Modifiable lifestyle factors in the primordial prevention of hypertension in three US cohorts

Rikuta Hamaya; Molin Wang; Ellen Hertzmark; Nancy R Cook; JoAnn E Manson; Qi Sun; Meir J Stampfer; Kenneth J Mukamal; Gary Curhan; Eric B Rimm

doi:10.1016/j.ejim.2024.10.028

Modifiable lifestyle factors in the primordial prevention of hypertension in three US cohorts

Eur J Intern Med. 2024 Nov 6:S0953-6205(24)00447-3. doi: 10.1016/j.ejim.2024.10.028. Online ahead of print.

Authors

Rikuta Hamaya¹, Molin Wang², Ellen Hertzmark³, Nancy R Cook¹, JoAnn E Manson⁴, Qi Sun⁵, Meir J Stampfer⁶, Kenneth J Mukamal⁷, Gary Curhan⁸, Eric B Rimm⁹

Affiliations

¹ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
² Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
³ Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
⁴ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁵ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁶ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁷ Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
⁸ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Renal Division, Department of Medicine, Brigham and Womens' Hospital, Boston, MA, USA.
⁹ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: eric.rimm@channing.harvard.edu.

PMID: 39505681
DOI: 10.1016/j.ejim.2024.10.028

Abstract

Background: Evidence is lacking on the relative contributions of specific lifestyle factors and their overall contribution to prevention of hypertension, in particular early-onset hypertension.

Methods: This prospective cohort study included participants of the Nurses' Health Study (NHS, N = 52,780 women, aged 40-67 in 1986), the NHS II (N = 83,871 women, aged 27-46 in 1991), and the Health Professionals Follow-up Study (HPFS, N = 31,269 men, aged 40-75 in 1986), who were free from hypertension, cardiovascular disease and cancer at baseline. Four modifiable lifestyles were evaluated based on hypertension guidelines: BMI, moderate-to-vigorous physical activity, Dietary Approaches to Stop Hypertension (DASH) score, and alcohol intake. Primary outcome was incident self-reported diagnosis of hypertension with 27-31 years of follow-up.

Results: Each lifestyle factor was associated with incident hypertension in dose-dependent manners across the cohorts, with BMI having the strongest associations. On average, adhering to BMI <25 kg/m² was associated with 20.3 [18.5, 22.0], 25.0 [23.2, 26.8], and 18.6 [16.7, 20.7] months longer periods free from hypertension during 25-year follow-up in each cohort respectively. BMI accounted for approximately 20 % of incident hypertension in NHS and HPFS, and 35 % of early-onset hypertension (age < 55 y). Moderate-to-vigorous physical activity and diet accounted for 10-15 % of incident hypertension in women, and the contributions were greater for early-onset hypertension.

Conclusion: Healthy weight during adulthood was most substantially associated with incident hypertension among lifestyle factors, but diet, physical activity, and alcohol intake were also related to the risk across all ages, and hypertension-free periods, with stronger associations in early-onset hypertension.

Keywords: Hypertension; Lifestyle; Population attributable risk; Prevention; Restricted mean survival time.