Combination of Healthy Lifestyle Factors on the Risk of Hypertension in a Large Cohort of French Adults.

BACKGROUND

Healthy lifestyle factors are widely recommended for hypertension prevention and control. Nevertheless, little is known about their combined impact on hypertension, in the general population. Our aim was to compute a Healthy Lifestyle Index (HLI) comprising the main non-pharmacological measures usually recommended to improve hypertension prevention: normal weight, regular physical activity, limited alcohol consumption, adoption of a healthy diet; to evaluate their combined impact on hypertension incidence.

METHODS

We prospectively followed the incidence of hypertension among 80,426 French adults participating in the NutriNet-Santé cohort study. Self-reported dietary, socio-demographic, lifestyle and health data were assessed at baseline and yearly using a dedicated website; the association between HLI and hypertension risk was assessed by multivariable Cox proportional hazards models adjusted for age, sex, family history of hypertension, socio-demographic and lifestyle factors. Hypothetical Population Attributable Risks associated to each factor were estimated.

RESULTS

During a median follow-up of 3.5 years (IQR: 1.5-5.3), 2413 incident cases of hypertension were identified. Compared with no or one healthy lifestyle factor, the hazard ratios (HR) for hypertension were 0.76 (95% CI, 0.67-0.85) for two factors, 0.47 (95% CI, 0.42-0.53) for three factors and 0.35 (95% CI, 0.30-0.41) for all healthy lifestyle factors (-trend <0.0001). Compared with adhering to 0, 1, 2 or 3 healthy lifestyles, adhering to all of them was found associated with a reduction of the hypertension risk of half (HR = 0.55 (95% CI, 0.46-0.65)).

CONCLUSION

Active promotion of healthy lifestyle factors at population level is a key leverage to fight the hypertension epidemic.