Diet-dependent net acid load and risk of incident hypertension in United States women

Hypertension. 2009 Oct;54(4):751-5. doi: 10.1161/HYPERTENSIONAHA.109.135582. Epub 2009 Aug 10.


Animal and human studies suggest a potential link between acid-base status and blood pressure. Contemporary Western diets yield a daily systemic acid load of varying amounts, yet the association with hypertension has never been explored. We prospectively examined the association between the diet-dependent net acid load (also known as the estimated net endogenous acid production) and the risk of incident hypertension among 87 293 women without a history of hypertension in the Nurses' Health Study II. We also used the ratio of animal protein intake to potassium intake as an alternative evaluation of diet-dependent net acid load. We identified 15 385 incident cases of hypertension during 995 239 person-years of follow-up. After adjusting for potential confounders, women in the top decile of estimated diet-dependent net acid load had an increased risk of hypertension (relative risk: 1.14; 95% CI: 1.05 to 1.24; P for trend=0.01) compared with women in the bottom decile. To test whether the association between estimated diet-dependent net acid load and hypertension is independent of its individual components, an additional adjustment for intakes of protein and potassium was made and resulted in a relative risk of 1.23 (95% CI: 1.08 to 1.41; P for trend=0.003) for the top decile of estimated diet-dependent net acid load. Results of the ratio of animal protein intake to potassium intake were similar with those of estimated diet-depend net acid load. In conclusion, a high diet-dependent net acid load is independently associated with a higher risk of incident hypertension.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acid-Base Imbalance / complications*
  • Acid-Base Imbalance / metabolism*
  • Acids / metabolism
  • Adult
  • Blood Pressure / drug effects
  • Cohort Studies
  • Dietary Proteins / adverse effects*
  • Dietary Proteins / metabolism
  • Dietary Proteins / pharmacology
  • Female
  • Follow-Up Studies
  • Health Surveys
  • Humans
  • Hypertension / epidemiology*
  • Hypertension / metabolism*
  • Incidence
  • Potassium, Dietary / adverse effects*
  • Potassium, Dietary / metabolism
  • Potassium, Dietary / pharmacology
  • Prospective Studies
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Factors
  • United States / epidemiology


  • Acids
  • Dietary Proteins
  • Potassium, Dietary