Abstract
Background: The 7th Joint National Committee (JNC7) recommends lifestyle behavior modification as an essential strategy in the management of hypertension. Purpose: To identify gender-specific profiles among multiple JNC7-recommended lifestyle behaviors in a nationally-representative sample of adults on antihypertensive medications. Methods: We used data from the 2009 CDC Behavioral Risk Factors Surveillance Study on adults (age ≥18years) taking antihypertensive medications. Latent class mixture modeling (with sampling weights) was applied to identify common profiles among ordered categories of physical activity, fruit/vegetable consumption, alcohol consumption, body mass index, and smoking in models stratified by gender. Lo-Mendell-Rubin tests were used to compare model solutions (k vs. k-1 profiles). Within-profile gender differences were quantified using χ2 tests. Results are reported in weighted means or proportions ± standard errors. Results: Mean age (population estimate=45,703,441) was 61.1±0.1 years; 51% of the sample was female. Lifestyle behaviors fit best into three profiles for both women and men (both P<0.05). Hallmarks of profile 1 (35.9% of women, 37.3% of men) were high prevalence of physical activity, low prevalence of obesity, and frequent fruit/vegetable consumption. Hallmarks of profile 2 (52.2% of women, 52.5% of men) were very high prevalence of insufficient physical activity, very high prevalence of obesity, and moderate-to-low fruit/vegetable consumption. Hallmark of profile 3 (11.9% of women, 11.1% of men) were current smoking, high prevalence of insufficient/no physical activity, high prevalence of obesity, poor fruit/vegetable consumption, and the highest prevalence of alcohol consumption. Within each profile, there were significant differences in each lifestyle behavior comparing women with men (all P<1x10-7). Conclusions: We observed three distinct profiles that characterize a gradient of cardiovascular risk based on multiple modifiable lifestyle behaviors in hypertension that are different in women and men. Personalized and gender-specific interventions that focus on multiple lifestyle behaviors are needed to reduce cardiovascular risk in the treated hypertensive U.S. population.
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