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May 22, 1996, Vol 275, No. 20 >
ARTICLE | May 22, 1996

Dietary Protein and Blood Pressure FREE

Eva Obarzanek, PhD; Paul A. Velletri, PhD; Jeffrey A. Cutler, MD
[+] Author Affiliations

Corresponding author: Eva Obarzanek, PhD, National Heart, Lung, and Blood Institute, Division of Epidemiology and Clinical Applications, 2 Rockledge Centre, MSC 7936, 6701 Rockledge Dr, Room 8136, Bethesda, MD 20892-7936.


JAMA. 1996;275(20):1598-1603. doi:10.1001/jama.1996.03530440078040
Text Size: A A A
Published online
Article
References

Objective.  —To review published and presented data on the relationship between dietary protein and blood pressure in humans and animals.

Data Sources.  —Bibliographies from review articles and books on diet and blood pressure that had references to dietary protein. The bibliographies were supplemented with computerized MEDLINE search restricted to English language and abstracts presented at epidemiologic meetings.

Study Selection.  —Observational and intervention studies in humans and experimental studies in animals.

Data Extraction.  —In human studies, systolic or diastolic blood pressure were outcome measures, and dietary protein was measured by dietary assessment methods or by urine collections. In animal studies, blood pressure and related physiological effects were outcome measures, and experimental treatment included protein or amino acids.

Data Synthesis.  —Historically, dietary protein has been thought to raise blood pressure; however, studies conducted in Japan raised the possibility of an inverse relationship. Data analyses from subsequent observational studies in the United States and elsewhere have provided evidence of an inverse relationship between protein and blood pressure. However, intervention studies have mostly found no significant effects of protein on blood pressure. Few animal studies have specifically examined the effects of increased dietary protein on blood pressure.

Conclusions.  —Because of insufficient data and limitations in previous investigations, better controlled and adequately powered human studies are needed to assess the effect of dietary protein on blood pressure. In addition, more research using animal models, in which experimental conditions are highly controlled and detailed mechanistic studies can be performed, is needed to help provide experimental support for or against the protein—blood pressure hypothesis.(JAMA. 1996;275:1598-1603)

REFERENCES

1 +
National High Blood Pressure Education Program. Working Group Report on Primary Prevention of Hypertension . Bethesda, Md: National Heart, Lung, and Blood Institute, National Institutes of Health; 1993;. National Institutes of Health publication 93-2669.
2 +
Committee on Diet and Health, Food and Nutrition Board, Commission on Life Sciences, National Research Council.  Protein.  In: Diet and Health Implications for Reducing Chronic Disease Risk . Washington, DC: National Academy Press; 1989;; 259-271.
3 +
Meyer TW, Anderson S, Brenner BM.  Dietary protein intake and the course of renal disease: the role of capillary hypertension and hyperfusion in the pathogenesis of progressive glomerular sclerosis.  In: Horan MJ, Blaustein MP, Dunbar JB, Kachadorian W, Kaplan NM, Simopoulos AP, eds. NIH Workshop on Nutrition and Hypertension: Proceedings From a Symposium . New York, NY: Biomedical Information Corp; 1985;.
4 +
Kempner W.  Treatment of hypertensive vascular disease with rice diet. Am J Med . 1948;;4:545-577.
5 +
Brenner BM, Meyer TW, Hostetter TH.  Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease. N Engl J Med . 1982;;307: 652-659.
6 +
Sacks FM, Rosner B, Kass E.  Blood pressure in vegetarians. Am J Epidemiol . 1974;;100:390-398.
7 +
Yamori Y, Kihara M, Nara Y, et al.  Hypertension and diet: multiple regression analysis in a Japanese farming community. Lancet . 1981;;1:1204-1205.
8 +
Kihara M, Fujikawa J, Ohtaka M, et al.  Interrelationships between blood pressure, sodium, potassium, serum cholesterol, and protein intake in Japanese. Hypertension . 1984;;6:736-742.
9 +
Reed D, McGee D, Yano K, Hankin J.  Diet, blood pressure, and multicollinearity. Hypertension . 1985;; 7:405-410.
10 +
Pellum LK, Medeiros DM.  Blood pressure in young adult normotensives: effect of protein, fat, and cholesterol intakes. Nutr Rep Int . 1983;;27:1277-1285.
11 +
Elliott P, Kesteloot H, Dyer A, et al.  24-hour urinary nitrogen excretion and blood pressure: INTERSALT findings. Circulation . 1991;;84( (suppl 2) ):698. Abstract 2774.
12 +
Dyer A, Elliott P, Kesteloot H, et al.  Urinary nitrogen excretion and blood pressure in INTERSALT. J Hypertension . 1992;;10( (suppl 4) ): S122. Abstract. P95.
13 +
Stamler J, Caggiula A, Grandits GA.  Relationships of dietary variables to blood pressure (BP): findings of the Multiple Risk Factor Intervention Trial (MRFIT). Circulation . 1992;;85:867. Abstract 23.
14 +
Elliott P, Freeman J, Pryer J, Brunner E, Marmot M.  Dietary protein and blood pressure: a report from the Dietary and Nutritional Survey of British Adults. J Hypertension . 1992;;10( (suppl 4) ): S141. Abstract. P105.
15 +
Liu K, Ruth K, Flack J, et al.  Ethnic differences in 5-year blood pressure change in young adults: the CARDIA study. Circulation . 1992;;85:867. Abstract 22.
16 +
Zhou B, Wu X, Tao S, et al.  Dietary patterns in 10 groups and the relationship with blood pressure. Chin Med J (Engl) . 1989;;102:257-261.
17 +
Zhou B, Zhang X, Zhu A, et al.  The relationship of dietary animal protein and electrolytes to blood pressure: a study on three Chinese populations. Int J Epidemiol . 1994;;23:716-722.
18 +
Havlik RJ, Fabsitz RR, Kalousdian S, Borhani NO, Christian JC.  Dietary protein and blood pressure in monozygotic twins. Prev Med . 1990;;19:31-39.
19 +
Liu K, Ruth KJ, Shekelle RB, Stamler J.  Macronutrients and long-term change in systolic blood pressure. Circulation . 1993;;87:679. Abstract 7.
20 +
Kimura N.  Atherosclerosis in Japan: epidemiology. Atherosclerosis Rev . 1977;;2:209-221.
21 +
Beilin LJ.  Vegetarian and other complex diets, fats, fiber, and hypertension. Am J Clin Nutr . 1994;; 59( (suppl) ):1130S-1135S.
22 +
Chapman CB, Gibbons T, Henschel A.  The effect of the rice-fruit diet on the composition of the body. N Engl J Med . 1950;;243:899-905.
23 +
Hatch FT, Wertheim AR, Eurman GH, Watkin DM, Froeb HF, Epstein HA.  Effects of diet on essential hypertension, III: alterations in sodium chloride, protein, and fat intake. Am J Med . 1954;; 17:499-513.
24 +
Brussaard JH, van Raaij JMA, Strasse-Wolthuis M, Katan MB, Hautvast JGAJ.  Blood pressure and diet in normotensive volunteers: absence of an effect of dietary fiber, protein, or fat. Am J Clin Nutr . 1981;;34:2023-2029.
25 +
Sacks FM, Donner A, Castelli WP, et al.  Effect of ingestion of meat on plasma cholesterol of vegetarians. JAMA . 1981;;246:640-644.
26 +
Sacks FM, Wood PG, Kass EH.  Stability of blood pressure in vegetarians receiving dietary protein supplements. Hypertension . 1984;;6:199-201.
27 +
Sacks FM, Marais GE, Handysides GH, et al.  Lack of an effect of dietary saturated fat and cholesterol on blood pressure in normotensives. Hypertension . 1984;;6:193-198.
28 +
Prescott SL, Jenner DA, Beilin LJ, Margetts BM, Vandongen R.  Controlled study of the effects of dietary protein on blood pressure in normotensive humans. Clin Exp Pharmacol Physiol . 1987;; 14:159-162.
29 +
Sacks FM, Kass EH.  Low blood pressure in vegetarians: effects of specific foods and nutrients. Am J Clin Nutr . 1988;;48:795-800.
30 +
Kestin M, Rouse IL, Correll RA, Nestel PJ.  Cardiovascular disease risk factors in free-living men: comparison of two prudent diets, one based on lactoovovegetarianism and the other allowing lean meat. Am J Clin Nutr . 1989;;50:280-287.
31 +
Bosch JP, Saccaggi A, Lauer A, Ronco C, Belledonne M, Glabman S.  Renal functional reserve in humans: effect of protein intake on glomerular filtration rate. Am J Med . 1983;;75:943-950.
32 +
Klahr S, Levey AS, Beck GJ, et al, for the Modification of Diet in Renal Disease Study Group.  The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. N Engl J Med . 1994;;330:877-884.
33 +
Yamori Y, Horie R, Nara Y, Ikeda M, Ooshima A, Fukase M.  Genetics of hypertensive diseases: experimental studies on pathogenesis, detection of predisposition and prevention. Adv Nephrol . 1981;; 10:51-74.
34 +
Yamori Y, Horie R, Tanase H, Fujiwara K, Nara Y, Lovenberg W.  Possible role of nutritional factors in the incidence of cerebral lesions in stroke-prone spontaneously hypertensive rats. Hypertension . 1984;;6:49-53.
35 +
Sved A, Van Itallie CM, Ferstrom JD.  Studies on the antihypertensive action of L-tryptophan. J Pharmacol Exp Ther . 1982;;221:329-333.
36 +
Sved AF, Fernstrom JD, Wurtman RJ.  Tyrosine administration reduces blood pressure and enhances brain norepinephrine release in spontaneously hypertensive rats. Proc Natl Acad Sci U S A . 1979;;76:3511-3514.
37 +
Takemoto Y.  Central depressor effects of amino acids in conscious normotensive and two-kidney, one-clip renovascular hypertensive rats. Jpn J Physiol . 1991;;41:717-724.
38 +
Finot PA.  Proteins and cardiovascular problems. Bibl Nutr Dieta . 1992;;49( (suppl) ):83-92.
39 +
Nakaki T, Hishikawa K, Suzuki H, Saruta T, Kato R.  L-Arginine-induced hypotension. Lancet . 1990;;336:696.
40 +
Woods LL, Mizelle HL, Montani J-P, Hall JE.  Mechanisms controlling renal hemodynamics and electrolyte excretion during amino acids. Am J Physiol . 1986;;251:F303-F312.
41 +
De Nicola L, Blantz RC, Gabbai FB.  Renal functional reserve in treated and untreated hypertensive rats. Kidney Int . 1991;;40:406-412.
42 +
De Nicola L, Keiser JA, Blantz RC, Gabbai FB.  Angiotensin II and renal functional reserve in rats with Goldblatt hypertension. Hypertension . 1992;; 19:790-794.
43 +
Chalmers J, Arnolda L, Kapoor V, Llewellyn-Smith I, Minson J, Pilowsky P.  Amino acid neurotransmitters in the central control of blood pressure and in experimental hypertension. J Hypertension . 1992;;10( (suppl 7) ):S27-S37.
44 +
Arnolda L, Minson J, Kapoor V, Pilowsky P, Llewellyn-Smith I, Chalmers J.  Amino acid neurotransmitters in hypertension. Kidney Int . 1992;; 41( (suppl 37) ):S2-S7.
45 +
Moncada S, Higgs A.  The L-arginine-nitric oxide pathway. N Engl J Med . 1993;;329:2002-2012.
46 +
Hishikawa K, Nakaki T, Tsuda M, et al.  Effect of systemic L-arginine administration on hemodynamics and nitric oxide release in man. Jpn Heart J . 1992;;33:41-48.
47 +
Hishikawa K, Nakaki T, Suzuki H, Kato R, Saruta T.  Role of L-arginine-nitric oxide pathway in hypertension. J Hypertension . 1993;;11:639-645.
48 +
Fried LP, Borhani NO, Enright P, et al.  The Cardiovascular Health Study: design and rationale. Ann Epidemiol . 1991;;1:263-276.
49 +
The ARIC Investigators.  The ARIC study: design and objectives. Am J Epidemiol . 1989;;129: 687-702.
50 +
Whelton PK, Hebert PR, Cutler J, et al, for the Trials of Hypertension Prevention Collaborative Research Group.  Baseline characteristics of participants in phase I of the Trials of Hypertension Prevention. Ann Epidemiol . 1992;;2:295-310.
51 +
Appel LJ, Hebert PR, Cohen JD, et al, for the Trials of Hypertension Prevention (TOHP) Collaborative Research Group.  Baseline characteristics of participants in phase II of the Trials of Hypertension Prevention (TOHP II). Ann Epidemiol . 1995;;5:149-155.
52 +
The National Heart, Lung, and Blood Institute Growth and Health Study Research Group.  Obesity and cardiovascular disease risk factors in black and white girls: the NHLBI Growth and Health Study. Am J Public Health . 1992;;82:1613-1620.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
National High Blood Pressure Education Program. Working Group Report on Primary Prevention of Hypertension . Bethesda, Md: National Heart, Lung, and Blood Institute, National Institutes of Health; 1993;. National Institutes of Health publication 93-2669.
2 +
Committee on Diet and Health, Food and Nutrition Board, Commission on Life Sciences, National Research Council.  Protein.  In: Diet and Health Implications for Reducing Chronic Disease Risk . Washington, DC: National Academy Press; 1989;; 259-271.
3 +
Meyer TW, Anderson S, Brenner BM.  Dietary protein intake and the course of renal disease: the role of capillary hypertension and hyperfusion in the pathogenesis of progressive glomerular sclerosis.  In: Horan MJ, Blaustein MP, Dunbar JB, Kachadorian W, Kaplan NM, Simopoulos AP, eds. NIH Workshop on Nutrition and Hypertension: Proceedings From a Symposium . New York, NY: Biomedical Information Corp; 1985;.
4 +
Kempner W.  Treatment of hypertensive vascular disease with rice diet. Am J Med . 1948;;4:545-577.
5 +
Brenner BM, Meyer TW, Hostetter TH.  Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease. N Engl J Med . 1982;;307: 652-659.
6 +
Sacks FM, Rosner B, Kass E.  Blood pressure in vegetarians. Am J Epidemiol . 1974;;100:390-398.
7 +
Yamori Y, Kihara M, Nara Y, et al.  Hypertension and diet: multiple regression analysis in a Japanese farming community. Lancet . 1981;;1:1204-1205.
8 +
Kihara M, Fujikawa J, Ohtaka M, et al.  Interrelationships between blood pressure, sodium, potassium, serum cholesterol, and protein intake in Japanese. Hypertension . 1984;;6:736-742.
9 +
Reed D, McGee D, Yano K, Hankin J.  Diet, blood pressure, and multicollinearity. Hypertension . 1985;; 7:405-410.
10 +
Pellum LK, Medeiros DM.  Blood pressure in young adult normotensives: effect of protein, fat, and cholesterol intakes. Nutr Rep Int . 1983;;27:1277-1285.
11 +
Elliott P, Kesteloot H, Dyer A, et al.  24-hour urinary nitrogen excretion and blood pressure: INTERSALT findings. Circulation . 1991;;84( (suppl 2) ):698. Abstract 2774.
12 +
Dyer A, Elliott P, Kesteloot H, et al.  Urinary nitrogen excretion and blood pressure in INTERSALT. J Hypertension . 1992;;10( (suppl 4) ): S122. Abstract. P95.
13 +
Stamler J, Caggiula A, Grandits GA.  Relationships of dietary variables to blood pressure (BP): findings of the Multiple Risk Factor Intervention Trial (MRFIT). Circulation . 1992;;85:867. Abstract 23.
14 +
Elliott P, Freeman J, Pryer J, Brunner E, Marmot M.  Dietary protein and blood pressure: a report from the Dietary and Nutritional Survey of British Adults. J Hypertension . 1992;;10( (suppl 4) ): S141. Abstract. P105.
15 +
Liu K, Ruth K, Flack J, et al.  Ethnic differences in 5-year blood pressure change in young adults: the CARDIA study. Circulation . 1992;;85:867. Abstract 22.
16 +
Zhou B, Wu X, Tao S, et al.  Dietary patterns in 10 groups and the relationship with blood pressure. Chin Med J (Engl) . 1989;;102:257-261.
17 +
Zhou B, Zhang X, Zhu A, et al.  The relationship of dietary animal protein and electrolytes to blood pressure: a study on three Chinese populations. Int J Epidemiol . 1994;;23:716-722.
18 +
Havlik RJ, Fabsitz RR, Kalousdian S, Borhani NO, Christian JC.  Dietary protein and blood pressure in monozygotic twins. Prev Med . 1990;;19:31-39.
19 +
Liu K, Ruth KJ, Shekelle RB, Stamler J.  Macronutrients and long-term change in systolic blood pressure. Circulation . 1993;;87:679. Abstract 7.
20 +
Kimura N.  Atherosclerosis in Japan: epidemiology. Atherosclerosis Rev . 1977;;2:209-221.
21 +
Beilin LJ.  Vegetarian and other complex diets, fats, fiber, and hypertension. Am J Clin Nutr . 1994;; 59( (suppl) ):1130S-1135S.
22 +
Chapman CB, Gibbons T, Henschel A.  The effect of the rice-fruit diet on the composition of the body. N Engl J Med . 1950;;243:899-905.
23 +
Hatch FT, Wertheim AR, Eurman GH, Watkin DM, Froeb HF, Epstein HA.  Effects of diet on essential hypertension, III: alterations in sodium chloride, protein, and fat intake. Am J Med . 1954;; 17:499-513.
24 +
Brussaard JH, van Raaij JMA, Strasse-Wolthuis M, Katan MB, Hautvast JGAJ.  Blood pressure and diet in normotensive volunteers: absence of an effect of dietary fiber, protein, or fat. Am J Clin Nutr . 1981;;34:2023-2029.
25 +
Sacks FM, Donner A, Castelli WP, et al.  Effect of ingestion of meat on plasma cholesterol of vegetarians. JAMA . 1981;;246:640-644.
26 +
Sacks FM, Wood PG, Kass EH.  Stability of blood pressure in vegetarians receiving dietary protein supplements. Hypertension . 1984;;6:199-201.
27 +
Sacks FM, Marais GE, Handysides GH, et al.  Lack of an effect of dietary saturated fat and cholesterol on blood pressure in normotensives. Hypertension . 1984;;6:193-198.
28 +
Prescott SL, Jenner DA, Beilin LJ, Margetts BM, Vandongen R.  Controlled study of the effects of dietary protein on blood pressure in normotensive humans. Clin Exp Pharmacol Physiol . 1987;; 14:159-162.
29 +
Sacks FM, Kass EH.  Low blood pressure in vegetarians: effects of specific foods and nutrients. Am J Clin Nutr . 1988;;48:795-800.
30 +
Kestin M, Rouse IL, Correll RA, Nestel PJ.  Cardiovascular disease risk factors in free-living men: comparison of two prudent diets, one based on lactoovovegetarianism and the other allowing lean meat. Am J Clin Nutr . 1989;;50:280-287.
31 +
Bosch JP, Saccaggi A, Lauer A, Ronco C, Belledonne M, Glabman S.  Renal functional reserve in humans: effect of protein intake on glomerular filtration rate. Am J Med . 1983;;75:943-950.
32 +
Klahr S, Levey AS, Beck GJ, et al, for the Modification of Diet in Renal Disease Study Group.  The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. N Engl J Med . 1994;;330:877-884.
33 +
Yamori Y, Horie R, Nara Y, Ikeda M, Ooshima A, Fukase M.  Genetics of hypertensive diseases: experimental studies on pathogenesis, detection of predisposition and prevention. Adv Nephrol . 1981;; 10:51-74.
34 +
Yamori Y, Horie R, Tanase H, Fujiwara K, Nara Y, Lovenberg W.  Possible role of nutritional factors in the incidence of cerebral lesions in stroke-prone spontaneously hypertensive rats. Hypertension . 1984;;6:49-53.
35 +
Sved A, Van Itallie CM, Ferstrom JD.  Studies on the antihypertensive action of L-tryptophan. J Pharmacol Exp Ther . 1982;;221:329-333.
36 +
Sved AF, Fernstrom JD, Wurtman RJ.  Tyrosine administration reduces blood pressure and enhances brain norepinephrine release in spontaneously hypertensive rats. Proc Natl Acad Sci U S A . 1979;;76:3511-3514.
37 +
Takemoto Y.  Central depressor effects of amino acids in conscious normotensive and two-kidney, one-clip renovascular hypertensive rats. Jpn J Physiol . 1991;;41:717-724.
38 +
Finot PA.  Proteins and cardiovascular problems. Bibl Nutr Dieta . 1992;;49( (suppl) ):83-92.
39 +
Nakaki T, Hishikawa K, Suzuki H, Saruta T, Kato R.  L-Arginine-induced hypotension. Lancet . 1990;;336:696.
40 +
Woods LL, Mizelle HL, Montani J-P, Hall JE.  Mechanisms controlling renal hemodynamics and electrolyte excretion during amino acids. Am J Physiol . 1986;;251:F303-F312.
41 +
De Nicola L, Blantz RC, Gabbai FB.  Renal functional reserve in treated and untreated hypertensive rats. Kidney Int . 1991;;40:406-412.
42 +
De Nicola L, Keiser JA, Blantz RC, Gabbai FB.  Angiotensin II and renal functional reserve in rats with Goldblatt hypertension. Hypertension . 1992;; 19:790-794.
43 +
Chalmers J, Arnolda L, Kapoor V, Llewellyn-Smith I, Minson J, Pilowsky P.  Amino acid neurotransmitters in the central control of blood pressure and in experimental hypertension. J Hypertension . 1992;;10( (suppl 7) ):S27-S37.
44 +
Arnolda L, Minson J, Kapoor V, Pilowsky P, Llewellyn-Smith I, Chalmers J.  Amino acid neurotransmitters in hypertension. Kidney Int . 1992;; 41( (suppl 37) ):S2-S7.
45 +
Moncada S, Higgs A.  The L-arginine-nitric oxide pathway. N Engl J Med . 1993;;329:2002-2012.
46 +
Hishikawa K, Nakaki T, Tsuda M, et al.  Effect of systemic L-arginine administration on hemodynamics and nitric oxide release in man. Jpn Heart J . 1992;;33:41-48.
47 +
Hishikawa K, Nakaki T, Suzuki H, Kato R, Saruta T.  Role of L-arginine-nitric oxide pathway in hypertension. J Hypertension . 1993;;11:639-645.
48 +
Fried LP, Borhani NO, Enright P, et al.  The Cardiovascular Health Study: design and rationale. Ann Epidemiol . 1991;;1:263-276.
49 +
The ARIC Investigators.  The ARIC study: design and objectives. Am J Epidemiol . 1989;;129: 687-702.
50 +
Whelton PK, Hebert PR, Cutler J, et al, for the Trials of Hypertension Prevention Collaborative Research Group.  Baseline characteristics of participants in phase I of the Trials of Hypertension Prevention. Ann Epidemiol . 1992;;2:295-310.
51 +
Appel LJ, Hebert PR, Cohen JD, et al, for the Trials of Hypertension Prevention (TOHP) Collaborative Research Group.  Baseline characteristics of participants in phase II of the Trials of Hypertension Prevention (TOHP II). Ann Epidemiol . 1995;;5:149-155.
52 +
The National Heart, Lung, and Blood Institute Growth and Health Study Research Group.  Obesity and cardiovascular disease risk factors in black and white girls: the NHLBI Growth and Health Study. Am J Public Health . 1992;;82:1613-1620.

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