Dietary Patterns and Risk of Cardiovascular Disease and All-Cause Mortality in Adults with Untreated or Uncontrolled Hypertension

BACKGROUND While higher dietary quality scores for several established dietary indices has been consistently associated with lower risk of cardiovascular disease (CVD) and total mortality in the general population, limited evidence exists regarding their potential benefits among individuals with established hypertension. OBJECTIVE To examine the associations of dietary quality scores of multiple established dietary patterns with the risks of incident CVD and all-cause death among adults with hypertension, and to evaluate whether different dietary constructs exhibit heterogeneous prognostic relevance in this high-risk population. METHODS We analyzed 83,248 UK Biobank participants with hypertension and no prior CVD at baseline. Diet quality was assessed using repeated 24-hour recall questionnaires and scored according to five dietary indices: the Dietary Approaches to Stop Hypertension (DASH) score, the Alternative Healthy Eating Index-2010 (AHEI-2010), the Alternate Mediterranean Diet (AMED) score, the healthful Plant-Based Diet Index (hPDI), and the Empirical Dietary Inflammatory Pattern (EDIP). Each score was categorized into quintiles for analysis. The primary outcomes include a composite of nonfatal CVD events and cardiovascular death and all-cause mortality. Subgroup and interaction analyses were conducted across predefined clinical strata. RESULTS During 1,230,983 person-years of follow-up, 4,889 primary CVD events were documented. After adjustment for demographic and cardiovascular risk factors, compared with the lowest quintile, the highest quintile of the DASH score was associated with significantly lower CVD risk (HR 0.85 [95% CI: 0.77-0.93]), as was the reversed EDIP score (HR 0.89 [0.81-0.97]). The AHEI-2010 score also showed a significant association (HR 0.91 [0.83-1.00]), while the AMED scores (HR 1.02 [0.93-1.11]) and hPDI (HR 0.95 [0.86-1.03]) were not significantly associated with CVD risk. All five dietary scores were inversely associated with all-cause mortality (Q5 vs Q1 HRs: 0.78-0.85; all P < 0.01), with the strongest association again observed for the DASH score. Food group-based analysis showed that higher intake of vegetables, whole grains, nuts and legumes, fruits, and dairy was significantly associated with lower CVD or mortality risk, whereas greater consumption of sugar-sweetened beverages and meats was significantly associated with higher risk (all P < 0.05). CONCLUSIONS Among adults with hypertension, higher dietary quality scores of healthy dietary patterns, especially the DASH diet and reversed EDIP, were associated with lower risks of CVD and all-cause mortality.