Abstract Body:
Background: Hypertension (HTN) prevalence in Puerto Rico (PR) is among the highest in the US. Few studies have objectively measured HTN prevalence compared to awareness (i.e., diagnosed) and how diet quality may influence these factors.

Objective: Examine the association between diet quality, blood pressure (BP), HTN, and HTN awareness in adults in PR.

Methods: We used cross-sectional data from 1050 adults (30-75 yrs) without diabetes in the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT) cohort. Diet was assessed using food frequency questionnaires, with the Alternate Healthy Eating Index-2010 (AHEI) to define diet quality. The AHEI score (0-110) includes 11 components; higher scores reflect a healthier diet. HTN was defined per ACC/AHA guidelines as medication use or average BP≥120/80 mmHg from 3 measurements. Participants self-reported HTN awareness as ‘ever told by a health professional’, sociodemographic and lifestyle behaviors. Adjusted linear models evaluated the association between AHEI and BP, and adjusted logistic models estimated the odds ratio (OR;95%CI) of HTN and HTN awareness per-10 unit AHEI score.

Results: Of the 53% of participants with HTN, 38% were unaware of their disease. Mean(SD) diet quality was 57.1(10.7). Participants with HTN were older, male, retired, married, past smokers, and with lower education. AHEI was not associated with BP. However, higher fruit and omega-3 intake were significantly associated with lower systolic BP (β(S.E.):-1.16(6.8) and -0.85(0.42), respectively;p<0.05). Lower sugary drink intake was linked to lower diastolic BP (-0.36(0.15);p <0.05). A 10-unit AHEI increase was associated with lower odds of HTN (0.88;0.83,0.93) and higher odds of HTN awareness (1.06;1.02,1.10). Higher whole grain intake was associated with lower odds of HTN (0.91;0.84,0.98), while lower sodium intake was linked to higher odds of HTN awareness (1.07;1.01,1.14).

Conclusions: A healthier diet, mainly one rich in whole grains, is associated with lower odds of HTN. In addition, higher fruit and omega-3 and lower sugary drink intake may keep lower BP levels. Participants with higher diet quality and lower sodium intake were more likely to be aware of their HTN status, suggesting HTN awareness may drive adherence to diet recommendations. These results should be confirmed with longitudinal data. Public health efforts in PR should focus on widespread HTN screening and healthy food programs.