Association between Healthy Eating Index-2020 and Trouble Sleeping and Hypertension in US Adults: Result from NHANES 2017 March to 2020 Pre-Pandemic Data

Abstract Background Hypertension is a major risk factor for cardiovascular disease, with contributing factors including diet and sleep quality. The Healthy Eating Index-2020 (HEI-2020) provides a framework for assessing diet quality across various components, offering insights into how dietary patterns and trouble sleeping may influence the risk of hypertension. Methods We analyzed data from March to 2020 Pre-Pandemic data in National Health and Nutrition Examination Surveys (NHANES),. Hypertension was defined by blood pressure tests, questionnaires, or prevention medication use, and trouble sleeping was defined by questionnaire. The study controlled for demographic factors, and according to HEI-2020 scores and the answer of trouble sleeping, participants were divided into four groups to assess the relationship with hypertension risk. We used logistic regression analyses and subgroup analysis to explore the association between HEI levels and trouble sleeping and hypertension. Results This study includes a total of 5,713 participants which includes 2,738 males and 2,975 females, and 2,820 participants have hypertension. The participants are divided into four groups, the second group which represents the bad diet and no trouble sleeping, and the fourth group which represents the not bad diet and no trouble sleeping show the most significant risk reduction across three adjusted models, with odds ratios ranging from 0.53 to 0.50 (p-values from 0.000 to 0.000), showing good sleep were associated with lower hypertension risk, and effect could be even greater if complemented with a better diet. Conclusion This study found that the absence of trouble sleeping is significantly associated with a lower risk of hypertension, even if the diet is poor. The reduction in hypertension risk was most pronounced in participants who had good sleep and a balanced diet.