MMSc*1, Isao Muraki, MD, PhD*

3, Ambika Satija, BA

3, Walter C. Willett MD, Dr.P.H

2,3, Eric B. Rimm, ScD

2,3, John P. Forman MD,

MSc1,2

1Renal Division, Brigham and Women’s Hospital, Boston.

2Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston

3

Departments of Nutrition and Epidemiology, Harvard T.H. School of Public Health *equal contribution

Short title: Hypertension Risk with Fruit and Vegetable Intake

Word Count: 6,000 for manuscript and 228 for abstract. 5 tables in online supplement.

Corresponding Author: Lea Borgi, 41 Avenue Louis Pasteur, 121-C, Boston, MA 02115.

Phone/fax numbers: 617 264 3068, 617 264 5975. Email: [email protected].


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Supplementary Table S1: Baseline characteristics of participants in the Nurses’ Health Study, Nurses’ Health Study II and the Health Professionals

Follow-up Study. Values are median (interquartile range) or percentages unless stated

Nurses’ Health Study* Total Fruits (servings) Total Vegetables (servings)

≤4 per week 1 per day ≥4 per day ≤4 per week 1 per day ≥4 per day

Age (years) 47 (42-53) 50(44-56) 53 (47-58) 49 (43-55) 48(43-54) 51 (45-57)

White (%) 95 95 92 92 94 95Body Mass Index 23.2 (21.3-25.8) 23.5(21.6-26.4) 23.4 (21.3-26.4) 23.1 (21.2-26.0) 26.1(21.3-26.1) 23.5 (21.9-26.3)

Total daily calories (kcal) 1507(1203-1863) 1693(1388-2043) 2162(1779-2566) 1217(972-1611) 1426(1144-1746) 1917(1578-2310)

Alcohol (serving/day) 2.9(0.0-12.2) 2.1(0.0-8.5) 1.8(0.0-5.5) 0.9(0.0-3.9) 1.5(0.0-6.3) 2.9(0.0-11.0)

Animal Flesh§(serving/day) 1.2(0.9-1.7) 1.3(0.9-1.8) 1.4(0.9-1.9) 0.9(0.5-1.2) 1.1(0.7-1.5) 1.6(1.1-2.1)

Physical Activity (METs/w) 5.0 (1.7-13.6) 8.0(2.9-19.0) 12.6 (4.5-29.0) 3.9 (0.9-10.9) 4.6(1.6-13.9) 10.4 (3.7-23.6)

Current Smokers (%) 37 21 15 39 28 21

Family History of HTN (%) 42 43 38 40 43 42

Nurses’ Health Study 2† ≤4 per week 1 per day ≥4 per day ≤4 per week 1 per day ≥4 per day

Age (years) 42 (37-47) 43(38-48) 42 (37-48) 39 (34-44) 41(36-46) 44 (39-49)

White (%) 93 94 90 91 93 94

Body Mass Index 24.0 (21.5-27.9) 24.1(21.7-27.8) 23.2 (21.0-26.6) 23.7 (21.3-27.5) 23.8(21.5-27.5) 24.2 (21.7-28.0)


Alcohol (serving/day) 1.0(0.0-4.9) 1.5(0.0-5.3) 1.1(0.0-4.3) 0.0(0.0-2.0) 0.9(0.0-3.0) 1.9(0.0-6.7)



Current Smokers (%) 17 8 5 17 12 9


Health ProfessionalsFollow-up Study

‡ ≤4 per week 1 per day ≥4 per day ≤4 per week 1 per day ≥4 per day

Age (years) 49 (43-57) 52(61-44) 56 (47-64) 51 (43-61) 51(43-59) 53 (45-62)

White (%) 91 92 91 88 90 92

Body Mass Index 25.1 (23.3-26.9) 25.0(23.3-26.6) 23.0 (23.0-26.5) 25.1 (23.3-26.7) 25.1(23.3-26.7) 24.7 (23.1-26.6)




Current Smokers (%) 17 9 3 16 12 7



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* Baseline for Nurses’ Health Study is 1984.

† Baseline for Nurses’ Health Study II is 1991.

‡ Baseline for Health Professionals Follow-up Study is 1986.

§Animal flesh: combination of processed and unprocessed red meat, poultry and seafood.


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Supplementary Table S2: Pooled hazard ratios (95% confidence intervals) of incident hypertension for individual vegetable consumption in Nurses’

Health Study, Nurses’ Health Study II and Health Professional Follow -up Study

Consumption Levels

Individual Vegetables


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Broccoli

NHS* 1311/41124 12029/344916 20165/594694 1870/53687

Adjusted hazard ratio§ 1.00 1.03(0.97-1.09) 1.00(0.94-1.07) 0.95(0.88-1.03) 0.01

NHS II † 1369/71841 8851/458751 13443/738131 1583/75751


HPFS ‡ 1317/43027 6517/210667 8162/283077 756/23457


Pooled Results|| 1.00 0.99(0.96-1.03) 0.97(0.93-1.00) 0.94(0.90-0.99)


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Pooled Results||

1.00 0.99(0.95-1.03) 0.97(0.93-1.01) 0.95(0.91-0.99) 0.003

Beans or lentils

NHS* 9471/288351 20693/586063 5016/153415 195/6592


NHS II † 6019/343499 12874/647498 5890/325553 463/27926


HPFS ‡ 3257/112284 8551/279173 4610/156620 334/12150


Pooled Results||

1.00 1.00(0.98-1.01) 1.00(0.97-1.02) 0.94(0.87-1.00) 0.31

Tofu or soybeans

NHS* 32442/937828 2295/74142 553/19369 85/3083

Adjusted hazard ratio§ 1.00 0.93(0.89-0.97) 0.90(0.82-0.98) 0.90(0.73-1.13)


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*Follow-up in Nurses’ Health Study was from 1984 to 2010 (cases/persons-years).

† Follow-up in Nurses’ Health Study II was from 1991-2011

‡ Follow-up in Health Professionals Follow-up study was from 1986 to 2010.

§ Adjusted for age, race/ethnicity (white, African-American, Asian, Hispanic, other), body mass index, current smoking status, physical activity,

weight change per food frequency questionnaire cycle, menopausal status (NHS and NHS II), alcohol intake, current oral contraceptive use (NHS II),

analgesic use (nonsteroidal antiinflammatory drugs, acetaminophen, aspirin), family history of hypertension, total energy intake, animal flesh

intake (combination of processed and unprocessed red meat, poultry and seafood), whole grains, sugar-sweetened beverage intake, artificially-

sweetened diet beverage intake.

|| Pooled hazard ratios of the three cohorts using a fixed effects model.


HPFS ‡ 556/18773 2725/90927 8910/307983 4561/142545


Pooled Results||

1.00 0.98(0.94-1.02) 1.01(0.97-1.05) 1.01(0.97-1.05) 0.14

Onions

NHS* 12451/316424 10894/263324 4336/100943 565/13840


NHS II † 9004/522242 10066/506040 5069/263935 1107/52259Adjusted hazard ratio

§ 1.00 1.01(0.98-1.04) 0.98(0.95-1.02) 0.99(0.93-1.06) 0.39

HPFS ‡ 5630/180698 6121/178794 2309/62679 257/7152


Pooled Results||

1.00 1.00(0.98-1.02) 0.99(0.96-1.01) 0.96(0.92-1.01) 0.10


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Supplementary Table S3: Pooled hazard ratios (95% confidence intervals) of incident hypertension for individual fruit consumption in Nurses’

Health Study, Nurses’ Health Study II and Health Professional Follow -up Study

Consumption Levels

Individual Fruits


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NHS II † 3800/205254 14031/720867 6762/381876 653/36478


HPFS ‡ 5188/167653 9062/306494 2329/80359 173/5723


Pooled Results||

1.00 0.98(0.96-1.00) 0.99(0.97-1.02) 1.01(0.95-1.07) 0.79

BlueberriesNHS* 19275/555984 13442/395363 2520/78823 138/4252


NHS II † 14159/740832 8786/469293 2148/124999 153/9351


HPFS ‡ 10156/331043 5542/192300 970/34108 84/2777


Pooled Results||

1.00 0.97(0.95-0.98) 0.95(0.92-0.98) 0.92(0.83-1.03) 0.01

Oranges

NHS* 5644/167350 13069/384701 12973/376109 3689/106260Adjusted hazard ratio

§ 1.00 1.01(0.97-1.04) 1.01(0.98-1.05) 1.00(0.96-1.06) 0.68

NHS II † 5439/291361 11451/605132 7237/387572 1119/60410


HPFS ‡ 2573/84536 5559/183363 6312/214668 2308/77661


Pooled Results¶ 1.00 0.97(0.95-0.99) 0.98(0.96-1.01) 0.97(0.93-1.00) 0.17

Peaches, apricots or

plumsNHS* 6122/185505 18155/524919 9979/290092 1119/33905

Adjusted hazard ratio

§

1.00 1.01(0.98-1.05) 1.03(0.99-1.07) 1.00(0.93-1.07) 0.68NHS II † 6133/324975 12283/632052 6148/349298 682/38152


HPFS ‡ 473/154738 8216/271786 3377/118507 426/15197


Pooled Results||

1.00 1.02(0.99-1.04) 1.02(1.00-1.05) 1.01(0.96-1.06) 0.30

Prunes

NHS* 27319/802498 5928/171971 1628/45532 500/14420


NHS II † 21481/1130042 3023/166336 605/39632 137/8466


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*Follow-up in Nurses’ Health Study was from 1984 to 2010 (cases/persons-years).

† Follow-up in Nurses’ Health Study II was from 1991-2011

‡ Follow-up in Health Professionals Follow-up study was from 1986 to 2010.

§ Adjusted for age, race/ethnicity (white, African-American, Asian, Hispanic, other), body mass index, current smoking status, physical activity,

weight change per food frequency questionnaire cycle, menopausal status (NHS and NHS II), alcohol intake, current oral contraceptive use (NHS II),

analgesic use (nonsteroidal antiinflammatory drugs, acetaminophen, aspirin), family history of hypertension, total energy intake, animal flesh

intake (combination of processed and unprocessed red meat, poultry and seafood), whole grains, sugar-sweetened beverage intake, artificially-

sweetened diet beverage intake.

|| Pooled hazard ratios of the three cohorts using a fixed effects model.


HPFS ‡ 14065/476649 2007/61753 519/16423 161/5402

Adjusted hazard ratio§ 1.00 0.98(0.94-1.030 0.94(0.86-1.03) 0.86(0.73-1.02) 0.02

Pooled Results||

1.00 1.01(0.99-1.03) 0.96(0.93-1.00) 0.99(0.92-1.06) 0.16

AvocadoNHS* 28895/799042 3951/116154 303/9843 20/651

Adjusted hazard ratio§

1.00 0.98(0.95-1.02) 0.85(0.76-0.95) 0.99(0.64-1.54) 0.01NHS II † 20442/1068957 4227/237179 557/36621 20/1718

Adjusted hazard ratio§ 1.00 0.95(0.92-0.98) 0.91(0.84-0.99) 0.77(0.49-1.19)


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Supplementary Table S4: Pooled hazard ratios (95% confidence intervals) of incident hypertension for 8-year change in total whole fruits and total

vegetables consumption in Nurses’ Health Study, Nurses’ Health Study II and Health Professional Follow-up Study

Change in consumption levels

Fruits and

VegetablesDecreased

≥7 per week

Decreased

4.0-6.9 per week

Decreased

1.0-3.9 per week

No change

(±0.9 per

week)

Increased

1.0-3.9 per week

Increased

4.0-6.9 per week

Increased

≥7 per week

Linear

P

Trend

Total Fruits||

NHS * 2,354/66,202 1,748/49,574 3,299/94,925 3,838/106,256 3,812/105,055 2,148/60,205 2,948/84,062

Adjusted HR§ 1.01(0.95-1.08) 0.99(0.94-1.06) 0.98(0.93-1.02) 1.00(reference) 1.00(0.96-1.05) 0.98(0.93-1.03) 0.96(0.91-1.01) 0.17

NHS II † 1,571/65,946 1,360/55,944 2,934/121,711 3,752/149,998 2,963/132,509 1,492/68,459 1,900/89,135

Adjusted HR§ 1.04(0.97-1.12) 1.03(0.96-1.10) 0.99(0.94-1.04) 1.00 0.93(0.88-0.98) 0.92(0.87-0.98) 0.93(0.87-0.98)


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* Follow-up in Nurses’ Health Study was from 1994 to 2010 (cases/persons-years).

† Follow-up in Nurses’ Health Study II was from 1999 to 2011 (cases/persons-years).

‡ Follow-up in Health Professionals Follow-up study was from 1994 to 2010 (cases/persons-years).

§ Adjusted for age, race/ethnicity (white, African-American, Asian, Hispanic, other), body mass index at baseline, smoking status (never/never,

never/current, past/past, past/current, current/past, or current/current), physical activity, menopausal status (in NHS and NHS II), current oral

contraceptive use (in NHS II), analgesic use (acetaminophen, aspirin, other nonsteroidal anti-inflammatory drugs), family history of hypertension,

initial and change values of alcohol intake, total energy intake, animal flesh intake (combination of processed and unprocessed red meat, poultry

and seafood), whole grains, sugar-sweetened beverage intake, artificially-sweetened beverage intake (all in quintiles).

||Multivariable model including initial and change values of total vegetables was mutually adjusted for initial and change values of total fruits

intake (quintiles for variables other than change variables of total vegetable intake and total fruit intake, and five categories for change variables of

total vegetable intake and total fruit intake).

¶Pooled hazard ratios of the three cohorts using a fixed effects model.


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*Adjusted for age, race/ethnicity (white, African-American, Asian, Hispanic, other), body mass index at baseline, smoking status (never/never, never/current,

past/past, past/current, current/past, or current/current), physical activity, menopausal status (in NHS and NHS II), current oral contraceptive use (in NHS II),

analgesic use (acetaminophen, aspirin, other nonsteroidal anti-inflammatory drugs), family history of hypertension, initial value of total fruit intake (quintiles),

initial and change values of alcohol intake, total energy intake, animal flesh intake (combination of processed and unprocessed red meat, poultry and seafood),

whole grains, sugar-sweetened beverage intake, artificially-sweetened beverage intake, total vegetable intake (quintiles for variables other than change

variables of total vegetable intake, and five categories for change variables of total vegetable intake). And for fruit juices, further adjusted for change values of

total fruit intake (five categories)

†Pooled hazard ratios of the three cohorts using a fixed effects model.

consumo frutas y vegetales para hta

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