Association Between Protein Intake and Mortality in Hypertensive Patients Without Chronic Kidney Disease in the OLD-HTA Cohort.
Protein intake may have some benefits on reducing blood pressure and cardiovascular events, but their effects are still debated. The objective of this study was to test the prognostic value of protein intake assessed by 24-hour urinary urea in a cohort of hypertensive patients with preserved renal function. A total of 1128 hypertensive patients were followed according to tertile of protein intake adjusted for ideal body weight: <0.70, 0.70 to 0.93, and >0.93 g/kg. Baseline characteristics (mean±standard deviation) were age 45.1±13.2 years, systolic/diastolic blood pressure 185±32/107±20 mm Hg, and estimated glomerular filtration rate 82±32 mL/min. After 10 years of follow-up, 289 deaths occurred, 202 of which were of cardiovascular cause. After adjustment for major cardiovascular risk factors, patients in the second and third tertiles of protein intake had a decreased risk of all-cause death (hazard ratio [95% confidence interval], 0.71 [0.56-0.91]) and cardiovascular death (0.72 [0.54-0.96]), but not of stroke death (0.72 [0.41-1.28]) in comparison to patients in the low protein intake tertile. Normal-high protein intake was associated with a better outcome in a subset of the population: younger patients, low salt intake, without aortic atherosclerosis, or previous cardiovascular events (Pinteraction<0.10 for all). Hypertensive patients having a protein intake >0.7 g/kg ideal body weight, particularly those at low risk, had lower all-cause and cardiovascular mortality rates. Physicians may encourage hyper tensive patients to have normal or high protein diet in addition to low salt consumption, moderate alcohol consumption, and regular physical activity.
From the Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C., C.L., H.M., A.D., B.H., P.L.); Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France (P.-Y.C., B.H., P.L.); and Department of Nephrology and Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, CARMEN, CENS, Université Claude Bernard Lyon 1, F-69310, Pierre-Bénite, France (D.F.). pycourand@hotmail.com.
Pierre-Yves
PY
Courand
From the Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C., C.L., H.M., A.D., B.H., P.L.); Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France (P.-Y.C., B.H., P.L.); and Department of Nephrology and Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, CARMEN, CENS, Université Claude Bernard Lyon 1, F-69310, Pierre-Bénite, France (D.F.).
Chloé
C
Lesiuk
From the Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C., C.L., H.M., A.D., B.H., P.L.); Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France (P.-Y.C., B.H., P.L.); and Department of Nephrology and Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, CARMEN, CENS, Université Claude Bernard Lyon 1, F-69310, Pierre-Bénite, France (D.F.).
Hugues
H
Milon
From the Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C., C.L., H.M., A.D., B.H., P.L.); Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France (P.-Y.C., B.H., P.L.); and Department of Nephrology and Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, CARMEN, CENS, Université Claude Bernard Lyon 1, F-69310, Pierre-Bénite, France (D.F.).
Alice
A
Defforges
From the Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C., C.L., H.M., A.D., B.H., P.L.); Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France (P.-Y.C., B.H., P.L.); and Department of Nephrology and Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, CARMEN, CENS, Université Claude Bernard Lyon 1, F-69310, Pierre-Bénite, France (D.F.).
Denis
D
Fouque
From the Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C., C.L., H.M., A.D., B.H., P.L.); Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France (P.-Y.C., B.H., P.L.); and Department of Nephrology and Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, CARMEN, CENS, Université Claude Bernard Lyon 1, F-69310, Pierre-Bénite, France (D.F.).
Brahim
B
Harbaoui
From the Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C., C.L., H.M., A.D., B.H., P.L.); Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France (P.-Y.C., B.H., P.L.); and Department of Nephrology and Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, CARMEN, CENS, Université Claude Bernard Lyon 1, F-69310, Pierre-Bénite, France (D.F.).
Pierre
P
Lantelme
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001795:Blood Pressure Determination; D002318:Cardiovascular Diseases / Q000401:mortality / Q000503:physiopathology; D002423:Cause of Death; D015331:Cohort Studies; D004044:Dietary Proteins / Q000008:administration & dosage*; D005260:Female; D005602:France; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000401:mortality / Q000503:physiopathology; D016019:Survival Analysis; D014508:Urea / Q000652:urine
D000959:Antihypertensive Agents; D004044:Dietary Proteins; D014508:Urea
blood pressure; hypertension; lifestyle changes; mortality; protein intake; stroke