ORIGINAL RESEARCH article

Front. Cardiovasc. Med., 24 June 2025

Sec. Hypertension

Volume 12 - 2025 | https://doi.org/10.3389/fcvm.2025.1538095

This article is part of the Research TopicNew Insights into Oxidative Medicine: Unraveling the Complexity of Oxidative Stress in Health and DiseaseView all 9 articles

Association between hypertension and oxidative balance score: data from National Health and Nutrition Examination Survey 2005–2018


Linfeng Tao,&#x;Linfeng Tao1,†Yanyou Zhou,&#x;Yanyou Zhou1,†Lifang Wu,&#x;Lifang Wu2,†Yue ZhuYue Zhu3Juntu LiJuntu Li1Chao LiChao Li4Yiyuan PanYiyuan Pan4Jun Liu

Jun Liu1*
  • 1Department of Critical Care Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou Clinical Medical Center of Critical Care Medicine, Gusu School of Nanjing Medical University, Suzhou, China
  • 2Department of Critical Care Medicine, Kunshan Third People’s Hospital, Suzhou, China
  • 3Department of Breast and Thyroid Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, China
  • 4Department of Critical Care Medicine, Suzhou Municipal Hospital, Suzhou, China

Background: Hypertension, a prevalent worldwide public health issue, can result in a wide range of illnesses. The notably association between oxidative stress and the onset of hypertension has been corroborated through diverse animal models. The oxidative balance score (OBS) served as a tool to evaluate the overall systemic status of oxidative stress, indicating that higher OBS scores corresponded to greater exposure to antioxidants. However, the exact correlation between OBS and hypertension is unclear. Therefore, we aimed to investigate whether adult OBS is attached to hypertension.

Methods: There are 28,035 participants who were chosen from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2018. The presence of hypertension was determined through a questionnaire. Twenty food and lifestyle parameters were used to score OBS. The connection between OBS and hypertension has been examined via weighted logistic regression and smoothing curves.

Results: The percentage of people with hypertension stood at 41.72%. In comparison to the first quartile of OBS, the adjusted odds ratios for the highest OBS quartile and hypertension were 0.81 (95% CI: 0.70–0.93), with a p-value for trend of 0.002. Age was the factor most strongly linked with both in stratified analysis.

Conclusions: OBS demonstrated a strong negative association with hypertension, particularly in the younger population (<60 years). These findings highlighted the importance of following an antioxidant-rich diet and lifestyle, which aids in hypertension prevention and appears to offer greater benefits to the younger age group.

1 Introduction

Hypertension is a prevalent cardiovascular disease in older adults. Over the past few years, hypertension has progressively grown to be a global health concern (1). From 1990–2019, the prevalence of hypertension doubled, with a total of approximately 1.2 billion adults global having hypertension, most in countries with middle or low income (2). A global blood pressure screening study found that more than a third of people have high blood pressure and approximately a half are unaware they have it (3). Since high blood pressure rarely causes symptoms on its own, it is frequently disregarded. Hypertension, as a risk factor often leads to cerebral hemorrhage, heart failure, coronary heart disease and even illness (4). Recent studies also show that high blood pressure increases the incidence of breast cancer and Parkinson's disease (5, 6). Therefore, determining the best course of action for managing high blood pressure and reducing associated consequences has taken precedence.

The pathological mechanism of hypertension presents multi-dimensional interactive characteristics, involving multi-dimensional factors such as abnormal activation of the renin-angiotensin-aldosterone system (RAAS), imbalance of immune homeostasis, metabolic regulation disorders, vascular endothelial damage and genetic susceptibility (7, 8). Previous research (9) has connected the development of hypertension to oxidative stress, and the immune system plays a core regulatory role in it (8, 10). The evidence shows that hypertensive patients present with a persistent low-grade inflammatory state (11). The synergistic effect of innate and adaptive immune responses leads to abnormal activation and infiltration of monocytes/macrophages and lymphocytes, accompanied by enrichment of proinflammatory factors and chemokines, which aggravates oxidative stress. Oxidative stress reversely promotes the release of inflammatory mediators through signaling pathways (10). The two form a cascade amplification effect, jointly driving a vicious cycle of vascular remodeling and target organ damage. Besides, Oxidative stress occurs when there is an unbalanced concentration of oxidants and antioxidants in the body, with an emphasis on oxidants (12). This imbalance can cause disruptions to redox signaling, regulation, and molecular damage (12, 13). In addition to producing reactive oxygen species (ROS) by itself, which damages and kills endothelium, oxidative stress also interacts with the body's inflammatory proteins, hastening the death of cells (14, 15). Studies have shown that reducing oxidative stress in the body improves blood vessel stiffness and improves blood pressure (16).

However, several factors have a limited effect on the total oxidant/antioxidant system. Variations in dietary composition, obesity, exercise, smoking, and other lifestyle choices impact the body's degree of oxidative stress. Thus, we selected the oxidative balance score (OBS) as a measure to quantify the effect of diverse diets and lifestyles on the entire oxidant/antioxidant system (17). OBS is a composite index of 20 distinct dietary and lifestyle elements that accentuates the overall balance of antioxidants and oxidants at the dietary level. It's acknowledged that a higher OBS indicates superior antioxidant status. Previous researches have demonstrated an adverse association between OBS and various diseases, including metabolic syndrome (18), depression (19), breast cancer (20), and type 2 diabetes (21). Here, we explored the connection between OBS and the incidence of hypertension. We investigated the potential effects of OBS on hypertension using data from the National Health and Nutrition Examination Survey (NHANES) from 2007–2018.

2 Method

2.1 Extraction of data and study population

NHANES employs a multistage, stratified probability approach to pick a representative sample of US citizens. It has been approved by the Ethics Review Board of the National Center for Health Statistics, and all participants have provided written, informed consent. It comprises of interview and examination components. In this study, data from seven NHANES cycles spanning from 2005 to 2006 to 2017–2018 were utilized, resulting in an initial pool of 70,190 patients. After excluding patients lacking dietary or lifestyle data, hypertension data, and variables with missing values, 28,035 subjects were included in the study (Figure 1).

Figure 1
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Figure 1. Flow chart.

2.2 Evaluation of diabetes (outcomes)

To determine whether our patients had hypertension, we employed three different techniques. First, the presence of hypertension was confirmed if it was indicated in the medications prescribed to the patient. Second, Questionnaires have been employed to gather information about hypertension. “Has a doctor or other health professional ever told you that you have high blood pressure, also known as hypertension?” was the question that was used to measure self-reported hypertension. Prior studies have also confirmed the use of self-reported hypertension (22). Third, we computed the patient's average blood pressure, either systolic or diastolic. Patients were classified as hypertensive if their systolic blood pressure was equal to or greater than 140 mm Hg, or if their diastolic blood pressure was equal to or greater than 90 mm Hg. Therefore, hypertension was considered an outcome variable in our study.

2.3 Calculation of the oxidative balance score (exposure)

Based on a previous study (23), OBS was determined by screening 16 nutrients and 4 lifestyle factors, encompassing 15 antioxidants and 5 pro-oxidants. There was a favorable correlation between participants' antioxidant activity and higher OBS. Dietary intake of 16 nutrients, including dietary fiber, carotene, riboflavin, niacin, vitamin B6, total folate, vitamin B12, vitamin C, vitamin E, calcium, magnesium, zinc, copper, selenium, total fat, and iron, was obtained from the first dietary review interview. The four lifestyle factors are physical activity, body mass index (BMI), alcohol consumption, and smoking. The amount of smoking is measured in terms of cotinine. The remaining factors were classified as antioxidants, while total fat, iron, BMI, alcohol use, and smoking were classified as pro-oxidants.

2.4 Covariates

We incorporated potential covariates that could impact the relationship between OBS and hypertension, such as sociodemographic variables, dietary quality, lipid-related indicators, lifestyle, and co-morbidities. Sociodemographic variables encompassed age, gender (male/female), race (black, Mexican, white, and other), education (<high school, high school, college), BMI, and poverty income ratio (PIR). Total calorie intake and the 2015 Healthy Eating Index (HEI) have been employed to judge overall dietary quality (24). Total cholesterol, and triglycerides are examples of lipid-related markers. Lifestyle primarily involved smoking and alcohol consumption. Co-morbidities included diabetes and hyperlipidemia. Furthermore, we employed stratified variables for age (below/above 60), sex (male/female), hyperlipidemia (yes/no), diabetes (DM, IFG, IGT, NO), and pre-specified effect modifiers to assess the interaction effect.

2.5 Statistical analysis

Due to the complexity of stratified sampling, weighted statistics are used in this paper. We applied the frequency (percentage) for representation and chi-square tests for categorical variables and the mean (standard deviation) for representation and t-tests for continuous variables. To validate the correlation between OBS and hypertension and explore the potential nonlinear relationship, OBS was converted from a continuous variable into a categorical variable by utilizing quartiles (Q1, Q2, Q3, and Q4), and the P-value for trend was determined.

Multivariable logistic regression models (from crude model to model 2) were utilized to examine the relationship between OBS and hypertension while adjusting for various potential confounders. The only covariate in the crude model that was changed was OBSQ. Model 1 was corrected for age, gender, ethnicity, and OBSQ. Model 2 further adjusted for education, PIR, BMI, hyperlipidemia, DM, kcal, HEI, smoke, triglycerides, total cholesterol, and HDL. Heterogeneity between OBS and hypertension was further assessed through subgroup analysis based on variables such as age groups, gender, hyperlipidemia, and diabetes. Smooth curves were also plotted to display the association between OBS and hypertension.

All statistical analyses were conducted using R software (version 4.2) or Empowerstats (version 4.1). A significance threshold of alpha <0.05 was set, and all analyses were two-sided. A p-value of 0.05 or less on both sides was deemed statistically significant.

3 Results

3.1 Baseline characteristics

The study reported 28,035 samples in total, with a median age of 47.03, and 41.72% of those samples had hypertension (Table 1). The distribution of genders was fairly equal. The majority of the participants (12,662, 45.16%) were white, followed by black (5,687, 20.29%), individuals of other races (5,349, 19.08%), and Mexican individuals (4,337, 15.47%). The proportion of highly educated individuals in the population is greater than 50% (n = 14,939, 53.29%). Participants had lower BMI and smoking rates, but higher age, PIR, calorie, HEI, and HLD values, as well as a higher percentage of men and higher levels of education, as compared to the lowest OBS quartile.

Table 1
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Table 1. The distribution of baseline characteristics by quartiles of the OBS, national health and nutrition examination survey 2005–2018.

3.2 Association between OBS and hypertension

Weighted logistic regression analysis revealed a correlation between OBS and hypertension, as indicated in Table 2. Irrespective of covariate adjustments, a substantial inverse correlation was noted between the highest OBS quartile and the lowest OBS quartile with the likelihood of developing hypertension. In the crude model, however, there was a positive association between the second quartile of OBS and hypertension. Further sensitivity analysis confirmed this pattern (p for trend < 0.0001). Smooth curve (Figure 2) fitting revealed a declining probability of hypertension occurrence with increasing OBS values, consistent with the logistic regression outcomes. Additionally, after taking the logarithm of the odds ratio for hypertension, it was evident that higher OBS values were associated with a reduced risk of developing hypertension.

Table 2
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Table 2. Weighted logistic regression analysis models showing the relationship between OBS and hypertension.

Figure 2
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Figure 2. Smooth curve between OBS and hypertension.

3.3 Subgroup analysis

Table 3 displays the results of the subgroup analysis split down by age, gender, diabetes, and hyperlipidemia. The age subgroup of hypertension showed statistical significance (p for interaction = 0.041). Within the age subgroup, individuals under 60 years old were found to be more responsive to higher OBS compared to those over 60. In other words, the population of lower 60 years had an 17.9% lower risk of developing hypertension in the top quartile compared with the first quartile (all p for trend <0.05). Men in the fourth quartile of the OBS population who do not have diabetes mellitus or concomitant hyperlipidemia can also be observed to have a strong negative connection with hypertension.

Table 3
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Table 3. Subgroup analysis.

4 Discussion

28,035 samples from seven NHANES cycles between 2005 and 2018 have been included in this study's analysis of the connection between OBS and hypertension. We discovered in this study that OBS was considerably higher in non-hypertension individuals than in hypertensive individuals. Additionally, a higher OBS demonstrated a negative relationship with the likelihood of developing hypertension. Upon accounting for potential influencing factors, the findings indicated that the impact of OBS on hypertension was significantly influenced by age. People under 60 were more likely to benefit from the trial and had a lower risk of developing hypertension than people over 60.

Numerous studies on animals and in humans have tied oxidative stress to the onset and development of hypertension. When the quantity of ROS surpasses the antioxidants' ability to scavenge them, oxidative stress results. In addition to directly affecting cellular macromolecules, which may result in cell damage and death (25), oxidative stress also influences inflammatory factors, which can accelerate blood vessel aging and elevate blood pressure (15). The probability of cardiovascular disease climbs with age, indicating that age is an important factor in cardiovascular disease (26). A cohort study revealed a significant link between age and hypertension, particularly hastening the onset of hypertension in middle age (27). In aged hypertensive mice, Angela Wirth et al. (28) discovered the development of accelerated endothelial cell dysfunction in conjunction with elevated ROS in the vasculature. Besides, as we age, blood vessels begin to stiffen, and when the endothelial cells in the blood vessels are attacked by oxidants or inflammatory substances, the blood vessels stiffen rapidly, increasing blood flow (29). Aged cardiomyocytes have been shown to have increased free radicals and a chronic proinflammatory state too (30). The middle intima of medium-sized arteries thickens as a result of endothelial cell failure brought on by high levels of oxidative stress and inflammation in vivo (31). The renewal rate of cardiomyocytes is highest at around 20 years of age, declining steadily thereafter to less than 0.5% per year in the elderly (32). Based on these findings, it is believed that younger patients have better vascular conditions and are more likely to benefit from antioxidants.

It has been proven that the NOX family plays a substantial part in the development of hypertension (33). The production of oxides by the NOX family during the redox process in the population is the main reason for the increase in blood pressure (34, 35). In experiments with hypertensive mice, blocking the NOX pathway with a drug led to an improvement in blood vessel function and normalization of blood pressure (36). Consequently, NOX isoforms (NOX2) may be expressed in immune cells, producing high levels of oxygen free radicals and causing damage to the vascular endothelium (37).

Several research have also verified the positive correlation between antioxidants and a decreased risk of hypertension. A retrospective study discovered that eating foods high in antioxidants, such as lycopene, α-carotene, β-carotene, lutein with zeaxanthin, and total carotenoids, reduced the incidence of high blood pressure (38). Besides, in a dietary study aimed at elderly patients with metabolic syndrome (MetS) in Korea, when patients ate foods rich in antioxidants for 4 weeks, changes in the state of oxidative stress and MetS involving hypertension, arteriosclerosis and dyslipidemia (39). Additionally, in vitro experiments conducted on mice demonstrated that resveratrol plays a role in lowering blood pressure, improving oxidative stress, and enhancing cellular endothelial function (40). Furthermore, a recent study on mice demonstrated that raising the levels of the mitochondrial deacetylase sirt3 decreased oxidative stress, prevented endothelial dysfunction and vascular inflammation, and slowed down hypertension and vascular aging (41). Patients with hypertension who received the physiological oxidant melatonin1 for that year exhibited improvements in arterial stiffness and a drop in serum TAC (a measure of oxidative stress), according to randomized controlled research (42).

According to this research, an antioxidant-rich diet and way of life are good for mental health. In addition, there was age dimorphism in these trends, with younger people seeing a higher protective impact from antioxidant diet and lifestyle choices. The results emphasize the need of maintaining a diet and way of life high in antioxidants, as they can aid in the prevention and treatment of hypertension.

This study revealed the dual value of antioxidant dietary patterns and lifestyle interventions in the management of hypertension. Data from a cohort study confirmed that higher OBS in hypertensive patients was significantly associated with reduced all-cause mortality (43). Coincidentally, a large-scale cross-sectional study conducted in China also found that a healthy lifestyle and a diet rich in antioxidants can prevent hypertension (44). These findings reinforce the pivotal role of the balance of the oxidation/antioxidant system in blood pressure regulation from an epidemiological perspective. It is worth noting that OBS, as a quantitative assessment tool, can provide individuals with a visual oxidative stress risk assessment by integrating dietary components and lifestyle parameters, thereby guiding precise nutritional counseling.

Our research advantages lie in the following aspects. First, we used seven waves of high-quality, representative data from the NHANES, which are large and multi-stage. Second, the logistic regression model was adjusted to eliminate some potential confounding factors, including demographic, socioeconomic, health and lifestyle information, to obtain more accurate results.

There are a few other restrictions on the current investigation. First, because the study is cross-sectional, it is challenging to determine a causal association between OBS and hypertension. Thus, more research with a prospective design is required to demonstrate the effectiveness of OBS. In the future, prospective study designs will be used to track the association between dynamic changes in OBS and blood pressure trajectories and to use bidirectional Mendelian methods to explore the causal relationship between OBS and hypertension. Second, it is difficult to integrate all OS-related nutrition and lifestyle exposures into OBS; flavonoids, for example, were one of the components with restricted availability. Subsequent studies need to integrate food composition databases to more accurately quantify dietary antioxidant exposure. Third, all pro-oxidants and antioxidants are assumed to have a linear correlation with oxidative stress, ignoring the threshold effects of antioxidants. Finally, the limited data did not account for the effect of hypertensive medications on hypertensive patients, making it impossible to determine whether there was a differential effect of OBS between hypertensive patients taking or not taking hypertensive medications. It is anticipated that this problem will be addressed in later clinical research.

5 Conclusion

In conclusion, our analysis suggested that there was a substantial reverse correlation among OBS and hypertension. The study revealed that higher OBS, which signifies greater antioxidant exposure compared to prooxidant exposure in diet and lifestyle, is linked to decreased likelihood of hypertension. The precise mechanism behind the association between OBS and hypertension as well as its causal link warrant further investigation.

Data availability statement

Publicly available datasets were analyzed in this study. This data can be found here: https://www.cdc.gov/nchs/nhanes/index.htm.

Author contributions

LT: Conceptualization, Writing – review & editing. YZ: Writing – original draft, Software. LW: Methodology, Supervision, Writing – review & editing. YZ: Validation, Visualization, Writing – original draft. JL: Formal analysis, Visualization, Writing – original draft. CL: Conceptualization, Supervision, Writing – review & editing. YP: Validation, Writing – review & editing. JL: Funding acquisition, Resources, Writing – review & editing.

Funding

The author(s) declare that financial support was received for the research and/or publication of this article. This study was supported by the Key Social Development Project of Jiangsu Province (BE2021660), Key R&D Plan Projects in Kunshan City (KSF202105) and Suzhou Science and Technology Project (SKY2023197).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The author(s) declare that no Generative AI was used in the creation of this manuscript.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

References

1. Fisher NDL, Curfman G. Hypertension—a public health challenge of global proportions. JAMA. (2018) 320(17):1757. doi: 10.1001/jama.2018.16760

PubMed Abstract | Crossref Full Text | Google Scholar

2. Zhou B, Carrillo-Larco RM, Danaei G, Riley LM, Paciorek CJ, Stevens GA, et al. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1,201 population-representative studies with 104 million participants. Lancet. (2021) 398(10304):957–80. doi: 10.1016/S0140-6736(21)01330-1

PubMed Abstract | Crossref Full Text | Google Scholar

3. Beaney T, Schutte AE, Stergiou GS, Borghi C, Burger D, Charchar F, et al. May measurement month 2019: the global blood pressure screening campaign of the international society of hypertension. Hypertension. (2020) 76(2):333–41. doi: 10.1161/HYPERTENSIONAHA.120.14874

PubMed Abstract | Crossref Full Text | Google Scholar

4. Qamar A, Braunwald E. Treatment of hypertension addressing a global health problem. JAMA. (2018) 320(17):1751. doi: 10.1001/jama.2018.16579

PubMed Abstract | Crossref Full Text | Google Scholar

5. Chen J, Zhang C, Wu Y, Zhang D. Association between hypertension and the risk of parkinson’s disease: a meta-analysis of analytical studies. Neuroepidemiology. (2019) 52:181–92. doi: 10.1159/000496977

PubMed Abstract | Crossref Full Text | Google Scholar

6. Han H, Guo W, Shi W, Yu Y, Zhang Y, Ye X, et al. Hypertension and breast cancer risk: a systematic review and meta-analysis. Sci Rep. (2017) 7(1):44877. doi: 10.1038/srep44877

PubMed Abstract | Crossref Full Text | Google Scholar

7. Singh V, Van Why SK. Monogenic etiology of hypertension. Med Clin. (2024) 108:157–72. doi: 10.1016/j.mcna.2023.06.005

PubMed Abstract | Crossref Full Text | Google Scholar

8. Formanowicz D, Rybarczyk A, Radom M, Formanowicz P. A role of inflammation and immunity in essential hypertension—modeled and analyzed using Petri nets. Int J Mol Sci. (2020) 21(9):3348. doi: 10.3390/ijms21093348

PubMed Abstract | Crossref Full Text | Google Scholar

9. Guzik TJ, Touyz RM. Oxidative stress, inflammation, and vascular aging in hypertension. Hypertension. (2017) 70(4):660–7. doi: 10.1161/HYPERTENSIONAHA.117.07802

PubMed Abstract | Crossref Full Text | Google Scholar

10. Zhang Z, Zhao L, Zhou X, Meng X, Zhou X. Role of inflammation, immunity, and oxidative stress in hypertension: new insights and potential therapeutic targets. Front Immunol. (2023) 13:1098725. doi: 10.3389/fimmu.2022.1098725

PubMed Abstract | Crossref Full Text | Google Scholar

11. McMaster WG, Kirabo A, Madhur MS, Harrison DG. Inflammation, immunity, and hypertensive end-organ damage. Circ Res. (2015) 116:1022–33. doi: 10.1161/CIRCRESAHA.116.303697

PubMed Abstract | Crossref Full Text | Google Scholar

12. Lushchak VI. Free radicals, reactive oxygen species, oxidative stress and its classification. Chem Biol Interact. (2014) 224:164–75. doi: 10.1016/j.cbi.2014.10.016

PubMed Abstract | Crossref Full Text | Google Scholar

13. Schulz E, Gori T, Münzel T. Oxidative stress and endothelial dysfunction in hypertension. Hypertens Res. (2011) 34(6):665–73. doi: 10.1038/hr.2011.39

PubMed Abstract | Crossref Full Text | Google Scholar

14. Griendling KK, Camargo LL, Rios FJ, Alves-Lopes R, Montezano AC, Touyz RM. Oxidative stress and hypertension. Circ Res. (2021) 128(7):993–1020. doi: 10.1161/CIRCRESAHA.121.318063

PubMed Abstract | Crossref Full Text | Google Scholar

15. Tchalla AE, Wellenius GA, Travison TG, Gagnon M, Iloputaife I, Dantoine T, et al. Circulating vascular cell adhesion molecule-1 is associated with cerebral blood flow dysregulation, mobility impairment, and falls in older adults. Hypertension. (2015) 66(2):340–6. doi: 10.1161/HYPERTENSIONAHA.115.05180

PubMed Abstract | Crossref Full Text | Google Scholar

16. Takayanagi T, Kawai T, Forrester SJ, Obama T, Tsuji T, Fukuda Y, et al. Role of epidermal growth factor receptor and endoplasmic reticulum stress in vascular remodeling induced by angiotensin II. Hypertension. (2015) 65(6):1349–55. doi: 10.1161/HYPERTENSIONAHA.115.05344

PubMed Abstract | Crossref Full Text | Google Scholar

17. Goodman M, Bostick RM, Dash C, Flanders WD, Mandel JS. Hypothesis: oxidative stress score as a combined measure of pro-oxidant and antioxidant exposures. Ann Epidemiol. (2007) 17(5):394–9. doi: 10.1016/j.annepidem.2007.01.034

PubMed Abstract | Crossref Full Text | Google Scholar

18. Park HM, Han TH, Kwon YJ, Lee JH. Oxidative balance score inversely associated with the prevalence and incidence of metabolic syndrome: analysis of two studies of the Korean population. Front Nutr. (2023) 10:1226107. doi: 10.3389/fnut.2023.1226107

PubMed Abstract | Crossref Full Text | Google Scholar

19. Liu X, Liu X, Wang Y, Zeng B, Zhu B, Dai F. Association between depression and oxidative balance score: national health and nutrition examination survey (NHANES) 2005–2018. J Affect Disord. (2023) 337:57–65. doi: 10.1016/j.jad.2023.05.071

PubMed Abstract | Crossref Full Text | Google Scholar

20. Sohouli MH, Baniasadi M, Hernández-Ruiz Á, Melekoglu E, Zendehdel M, José Soto-Méndez M, et al. Adherence to oxidative balance scores is associated with a reduced risk of breast cancer; a case-control study. Nutr Cancer. (2023) 75(1):164–73. doi: 10.1080/01635581.2022.2102658

PubMed Abstract | Crossref Full Text | Google Scholar

21. Golmohammadi M, Ayremlou P, Zarrin R. Higher oxidative balance score is associated with better glycemic control among Iranian adults with type-2 diabetes. Int J Vitam Nutr Res. (2021) 91(1–2):31–9. doi: 10.1024/0300-9831/a000596

PubMed Abstract | Crossref Full Text | Google Scholar

22. Cai Y, Chen M, Zhai W, Wang C. Interaction between trouble sleeping and depression on hypertension in the NHANES 2005–2018. BMC Public Health. (2022) 22(1):481. doi: 10.1186/s12889-022-12942-2

PubMed Abstract | Crossref Full Text | Google Scholar

23. Lei X, Xu Z, Chen W. Association of oxidative balance score with sleep quality: NHANES 2007–2014. J Affect Disord. (2023) 339:435–42. doi: 10.1016/j.jad.2023.07.040

PubMed Abstract | Crossref Full Text | Google Scholar

24. Krebs-Smith SM, Pannucci TE, Subar AF, Kirkpatrick SI, Lerman JL, Tooze JA, et al. Update of the healthy eating index: HEI-2015. J Acad Nutr Diet. (2018) 118(9):1591–602. doi: 10.1016/j.jand.2018.05.021

PubMed Abstract | Crossref Full Text | Google Scholar

25. Ghezzi P, Jaquet V, Marcucci F, Schmidt HHHW. The oxidative stress theory of disease: levels of evidence and epistemological aspects. Br J Pharmacol. (2017) 174(12):1784–96. doi: 10.1111/bph.13544

PubMed Abstract | Crossref Full Text | Google Scholar

26. Triposkiadis F, Xanthopoulos A, Butler J. Cardiovascular aging and heart failure: JACC review topic of the week. J Am Coll Cardiol. (2019) 74:804–13. doi: 10.1016/j.jacc.2019.06.053

PubMed Abstract | Crossref Full Text | Google Scholar

27. Wills AK, Lawlor DA, Matthews FE, Sayer AA, Bakra E, Ben-Shlomo Y, et al. Life course trajectories of systolic blood pressure using longitudinal data from eight UK cohorts. PLoS Med. (2011) 8(6):e1000440. doi: 10.1371/journal.pmed.1000440

PubMed Abstract | Crossref Full Text | Google Scholar

28. Wirth A, Wang S, Takefuji M, Tang C, Althoff TF, Schweda F, et al. Age-dependent blood pressure elevation is due to increased vascular smooth muscle tone mediated by G-protein signalling. Cardiovasc Res. (2016) 109(1):131–40. doi: 10.1093/cvr/cvv249

PubMed Abstract | Crossref Full Text | Google Scholar

29. Wu J, Saleh MA, Kirabo A, Itani HA, Montaniel KRC, Xiao L, et al. Immune activation caused by vascular oxidation promotes fibrosis and hypertension. J Clin Invest. (2016) 126(4):1607–1607. doi: 10.1172/JCI87425

PubMed Abstract | Crossref Full Text | Google Scholar

30. Akbari M, Shanley DP, Bohr VA, Rasmussen LJ. Cytosolic self-DNA-A potential source of chronic inflammation in aging. Cells. (2021) 10(12):3544. doi: 10.3390/cells10123544

PubMed Abstract | Crossref Full Text | Google Scholar

31. van den Munckhof ICL, Jones H, Hopman MTE, de Graaf J, Nyakayiru J, van Dijk B, et al. Relation between age and carotid artery intima-medial thickness: a systematic review. Clin Cardiol. (2018) 41(5):698–704. doi: 10.1002/clc.22934

PubMed Abstract | Crossref Full Text | Google Scholar

32. Lázár E, Sadek HA, Bergmann O. Cardiomyocyte renewal in the human heart: insights from the fall-out. Eur Heart J. (2017) 38(30):2333–42. doi: 10.1093/eurheartj/ehx343

PubMed Abstract | Crossref Full Text | Google Scholar

33. Kishi H, Kishi T, Folkers K. Bioenergetics in clinical medicine. III. Inhibition of coenzyme Q10-enzymes by clinically used anti-hypertensive drugs. Res Commun Chem Pathol Pharmacol. (1975) 12(3):533–40.1197930

PubMed Abstract | Google Scholar

34. Dikalova A, Clempus R, Lassègue B, Cheng G, McCoy J, Dikalov S, et al. Nox1 overexpression potentiates angiotensin II-induced hypertension and vascular smooth muscle hypertrophy in transgenic mice. Circulation. (2005) 112(17):2668–76. doi: 10.1161/CIRCULATIONAHA.105.538934

PubMed Abstract | Crossref Full Text | Google Scholar

35. Rivera J, Sobey CG, Walduck AK, Drummond GR. Nox isoforms in vascular pathophysiology: insights from transgenic and knockout mouse models. Redox Rep. (2010) 15(2):50–63. doi: 10.1179/174329210X12650506623401

PubMed Abstract | Crossref Full Text | Google Scholar

36. Li L, Lai EY, Luo Z, Solis G, Mendonca M, Griendling KK, et al. High salt enhances reactive oxygen species and angiotensin II contractions of glomerular afferent arterioles from mice with reduced renal mass. Hypertension. (2018) 72(5):1208–16. doi: 10.1161/HYPERTENSIONAHA.118.11354

PubMed Abstract | Crossref Full Text | Google Scholar

37. Briones AM, Tabet F, Callera GE, Montezano AC, Yogi A, He Y, et al. Differential regulation of Nox1, Nox2 and Nox4 in vascular smooth muscle cells from WKY and SHR. J Am Soc Hypertens. (2011) 5(3):137–53. doi: 10.1016/j.jash.2011.02.001

PubMed Abstract | Crossref Full Text | Google Scholar

38. Li Z, Chen J, Zhang D. Association between dietary carotenoid intakes and hypertension in adults. J Hypertens. (2019) 37(12):2371–9. doi: 10.1097/HJH.0000000000002200

PubMed Abstract | Crossref Full Text | Google Scholar

39. Chung HK, Kim JH, Choi A, Ahn CW, Kim YS, Nam JS. Antioxidant-rich dietary intervention improves cardiometabolic profiles and arterial stiffness in elderly Koreans with metabolic syndrome. Yonsei Med J. (2022) 63(1):26–33. doi: 10.3349/ymj.2022.63.1.26

PubMed Abstract | Crossref Full Text | Google Scholar

40. Prysyazhna O, Wolhuter K, Switzer C, Santos C, Yang X, Lynham S, et al. Blood pressure–lowering by the antioxidant resveratrol is counterintuitively mediated by oxidation of cGMP-dependent protein kinase. Circulation. (2019) 140(2):126–37. doi: 10.1161/CIRCULATIONAHA.118.037398

PubMed Abstract | Crossref Full Text | Google Scholar

41. Dikalova AE, Pandey A, Xiao L, Arslanbaeva L, Sidorova T, Lopez MG, et al. Mitochondrial deacetylase Sirt3 reduces vascular dysfunction and hypertension while Sirt3 depletion in essential hypertension is linked to vascular inflammation and oxidative stress. Circ Res. (2020) 126(4):439–52. doi: 10.1161/CIRCRESAHA.119.315767

PubMed Abstract | Crossref Full Text | Google Scholar

42. Franco C, Sciatti E, Favero G, Bonomini F, Vizzardi E, Rezzani R. Essential hypertension and oxidative stress: novel future perspectives. Int J Mol Sci. (2022) 23(22):14489. doi: 10.3390/ijms232214489

PubMed Abstract | Crossref Full Text | Google Scholar

43. Ma T, Wang L, Yan X. Relationship between oxidative balance score and all-cause mortality in hypertension. J Vasc Res. (2025) 62(3):121–32. doi: 10.1159/000543471

PubMed Abstract | Crossref Full Text | Google Scholar

44. Qiu W, Han Y, Huang J, Chen D, Fang J, Chang H, et al. Higher food and lifestyle oxidative balance scores decreases the risk of hypertension in Chinese adults: a population-based cross-sectional study. J Clin Hypertens. (2025) 27(4):e70042. doi: 10.1111/jch.70042

PubMed Abstract | Crossref Full Text | Google Scholar

Keywords: hypertension, oxidative stress, oxidative balance score, NHANES, OBS

Citation: Tao L, Zhou Y, Wu L, Zhu Y, Li J, Li C, Pan Y and Liu J (2025) Association between hypertension and oxidative balance score: data from National Health and Nutrition Examination Survey 2005–2018. Front. Cardiovasc. Med. 12:1538095. doi: 10.3389/fcvm.2025.1538095

Received: 11 March 2025; Accepted: 26 May 2025;
Published: 24 June 2025.

Edited by:

Matteo Becatti, University of Firenze, Italy

Reviewed by:

Dorota Formanowicz, Poznan University of Medical Sciences, Poland
Da-Wei Wu, Kaohsiung Medical University, Taiwan

Copyright: © 2025 Tao, Zhou, Wu, Zhu, Li, Li, Pan and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Jun Liu, bGl1anVucGhkQHNpbmEuY24=

These authors share first authorship

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