Objective To investigate the association between the dietary oxidative balance score (DOBS) and the risk of hypertension in adults.

Methods The publicly available data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018 was utilized. Adults aged≥18 years were included, while individuals with missing data on hypertension diagnosis or nutrient intake necessary for DOBS calculation were excluded. DOBS was calculated based on the intake of 14 antioxidant and 2 pro-oxidant nutrients and categorized into tertiles. Multivariable logistic regression models were used to assess the association between DOBS and hypertension. Restricted cubic spline (RCS) models were employed to explore potential nonlinear relationships of DOBS with hypertension. Subgroup and sensitivity analyses were conducted to test the robustness of the findings.

Results A total of 42 317 participants was included, among whom 14 340 had hypertension. The prevalence of hypertension decreased across DOBS tertiles 37.7% (4931/13066), 34.5% (4 574/13 273), and 30.3% (4 835/15 978), χ² = 182.29, P＜0.001. After adjusting for multiple confounders, the OR of hypertension was 0.987 (95% CI: 0.981 to 0.991) for 1-point increase in DOBS. Participants in the second (OR = 0.925, 95% CI: 0.872 to 0.982) and third tertiles (OR = 0.922, 95% CI: 0.869 to 0.979) of DOBS had lower risk of hypertension compared with those in the lowest tertile (P＜0.001). RCS analysis did not reveal a nonlinear relationship between DOBS and hypertension (P _nonlinear = 0.341). Subgroup analyses revealed that this association remained consistent across different age groups, genders, smoking statuses, and drinking statuses, while an interaction was observed between BMI and DOBS. Sensitivity analyses further supported the study findings.

Conclusion A higher DOBS is associated with a lower risk of hypertension among adults in the United States.