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(Hypertension. 2008;51:669.)
© 2008 American Heart Association, Inc.

Original Articles

Dietary Phosphorus and Blood Pressure

International Study of Macro- and Micro-Nutrients and Blood Pressure

Paul Elliott; Hugo Kesteloot; Lawrence J. Appel; Alan R. Dyer; Hirotsugu Ueshima; Queenie Chan; Ian J. Brown; Liancheng Zhao; Jeremiah Stamler for the INTERMAP Cooperative Research Group

From the Department of Epidemiology and Public Health (P.E., Q.C., I.J.B.), Faculty of Medicine, St Mary’s Campus, Imperial College London, London, United Kingdom; Central Laboratory (H.K.), Akademisch Ziekenhuis St Rafael, Leuven, Belgium; Welch Center for Prevention, Epidemiology, and Clinical Research (L.J.A.), Johns Hopkins University, Baltimore, Md; Department of Preventive Medicine (A.R.D., J.S.), Feinberg School of Medicine, Northwestern University, Chicago, Ill; Department of Health Science (H.U.), Shiga University of Medical Science, Otsu, Shiga, Japan; Department of Epidemiology (L.Z.), Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China.

Correspondence to Paul Elliott, Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, St Mary’s Campus, Norfolk Place, London W2 1PG, United Kingdom. E-mail p.elliott{at}imperial.ac.uk

Raised blood pressure is a leading cause of morbidity and mortality worldwide; improved nutritional approaches to population-wide prevention are required. Few data are available on dietary phosphorus and blood pressure and none are available on possible combined effects of phosphorus, magnesium, and calcium on blood pressure. The International Study of Macro- and Micro-Nutrients and Blood Pressure is a cross-sectional epidemiologic study of 4680 men and women ages 40 to 59 from 17 population samples in Japan, China, United Kingdom, and United States. Blood pressure was measured 8 times at 4 visits. Dietary intakes were obtained from four 24-hour recalls plus data on supplement use. Dietary phosphorus was inversely associated with blood pressure in a series of predefined multiple regression models, with the successive addition of potential confounders, both nondietary and dietary. Estimated blood pressure differences per 232 mg/1000 kcal (2 SD) of higher dietary phosphorus were –1.1 to –2.3 mm Hg systolic/–0.6 to –1.5 mm Hg diastolic (n=4680) and –1.6 to –3.5 mm Hg systolic/–0.8 to –1.8 mm Hg diastolic for 2238 "nonintervened" individuals, ie, those without special diet/nutritional supplements or diagnosis/treatment for cardiovascular disease or diabetes. Dietary calcium and magnesium, correlated with phosphorus (partial r=0.71 and r=0.68), were inversely associated with blood pressure. Blood pressures were lower by 1.9 to 4.2 mm Hg systolic/1.2 to 2.4 mm Hg diastolic for people with intakes above versus below country-specific medians for all 3 of the minerals. These results indicate the potential for increased phosphorus/mineral intake to lower blood pressure as part of the recommendations for healthier eating patterns for the prevention and control of prehypertension and hypertension.

Key Words: blood pressure • dietary phosphorus • calcium • magnesium • population study • primary prevention