**Background:** Hypertension is a major modifiable cardiovascular risk factor contributing to ASCVD worldwide. While the DASH and Mediterranean diets have established anti-hypertensive benefits, the MIND diet—a hybrid of these two dietary patterns originally designed for neurodegenerative delay—had not been investigated for its role in hypertension prevention or management. This study aimed to evaluate the association between MIND diet adherence and hypertension prevalence in the general population, as well as long-term mortality outcomes in hypertensive patients.
**Methods:** Data were drawn from two continuous NHANES cycles (2003-2006). After exclusions, 6,887 adult participants (2,984 hypertensive patients) were analyzed. Participants were divided into three groups based on MIND diet scores (MDS): low (<7.5), medium (7.5-8.0), and high (≥8.5). The MIND diet includes 10 brain-healthy food groups (green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, seafood, poultry, olive oil, wine) and 5 unhealthy food groups (red meats, butter/stick margarine, cheese, pastries/sweets, fried/fast food). Hypertension was defined as self-reported history, antihypertensive medication use, or BP ≥140/90 mmHg. ASCVD included CAD, heart attack, angina, congestive heart failure, stroke, and peripheral artery disease. Mortality outcomes were ascertained through linkage to the National Death Index through December 31, 2019 (mean follow-up 9.25 years, median 111.1 months, range 2-120 months). Multivariate logistic regression and Cox proportional hazards models were used, with progressive adjustment for demographics (Model 1), lifestyle factors and BMI (Model 2), and comorbidities plus energy intake (Model 3). Restricted cubic spline analyses assessed dose-response relationships.
**Key Results:** The overall weighted mean age was 47.13 years, 53.8% female. MDS ranged from 4.5 to 13 points. In the fully adjusted model (Model 3), participants in the MDS-high group had a significantly lower prevalence of hypertension compared to the MDS-low group (OR 0.76, 95% CI 0.58-0.97, p=0.040). Each one-score increase in MDS was associated with a 9% lower prevalence of hypertension in Model 2 (OR 0.91, 95% CI 0.86-0.97). Linear regression showed MDS was inversely correlated with systolic blood pressure (β=-0.41, p=0.033). Among hypertensive patients, 641 (21.5%) had ASCVD at baseline. Those in the MDS-high group had significantly lower ASCVD prevalence (OR 0.71, 95% CI 0.51-0.97, p=0.043). During follow-up, 787 all-cause deaths (26.4%) and 293 CV deaths (9.8%) occurred among hypertensive patients. High MDS was associated with significantly lower risk of all-cause death (HR 0.69, 95% CI 0.58-0.81, p<0.001) and CV death (HR 0.62, 95% CI 0.46-0.85, p=0.001). Per one-score MDS increase, all-cause death risk decreased by 10% (HR 0.90, 95% CI 0.86-0.95) and CV death risk by 13% (HR 0.87, 95% CI 0.79-0.96). RCS analyses showed linear dose-response relationships for all outcomes (p for non-linearity: hypertension=0.259, ASCVD=0.614, all-cause death=0.585, CV death=0.662). Subgroup analyses revealed more pronounced protective effects in older adults, females, and non-White participants. Sensitivity analyses excluding non-Hispanic Black participants, Mexican American/other participants, those who died within 1 year, and those with cerebral diseases yielded consistent results. Component analysis identified restricted intake of butter and red meat, and high intakes of fish, green leafy vegetables, nuts, poultry, and moderate wine as main protective contributors.
**Clinical Implications:** This study provides the first evidence that the MIND diet may be beneficial for both primary prevention of hypertension and secondary prevention of adverse outcomes in hypertensive patients. The findings suggest that the MIND diet could serve as a novel anti-hypertensive dietary pattern, extending its known neuroprotective benefits to cardiovascular health. The linear dose-response relationships indicate that even modest improvements in diet quality may confer meaningful benefits. However, the cross-sectional design for hypertension and ASCVD prevalence limits causal inference, ASCVD diagnosis relied on self-report, and the moderate sample size warrants validation in larger prospective cohorts and randomized controlled trials. The study was supported by CAMS Innovation Fund for Medical Sciences (grant no. 2021-I2M-1-008).