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Folate intake and incidence of hypertension among American young adults: a 20-y follow-up study

BACKGROUND: Laboratory studies suggest that folate intake may decrease blood pressure (BP) through increasing nitric oxide synthesis in endothelial cells and/or reducing plasma homocysteine concentrations. However, human studies, particularly longitudinal data, are limited. OBJECTIVE: Our objective was to investigate whether dietary folate intake is associated with the 20-y incidence of hypertension. DESIGN: We prospectively followed 4400 men and women (African Americans and whites aged 18-30 y) without hypertension at baseline (1985) in the Coronary Artery Risk Development in Young Adults study 6 times, in 1987, 1990, 1992, 1995, 2000, and 2005. Diet was assessed by dietary-history questionnaire at baseline and in 1992 and 2005. Incident hypertension was defined as the first occurrence at any follow-up examination of systolic BP >/=140 mm Hg, diastolic BP >/=90 mm Hg, or use of antihypertensive medication. RESULTS: A total of 989 incident cases were identified during the 20-y follow-up. After adjustment for potential confounders, participants in the highest quintile of total folate intake had a significantly lower incidence of hypertension (HR: 0.48; 95% CI: 0.38, 0.62; P-trend < 0.01) than did those in the lowest quintile. The multivariable HRs for the same comparison were 0.33 (95% CI: 0.22, 0.51; P-trend < 0.01) in whites and 0.54 (95% CI: 0.40, 0.75; P-trend < 0.01) in African Americans (P-interaction = 0.047). The inverse associations were confirmed in a subset of the cohort (n = 1445) with serum folate measured at baseline and in 1992 and 2000. CONCLUSIONS: Higher folate intake in young adulthood was longitudinally associated with a lower incidence of hypertension later in life. This inverse association was more pronounced in whites. Additional studies are warranted to establish the causal inference.

Authors: Xun P; Liu K; Loria CM; Bujnowski D; Shikany JM; Schreiner PJ; Sidney S; He K

Am J Clin Nutr. 2012 May;95(5):1023-30. Epub 2012 Apr 4.

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