Healthy lifestyle, medication adherence tied to lower mortality in hypertension

The combination of healthy lifestyle and adherence to antihypertensive medications was associated with decreased risk for mortality in patients with hypertension, according to data in JAMA Network Open.

“No study has examined the joint association of antihypertensive medication use and healthy lifestyle with mortality among individuals with hypertension, to our knowledge. In addition, whether improvement in lifestyle may yield health benefits for individuals with hypertension is unclear,” Qi Lu, MBBS, of the department of nutrition and food hygiene at the Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health (Incubating) at Tongji Medical College, Huazhong University of Science and Technology in Wuhan, China, and colleagues wrote. “To fill these knowledge gaps, we aimed to prospectively examine the association of antihypertensive medication use and healthy lifestyle, as well as changes in lifestyle, with risk of all-cause and cause-specific mortality among middle-aged and elderly adults with hypertension in China.”

Utilizing data from the Dongfeng-Tongji prospective cohort of employees at the Dongfeng Motor Corporation in China, researchers evaluated lifestyle factors, including BMI, smoking status, diet, physical activity and sleep duration. Lifestyle factors were scored on a scale of 0 to 2, with a higher score indicating a healthier lifestyle. Each participant’s total score of all five lifestyle factors was categorized as unfavorable (scores 0 to 4), intermediate (scores 5 to 7) and favorable (scores 8 to 10). Antihypertensive medication use was defined as use within the prior 2 weeks.

Lifestyle, antihypertensive use and mortality risk

The cohort included 14,392 participants with hypertension (mean age, 66 years; 51{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} men).

Researchers observed that individuals who took antihypertensive medications and were categorized with a favorable lifestyle had the lower risk for all-cause mortality (HR = 0.32; 95{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} CI, 0.25-0.42), CVD mortality (HR = 0.33; 95{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} CI, 0.21-0.53) and cancer mortality (HR = 0.3; 95{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} CI, 0.19-0.47) compared with those who were not using antihypertensives nor following an unfavorable lifestyle.

“The association was independent of traditional risk factors, including hypertension duration, common comorbidities, use of hypoglycemic and lipid-lowering medication, metabolic biomarkers and mental stress,” the researchers wrote.

In addition, participants who did not take antihypertensive medication treatment but adopted a favorable lifestyle experienced lower risk for all-cause mortality (HR = 0.34; 95{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} CI, 0.25-0.46), CVD mortality (HR = 0.4; 95{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} CI, 0.24-0.67) and cancer mortality (HR = 0.33; 95{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} CI, 0.19-0.55), compared with those who did not take medication and had an unfavorable lifestyle. However, participants who were taking antihypertensive medication but following an unfavorable lifestyle experienced no reduction in CVD mortality (HR = 0.71; 95{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} CI, 0.43-1.17) or cancer mortality (HR = 0.64; 95{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} CI, 0.38-1.07) compared with those who did not take medication and had an unfavorable lifestyle, but the medication/unfavorable lifestyle group did have reduced risk for all-cause mortality compared with the no medication/unfavorable lifestyle group (HR = 0.7; 95{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} CI, 0.52-0.94), according to the study.

Improving risk by improving lifestyle score

Researchers observed that for every 1-point increase in lifestyle score in participants not taking antihypertensive medication, risk for all-cause mortality decreased 17{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d}, risk for CVD mortality decreased 15{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} and risk for cancer mortality decreased 18{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d}. Among those who were taking antihypertensive medications, every 1-point increase in lifestyle score was associated with a 14{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} lower risk for all-cause mortality, 14{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} lower risk for CVD mortality and 13{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} lower risk for cancer mortality.

According to the study, there was no significant interaction between antihypertensive medication use and lifestyle score.

“Individuals using antihypertensive medication and following a favorable lifestyle had the lowest risk of all-cause, CVD, and cancer mortality,” the researchers wrote. “There were inverse linear associations between lifestyle score and mortality, regardless of hypertensive medication use. Additionally, for participants with an unfavorable lifestyle, there was no significant reduction in mortality risk even if they were using antihypertensive medication. Furthermore, we found that improvement in lifestyle after hypertension diagnosis was associated with significantly lower risk of subsequent death. From a public health perspective, BP management and complication prevention have great health and socioeconomic benefits, considering that the annual cost of hypertension has reached tens of billions of dollars per country.”