Abstract
Appropriate interventions might improve the prevention of essential hypertension. This requires a comprehensive view of modifiable lifestyle factors (MLFs) distribution and effect. To determine how six MLFs (general adiposity, abdominal adiposity, alcohol consumption, smoking, diet, physical inactivity) for risk of hypertension are distributed and how their combinations affect the risk, a prospective study cohort of 11,923 healthy participants from the population-based European Prospective Investigation into Cancer and Nutrition (EPIC)–Potsdam Study was used. Of these, 1,635 developed hypertension during a mean follow-up of 10.3 years. Mutually exclusive combinations, clustering and interactions of MLFs were then investigated stratifying by sex, Hazard Ratios (HRs) and Population Attributable Risks (PARs%) were calculated. General adiposity alone was sufficient to increase the risk of hypertension (HR = 1.86, PAR% 3.36), and in this cohort it played a major role in enhancing the risk of hypertension, together with smoking and physical inactivity. MLFs had a different impact and a different modulation of risk in women and men, and they showed a remarkable tendency to occur in specific patterns with higher prevalence than expected. This indication can help to promote a holistic approach through multifactorial preventive strategies addressing more than a factor at a time. For prevention of hypertension addressing adiposity together with smoking, promoting at the same time physical activity should be the first choice.
Highlights
Despite massive improvements achieved in primary and secondary prevention, incidence and prevalence of essential hypertension are still rising worldwide, and further increases are foreseen if no effective counteractions are undertaken1,2
No appreciable difference was noticed in the Dietary Approach to Stop Hypertension” (DASH) score between cases and non-cases in both sexes (Table 1)
General and abdominal adiposity, smoking and physical inactivity appear to play a major role in increasing the risk of incidence of hypertension
Summary
Despite massive improvements achieved in primary and secondary prevention, incidence and prevalence of essential hypertension (hereafter referred to as hypertension) are still rising worldwide, and further increases are foreseen if no effective counteractions are undertaken. Population-based and/or individual interventions could be effective counteractions as they have shown to reduce blood pressure values and hypertension incidence and subsequently the risk of major cardiovascular diseases. The implementation of interventions requires a good understanding of modifiable lifestyle factors (MLFs) within the targeted population. The implementation of interventions requires a good understanding of modifiable lifestyle factors (MLFs) within the targeted population8,9 This should include insights on how the MLFs interact with each other and which MLFs profile could be a target of interventions with the highest potential impact. The largest body of literature analysed MLFs separately, and information about how they are combined in the population and how such combinations impact risk are scarce, as well as information about clusters of association and mutual interactions. This study aimed to provide information about the prevalence and risk association of the MLFs combinations observed in a large adult German cohort, with insights about clustering and interactions of MLFs
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