{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T16:49:35Z","timestamp":1773334175368,"version":"3.50.1"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"The COcoa Supplement and Multivitamin Outcomes Study","award":["AG050657"],"award-info":[{"award-number":["AG050657"]}]},{"name":"The COcoa Supplement and Multivitamin Outcomes Study","award":["AG071611"],"award-info":[{"award-number":["AG071611"]}]},{"name":"The COcoa Supplement and Multivitamin Outcomes Study","award":["EY025623"],"award-info":[{"award-number":["EY025623"]}]},{"name":"The COcoa Supplement and Multivitamin Outcomes Study","award":["HL157665"],"award-info":[{"award-number":["HL157665"]}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multivitamin-multimineral (MVM) supplements have been associated with lower blood pressure (BP) in several small trials. We investigated the effects of a MVM on incident hypertension and BP in a secondary analysis of the COcoa Supplement and Multivitamin Outcomes Study (COSMOS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>COSMOS is a 2\u00d72 factorial, double-blinded RCT testing effects of cocoa extract and MVM supplementation among women aged \u226565 years and men aged \u226560 years. Among 8905 COSMOS participants free from hypertension, effects of MVM supplementation on incident hypertension were investigated. Hypertension diagnosis was ascertained through self-reports. Additionally, in two substudies with BP measurements (N\u2009=\u2009529 at clinic by research staff and 994 at home by technician), we evaluated the effects on 2-year BP changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Incident hypertension was observed in N\u2009=\u20091034 (22.9%) in MVM arm and N\u2009=\u20091039 (23.6%) in placebo arm over a median of 3.4 years (IQR: 3.0, 3.9) of follow-up, with hazard ratio (HR) 0.98 [95% CI: 0.90, 1.06]. Effects differed according to baseline diet quality, with HRs of incident hypertension 0.81 [0.70, 0.95] and 1.14 [1.01, 1.28] among participants with lower and higher Alternate Mediterranean Diet score, respectively (P-interaction\u2009=\u2009.001). There was no effect of MVM on 2-year changes in systolic BP (4.4 mmHg in MVM; 4.5 mmHg in placebo), while pronounced effects were observed for baseline normal BP (P-interaction\u2009=\u2009.004).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MVM supplementation versus placebo did not reduce hypertension incidence or lower BP overall. Exploratory analyses showed greater reduction in hypertension risk and BP changes among those with lower dietary quality and normal BP at baseline, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration<\/jats:title>\n                    <jats:p>NCT02422745.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajh\/hpaf224","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T13:03:32Z","timestamp":1762952612000},"page":"538-546","source":"Crossref","is-referenced-by-count":0,"title":["Long-Term Effect of Multivitamin Supplementation on Incident Self-Reported Hypertension and Blood Pressure Changes in the COSMOS Trial"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2129-8956","authenticated-orcid":false,"given":"Rikuta","family":"Hamaya","sequence":"first","affiliation":[{"name":"Division of Preventive Medicine, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School , Boston, MA,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4798-8920","authenticated-orcid":false,"given":"Sidong","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Preventive Medicine, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School , Boston, MA,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Lau","sequence":"additional","affiliation":[{"name":"Division of Preventive Medicine, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School , Boston, MA,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanne","family":"Rautiainen","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet , Stockholm,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernhard","family":"Haring","sequence":"additional","affiliation":[{"name":"Department of Medicine IV, Clinic Hietzing , Vienna,","place":["Austria"]},{"name":"Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY,","place":["United States"]},{"name":"HOMICAREM (HOMburg Institute for CArdioREnalMetabolic Medicine), Saarland University , Homburg\/Saar,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simin","family":"Liu","sequence":"additional","affiliation":[{"name":"Joe Wen School of Population & Public Health Department of Epidemiology & Biostatistics, , University of California , Irvine, Irvine, CA,","place":["United States"]},{"name":"Department of Medicine Mary & Steve Wen Cardiovascular Division, , School of Medicine, University of California , Irvine, Irvine, CA,","place":["United States"]},{"name":"Susan & Henry Samueli College of Health Sciences Center for Global Cardiometabolic Health & Nutrition, , University of California, Irvine , Irvine, CA,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aladdin H","family":"Shadyab","sequence":"additional","affiliation":[{"name":"Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego , La Jolla, CA,","place":["United States"]},{"name":"Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California San Diego , La Jolla, CA,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa Warsinger","family":"Martin","sequence":"additional","affiliation":[{"name":"School of Medicine and Health Sciences, George Washington University , Washington, DC,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvia","family":"Wassertheil-Smoller","sequence":"additional","affiliation":[{"name":"Albert Einstein College of Medicine Department of Epidemiology and Population Health, , Bronx, NY,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela M","family":"Rist","sequence":"additional","affiliation":[{"name":"Division of Preventive Medicine, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School , Boston, MA,","place":["United States"]},{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health , Boston, MA,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JoAnn E","family":"Manson","sequence":"additional","affiliation":[{"name":"Division of Preventive Medicine, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School , Boston, MA,","place":["United States"]},{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health , Boston, MA,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Howard D","family":"Sesso","sequence":"additional","affiliation":[{"name":"Division of Preventive Medicine, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School , Boston, MA,","place":["United States"]},{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health , Boston, MA,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"for the COSMOS Research Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rikuta","family":"Hamaya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sidong","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Lau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanne","family":"Rautiainen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernhard","family":"Haring","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simin","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aladdin H","family":"Shadyab","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa Warsinger","family":"Martin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvia","family":"Wassertheil-Smoller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela M","family":"Rist","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JoAnn E","family":"Manson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Howard D","family":"Sesso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"2026031200564075400_hpaf224-B1","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1093\/ajh\/hpae141","article-title":"Trends in blood pressure control among US adults with hypertension, 2013-2014 to 2021-2023","volume":"38","author":"Hardy","year":"2025","journal-title":"Am J Hypertens"},{"key":"2026031200564075400_hpaf224-B2","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1161\/01.HYP.34.3.472","article-title":"Effect of dietary patterns on ambulatory blood pressure: results from the Dietary Approaches to Stop Hypertension (DASH) trial. 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