Adherence to Healthy Lifestyle and Risk of Cardiometabolic Diseases in Individuals With Hypertension
Authors' conclusion
In this cohort study of individuals living with hypertension, maintaining a healthy lifestyle was associated with lower risk of major cardiometabolic diseases independent of antihypertensive medication use, underscoring the value of adopting multiple healthy lifestyle behaviors.
Study context
- Population
- US individuals with incident hypertension in the Nurses' Health Study and Health Professionals Follow-Up Study (1986–2014); mean age 60.6 years, 72.6% female
- Participants
- 25,820 individuals
- Exposure
- Highest healthy lifestyle score vs lowest
- Outcome
- Incident CVDs and/or T2D
- Follow-up
- Median 24 years (IQR, 23-25 years)
Methodological detailstime-varying lifestyle scores, multivariable-adjusted
- Time-varying lifestyle scores
- Multivariable-adjusted
Main finding
As reported in the abstract
Each group vs HLS 0 or 1Estimate (95% CI)
HLS 5
aHR (total CVDs) 0.49(0.39–0.61)
HLS 5
aHR (T2D) 0.21(0.14–0.30)
- Incident cardiovascular diseases (CVDs)
- 3300
- Incident T2D cases
- 2529
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | |
|---|---|---|
| HLS improved from lower (0-3) to higher (4 or 5) after diagnosis vs consistently lower HLSImproved HLSvs Consistently lower HLS | aHR (CVDs) 0.88 (95% CI 0.79–0.98) | |
| HLS improved from lower (0-3) to higher (4 or 5) after diagnosis vs consistently lower HLSImproved HLSvs Consistently lower HLS | aHR (T2D) 0.56 (95% CI 0.48–0.65) | |
| HLS declined after diagnosis vs consistently higher HLSDeclined HLSvs Consistently higher HLS | aHR (CVDs) 1.14 (95% CI 1.00–1.30) | |
| HLS declined after diagnosis vs consistently higher HLSDeclined HLSvs Consistently higher HLS | aHR (T2D) 1.75 (95% CI 1.45–2.10) | |
| Joint analysis: HLS 5 vs HLS 0 to 2 without antihypertensive medication, by medication useHLS 5, nonusersvs HLS 0 to 2, no medication | aHR (CVDs) 0.62 (95% CI 0.42–0.93) | |
| Joint analysis: HLS 5 vs HLS 0 to 2 without antihypertensive medication, by medication useHLS 5, usersvs HLS 0 to 2, no medication | aHR (CVDs) 0.63 (95% CI 0.50–0.80) | |
| Joint analysis: HLS 5 vs HLS 0 to 2 without antihypertensive medication, by medication useHLS 5, nonusersvs HLS 0 to 2, no medication | aHR (T2D) 0.32 (95% CI 0.13–0.78) | |
| Joint analysis: HLS 5 vs HLS 0 to 2 without antihypertensive medication, by medication useHLS 5, usersvs HLS 0 to 2, no medication | aHR (T2D) 0.44 (95% CI 0.30–0.67) | |
| 0.10.31310Ratio (log scale) |
Joint analysis: Healthy lifestyle score (HLS) 5 vs HLS 0 to 2 without antihypertensive medication, by medication use
- Higher HLS associated with lower risk of cardiometabolic diseases irrespective of antihypertensive medication use
Original publication
Adherence to Healthy Lifestyle and Risk of Cardiometabolic Diseases in Individuals With Hypertension. JAMA Netw Open. Published 2 March 2026. doi:10.
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