Cardiovascular disease (CVD) is the leading cause of death in China, with hypertension being a major risk factor. The prevalence of hypertension in China has risen dramatically in recent decades, partly due to a nutrition transition from traditional to Westernized diets. This study aimed to examine the long-term relationship between dietary patterns and hypertension in a large cohort of Chinese adults. Understanding these relationships is crucial for developing effective public health interventions to combat the growing burden of hypertension in China. Previous studies, primarily cross-sectional or based on provincial data, have explored this association but lacked the longitudinal perspective and national scope of this research. The study uses data from the China Health and Nutrition Survey (CHNS), a well-established, nationally representative longitudinal dataset. By leveraging the extensive data collected over 28 years, the research provides a more comprehensive and robust understanding of the long-term influence of dietary patterns on blood pressure and hypertension development in the Chinese adult population. This understanding is crucial for informing the development of effective public health strategies aimed at the prevention and management of hypertension in China, a country facing a significant and growing public health challenge.

Numerous studies have linked dietary patterns to blood pressure and hypertension risk. The Mediterranean diet (MED) and Dietary Approaches to Stop Hypertension (DASH) diet are well-established examples of healthy dietary patterns associated with reduced hypertension risk. However, most of these studies were conducted in Western populations, limiting their generalizability to populations with different cultural and dietary habits. While some research has explored these associations within the Chinese population, many studies were cross-sectional or focused on specific regions. This study addresses this gap by utilizing a large, nationally representative, longitudinal dataset spanning 28 years, providing a more comprehensive and nuanced understanding of the dietary-hypertension relationship within the diverse Chinese population during a period of significant dietary change.

This study analyzed data from the China Health and Nutrition Survey (CHNS), a longitudinal, household-based survey conducted from 1989 to 2018 across fifteen provinces in China. The study included 15,929 adults aged 18 years or older with data from at least two survey waves. Pregnant or lactating women and those with implausible dietary data were excluded. Dietary data was collected using three consecutive 24-hour dietary recalls. Blood pressure was measured using standard mercury sphygmomanometers, with hypertension defined as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg, current antihypertensive medication use, or previous physician diagnosis. Factor analysis was performed on 18 food groups to identify dietary patterns. Three-level mixed-effects linear regression models were used to assess the association between dietary patterns and SBP/DBP, while three-level mixed-effects logistic regression models assessed the association with hypertension risk. The models adjusted for confounders including age, gender, living area, income, education, physical activity, smoking, alcohol consumption, total energy intake, sodium intake, and BMI.

Factor analysis revealed three distinct dietary patterns: a "modern" pattern characterized by high intakes of fruits and dairy products; a "meat" pattern characterized by high intakes of poultry, organ meats, and other livestock meats; and a "southern" pattern characterized by high intakes of rice, vegetables, and pork. Participants in the highest quartile of the modern pattern showed a significant decrease in SBP (β = −0.51; 95% CI −0.86, −0.16; *P* < 0.01) after adjusting for confounders. In contrast, participants in the highest quartile of the meat pattern showed a significant increase in DBP (β = 0.31; 95% CI 0.08, 0.53; *P* < 0.01) and a significantly increased risk of hypertension (OR = 1.14; 95% CI 1.03, 1.24; *P* < 0.01). No significant association was found between the southern pattern and blood pressure or hypertension. These findings suggest that a diet rich in fruits and dairy products may help lower SBP, while a diet high in meat, particularly processed meats, is associated with higher DBP and an elevated risk of hypertension in Chinese adults.

This study provides strong longitudinal evidence linking specific dietary patterns to blood pressure and hypertension risk in a large Chinese adult population over 28 years. The inverse association between the modern pattern (high fruit and dairy) and SBP supports previous findings on the benefits of these foods for cardiovascular health. The positive association between the meat pattern and DBP and hypertension risk highlights the potential detrimental effects of high meat consumption. The lack of association with the southern pattern may be related to its traditional composition and lower overall energy density. The study's strengths include its longitudinal design, large sample size, and national representation. These findings have significant public health implications, suggesting that food-based dietary guidelines focusing on reducing meat consumption and increasing fruit and dairy intake could be beneficial in preventing and managing hypertension in China.

This 28-year longitudinal study demonstrates the significant association between dietary patterns and hypertension risk in Chinese adults. The modern pattern, characterized by higher fruit and dairy intake, is associated with lower SBP, while the meat pattern is associated with higher DBP and increased hypertension risk. These findings support the development of public health interventions promoting dietary shifts towards healthier patterns. Future research could explore the specific types of meat and the mechanisms underlying these associations, and investigate the long-term impact of dietary interventions on hypertension prevalence in China. Further research is also needed to study traditional dietary patterns across Asia to better understand the diverse influence of diet on hypertension.

While this study is robust due to its size and longitudinal nature, some limitations exist. Dietary recall methods may be subject to recall bias. The CHNS sample, although large and nationally representative, may not perfectly capture the diversity of dietary patterns across all regions and socioeconomic groups within China. Additionally, the study design does not establish causality but rather shows associations; therefore, further investigation through intervention studies is warranted to confirm these findings.