H igh blood pressure (BP) is a major risk factor for coronary heart disease, congestive heart failure, stroke, and renal disease 1 and as such is the leading cause of preventable deaths worldwide. 2 In 2000, 26.4% of the adult world population (972 million) had hypertension, defined as BP ≥140/90 mm Hg or current use of antihypertensive medication, and 29.2% were projected to be hypertensive by 2025. 3 The prevalence of hypertension increases with age, with the estimated lifetime risk for elderly subjects reaching 90%. 4 The magnitude of this burden underscores the need for increased awareness, treatment, control, and, primarily, prevention.A healthful lifestyle is a critical component of hypertension reduction strategies, 5 and diet is the lifestyle factor with the strongest effects on BP. 6,7 Established dietary modifications that effectively lower BP are weight loss, reduced sodium and increased potassium intake, reduction in excessive alcohol consumption, and vegetarian and dietary approaches to stop hypertension (DASH)-type dietary patterns. 6,7 The original DASH diet combined increased intake of fruits, vegetables, and low-fat dairy products with a relatively low intake of total and saturated fat, 8 and a subsequent version incorporated sodium restriction to further enhance BP reduction. Abstract-The PREvención con DIeta MEDiterránea (PREDIMED) trial showed that Mediterranean diets (MedDiets) supplemented with either extravirgin olive oil or nuts reduced cardiovascular events, particularly stroke, compared with a control, lower fat diet. The mechanisms of cardiovascular protection remain unclear. We evaluated the 1-year effects of supplemented MedDiets on 24-hour ambulatory blood pressure (BP), blood glucose, and lipids. Randomized, parallel-design, controlled trial was conducted in 2 PREDIMED sites. Diets were ad libitum, and no advice on increasing physical activity or reducing sodium intake was given. Participants were 235 subjects (56.5% women; mean age, 66.5 years) at high cardiovascular risk (85.4% with hypertension). Adjusted changes from baseline in mean systolic BP were −2.3 (95% confidence interval [CI], −4.0 to −0.5) mm Hg and −2.6 (95% CI, −4.3 to −0.9) mm Hg in the MedDiets with olive oil and the MedDiets with nuts, respectively, and 1.7 (95% CI, −0.1 to 3.5) mm Hg in the control group (P<0.001). Respective changes in mean diastolic BP were −1.2 (95% CI, −2.2 to −0.2), −1.2 (95% CI, −2.2 to −0.2), and 0.7 (95% CI, −0.4 to 1.7) mm Hg (P=0.017). Daytime and nighttime BP followed similar patterns. Mean changes from baseline in fasting blood glucose were −6.1, −4.6, and 3.5 mg/dL (P=0.016) in the MedDiets with olive oil, MedDiets with nuts, and control diet, respectively; those of total cholesterol were −11.3, −13.6, and −4.4 mg/dL (P=0.043), respectively. In high-risk individuals, most with treated hypertension, MedDiets supplemented with extravirgin olive oil or nuts reduced 24-hour ambulatory BP, total cholesterol, and fasting glucose. Clinical Trial Registration-URL: http://www.clinical...

IntroductionProspective studies have consistently suggested that nut consumption is inversely related to fatal and non-fatal coronary heart disease. Limited data are available on the epidemiological associations between nut intake and cardiometabolic risk factors.ObjectiveTo evaluate associations between frequency of nut consumption and prevalence of cardiometabolic risk factors [obesity, metabolic syndrome (MetS), type-2 diabetes, hypertension, and dyslipidemia] in a Mediterranean population at high cardiovascular risk.Materials and MethodsCross-sectional study of 7,210 men and women (mean age, 67 y) recruited into the PREDIMED study. MetS was defined by the harmonized ATPIII and IDF criteria. Diabetes and hypertension were assessed by clinical diagnosis and dyslipidemia (high triglycerides, low HDL-cholesterol, and hypercholesterolemia) by lipid analyses. Nut consumption was assessed using a validated food frequency questionnaire and categorized as <1, 1–3, and >3 servings/wk. Control of confounding was done with multivariate logistic regression.ResultsCompared to participants consuming <1 serving/wk of nuts, those consuming >3 servings/wk had lower adjusted odds ratios (OR) for obesity (0.61, 95% confidence interval 0.54 to 0.68; P-trend <0.001), MetS (0.74, 0.65 to 0.85; P-trend<0.001), and diabetes (0.87, 0.78 to 0.99; P-trend = 0.043). Higher nut consumption was also associated with lower risk of the abdominal obesity MetS criterion (OR 0.68, 0.60 to 0.79; P-trend<0.001). No significant associations were observed for the MetS components high blood pressure, dyslipidemia, or elevated fasting glucose.ConclusionsNut consumption was inversely associated with the prevalence of general obesity, central obesity, MetS, and diabetes in subjects at high cardiovascular risk.