title: Dietary acid load and risk of hypertension: the Rotterdam Study.
abstract: BACKGROUND
  Mild metabolic acidosis, which can be caused by diet, may result in elevated blood pressure (BP).
  
  
  METHODS
  The analyses included 2241 participants aged ≥55 y who were free of hypertension at baseline (1990-1993) and who had complete dietary and BP data. Dietary data were obtained from a 170-item food-frequency questionnaire. We used 2 measures to characterize dietary acid load: (1) potential renal acid load (PRAL) by using an algorithm including protein, phosphorus, potassium, calcium, and magnesium, and (2) estimated net endogenous acid production (NEAP) based on protein and potassium. HRs for 6-y incidence of hypertension were obtained in tertiles of PRAL and NEAP with adjustment for age, sex, BMI, smoking, education, and intakes of alcohol, fiber, and total energy.
  
  
  RESULTS
  We identified 1113 incident cases of hypertension during 8707 person-years of follow-up. The median dietary acid load ranged from -14.6 to 19.9 mEq/d across categories of PRAL. Hypertension risk was not significantly associated with dietary acid load. The multivariate HRs (95% CIs) in consecutive tertiles of PRAL were 1.00 (reference), 1.01 (0.87, 1.17), and 1.02 (0.88, 1.18) (P trend = 0.83). The median dietary acid loads were 30.4, 36.7, and 43.7 mEq/d, respectively, in consecutive tertiles of NEAP. Corresponding HRs for NEAP were 1.00 (reference), 0.92 (0.80, 1.07), and 0.94 (0.81, 1.10) (P-trend = 0.46).
  
  
  CONCLUSIONS
  The findings from this prospective cohort study provided no evidence of an association between dietary acid load and risk of hypertension in older adults.
authors.affiliation: Top Institute Food and Nutrition, Wageningen, Netherlands. marielle.engberink@wur.nl
authors.forename: Marielle F
authors.initials: MF
authors.lastname: Engberink
authors.forename: Stephan J L
authors.initials: SJ
authors.lastname: Bakker
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Brink
authors.forename: Marleen A
authors.initials: MA
authors.lastname: van Baak
authors.forename: Frank J A
authors.initials: FJ
authors.lastname: van Rooij
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Jacqueline C M
authors.initials: JC
authors.lastname: Witteman
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Geleijnse
mesh_terms: D000138:Acidosis / Q000150:complications* / Q000378:metabolism; D000143:Acids / Q000378:metabolism*; D000368:Aged; D000465:Algorithms; D015415:Biomarkers / Q000378:metabolism; D004032:Diet; D004034:Diet Surveys; D004044:Dietary Proteins / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000209:etiology / Q000378:metabolism; D015994:Incidence; D007668:Kidney / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000494:pharmacology*; D009426:Netherlands; D011446:Prospective Studies; D012016:Reference Values; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D000143:Acids; D015415:Biomarkers; D004044:Dietary Proteins; D008903:Minerals