More evidence supports healthy lifestyle adoption for hypertension management

For adults with hypertension, maintaining a healthy lifestyle may help prevent the development of major cardiometabolic disease regardless of antihypertensive medication use, as shown in a study.

Researchers used data from the Nurses’ Health Study (1986-2014) and Health Professionals Follow-Up Study (1986-2014). They identified a total of 25,820 individuals (mean age 60.6 years, 72.6 percent female) with incident hypertension diagnosed during each study’s follow-up period.

All participants underwent assessments of healthy lifestyle practices, including eating a high-quality diet, not smoking, engaging in moderate-to-vigorous-intensity physical activity, having a moderate alcohol consumption, and having a healthy BMI. These lifestyle factors were evaluated every 2 to 4 years, and each criterion that was met contributed 1 point to the total healthy lifestyle score (HLS), which ranged from 0 (least healthy) to 5 (most healthy).

Outcomes of interest were incident cardiovascular diseases (CVDs) and/or type 2 diabetes (T2D).

The median HLS at diagnosis of hypertension was 3. There were 3,300 incident CVDs and 2,529 T2D cases documented over a median follow-up period of 24 years. In multivariable models adjusted for medication use and other relevant covariates, participants in the highest vs lowest HLS category (5 vs 0/1) had a 51-percent lower risk of CVDs (adjusted hazard ratio [aHR], 0.49, 95 percent confidence interval [CI], 0.39–0.61) and 79-percent reduced T2D risk (aHR, 0.21, 95 percent CI, 0.14–0.30).

Participants whose HLS improved from 0–3 to 4–5 after hypertension diagnosis also had decreased risks of CVDs (aHR, 0.88, 95 percent CI, 0.79–0.98) and T2D (AHR, 0.56, 95 percent CI, 0.48–0.65) compared with those who had consistently low HLS. Conversely, those whose HLS declined after diagnosis had higher risks of CVDs (aHR, 1.14, 95 percent CI, 1.00–1.30) and T2D (aHR, 1.75, 95 percent CI, 1.45–2.10) compared with those who consistently maintained a higher HLS.

Further analysis showed that higher HLS was associated with a lower risk of both outcomes independent of antihypertensive medication use. Specifically, the highest HLS vs HLS of 0–2 was associated with lower risks of incident CVDs and T2D among both antihypertensive users (CVD: aHR, 0.63, 95 percent CI, 0.50–0.80; T2D: aHR, 0.44, 95 percent CI, 0.30–0.67) and nonusers (CVD: aHR, 0.62, 95 percent CI, 0.42–0.93; T2D: aHR, 0.32, 95 percent CI, 0.13–0.78).