Independent and combined effects of DASH diet and sleep quality on hypertension

Background

Hypertension is a leading modifiable risk factor for cardiovascular disease. While the Dietary Approaches to Stop Hypertension (DASH) diet and adequate sleep are independently recognized for their cardiovascular benefits, their combined and synergistic effects on incident hypertension and blood pressure variations within a large population cohort remain inadequately explored.

Purpose

To investigate the independent and joint associations of adherence to the DASH diet and healthy sleep patterns with the incidence of hypertension and continuous blood pressure parameters.

Methods

This prospective cohort study used data from the UK Biobank. A total of 51,516 participants were included after excluding individuals with baseline hypertension or missing baseline diet and sleep data. The DASH diet adherence score was calculated using the 24-hour recall questionnaire collected by the UK Biobank and categorized into tertiles (Levels 1 to 3). The sleep quality was categorized into three levels using the healthy sleep score: poor (scores 0−1, Level 1), intermediate (scores 2−3, Level 2), and healthy (scores 4−5, Level 3). Cox proportional hazards models were utilized to evaluate the incidence of hypertension, and generalized linear models (GLM) were employed to analyze the associations with systolic and diastolic blood pressure (β estimates).

Results

Independent analysis demonstrated that higher sleep quality was significantly associated with a reduced risk of incident hypertension across all DASH diet strata. In the stratified Cox analysis, individuals with healthy sleep (Level 3) within the highest DASH adherence tertile (DASH Level 3) showed a markedly reduced hazard ratio (HR=0.56, 95% CI: 0.46, 0.70, p<0.001). In the combined overall effects model, the optimal combination of the highest DASH adherence and healthiest sleep (Level 3-3) yielded the lowest risk of developing hypertension compared to the poorest lifestyle reference group (HR=0.55, 95% CI: 0.45, 0.67, p<0.001). Furthermore, GLM analysis revealed significant combined effects on blood pressure; notably, the combination of healthy sleep and high DASH adherence (Level 3-3) resulted in a significant reduction in diastolic blood pressure (β<−1.0, p<0.05) compared to the reference group.

Conclusions

High adherence to the DASH diet and maintaining a healthy sleep pattern exert both independent and significant synergistic protective effects against incident hypertension. Fostering optimal dietary habits alongside comprehensive sleep hygiene may serve as a highly effective non-pharmacological strategy for blood pressure management and hypertension prevention.

Figure 1. Hazard Ratios for Incident Hypertension Associated with Sleep Quality, Stratified by DASH Diet Adherence and Combined Overall Effects.

Figure 2. Adjusted β Estimates for the Independent and Combined Effects of Sleep Quality and DASH Diet on Systolic and Diastolic Blood Pressure.figure 1figure 2