Hypertension Clinical Trial
Official title:
INTERMAP: International Population Study on Macronutrients and BP
To investigate the relationship between dietary factors, especially macronutrients, and blood pressure in an international, multicenter observational study. A particular focus is to help elucidate the role of these dietary factors in accounting for the even more adverse blood pressure patterns of less educated population strata, especially in the United States, in both less educated Blacks and whites.
BACKGROUND:
Overall study findings are to be used to estimate favorable impact on blood pressure of
multiple improvements in nutrition by populations. The investigators state that this should
aid in making additional dietary recommendations toward the goal of primary prevention of
hypertension and shifting blood pressure distributions downward to avoid excess risk
associated with present levels generally above optimal.
DESIGN NARRATIVE:
INTERMAP's cross-sectional design is patterned after the tested INTERSALT model: a large
sample size of 4,680 persons, half men and half women, ages 40-59 from 17 population samples
of varied ethnicity, socioeconomic status (SES) and dietary habits in four countries (China,
Japan, United Kingdom and the United States). There were eight United States INTERMAP
centers. Specific aims involve elucidating influences on blood pressure of the amount and
type of protein, lipids, carbohydrates, and also amino acids, calcium, magnesium,
antioxidants, fiber, and caffeine. Primary hypotheses tested, with control for body mass
index (BMI), intake of alcohol, age, sex, and other confounders are as follow: dietary
protein is inversely related to blood pressure; inverse relations between education and
blood pressure are significantly accounted for by education-related differences in dietary
protein intake; there is a direct relation to blood pressure of dietary saturated fatty
acids, cholesterol, Keys score, starch; there is an inverse relation of polyunsaturated
fatty acids and polyunsaturated/saturated fatty acids. Randomly selected participants
provide one timed 24-hr. urine collection for assessment of sodium, potassium, creatine, and
urea, and complete four 24-hr. dietary recalls. Blood pressure was measured eight times at
each of four clinic visits, with standardization and strict quality control of all
procedures.
The study is coordinated by two Coordinating Centers--Northwestern University, Chicago and
London School of Hygiene & Tropical Medicine. Urinary determinations are made at a Central
Laboratory in Leuven, Belgium. Twenty-four hour dietary recalls are converted into nutrients
with use of the Nutrition Data System of the University of Minnesota's Nutrition
Coordinating Center. Data analyses to test hypotheses are done at the London Coordinating
Center.
Recruitment and data collection began in July, 1996 through January, 1997. The main
statistical analytic method is multivariate regression analysis. The study was renewed in FY
2000 and in FY 2004 to continue analysis of the data through August, 2009.
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Observational Model: Cohort, Time Perspective: Cross-Sectional
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