Abstract
BACKGROUND: Dietary patterns play a pivotal role in managing hypertension and preventing mortality. However, comparative studies on the effects of different dietary patterns on mortality risk in hypertensive patients remain limited. The aim of this study is to evaluate and compare the associations between six established dietary indices and mortality risk in this population. METHODS: Utilizing data from the 2005-2018 NHANES, 13,230 hypertensive adults were included in the analysis. Six standardized dietary indices were employed, and the associations between these dietary patterns and mortality were analyzed using a weighted Cox proportional hazards model. Additionally, time trend analysis was conducted to examine changes in dietary patterns, while weighted quantile regression (WQS) was used to identify key dietary components contributing to mortality risk. RESULTS: Over a median follow-up of 8.3 years, a total of 2,420 deaths were recorded, including 637 due to cardiovascular diseases. Higher scores for AHEI, DASH, HEI-2020, MED, and MEDI were significantly associated with reduced risk of all-cause mortality, whereas a proinflammatory diet, reflected by elevated DII scores, was associated with increased risk. Only higher DASH index scores were independently associated with reduced cardiovascular mortality. Time trend analysis revealed a decline in adherence to DASH over the years, whereas MEDI scores slightly increased. WQS regression identified dairy products, whole grains, and fatty acids as key dietary components influencing mortality risk. CONCLUSIONS: Healthy dietary patterns markedly reduce all-cause mortality risk in hypertensive patients, with the DASH diet offering notable cardiovascular protection. These findings support personalized dietary interventions for hypertension management.