Joint association of polysocial risk score and lifestyle with incident essential hypertension: a prospective cohort study in the UK biobank

TL;DR

This study finds that both social vulnerability and unhealthy lifestyles increase the risk of developing essential hypertension, with the highest risk for those facing both.

Contribution

The study introduces a novel analysis of the joint and synergistic effects of social vulnerability and lifestyle on hypertension risk.

Findings

High polysocial risk scores (PsRS) are linked to a 15% increased risk of essential hypertension.

Unfavorable lifestyle scores are associated with a 23% reduced risk of hypertension compared to the worst lifestyle.

The combination of high PsRS and poor lifestyle leads to a 47% higher risk of hypertension due to synergistic effects.

Abstract

The polysocial risk score (PsRS) estimates cumulative social vulnerability. While social factors and lifestyles are linked to essential hypertension (EH), their combined effects are unclear. This study aims to explore the independent and joint associations of social vulnerability and lifestyle with EH in the UK Biobank Study.

The study included 131,154 UK Biobank participants without EH at baseline. PsRS was calculated from 14 social determinants across three risk categories: socio-economic, psychological, and environmental factors, all significantly linked to EH development after Bonferroni adjustment. The healthy lifestyle score was based on smoking, alcohol, physical activity, diet, and sleep. The Cox proportional hazards model with HR and 95% CI analyzed PsRS and lifestyle effects on EH incidence, and interactions between PsRS and lifestyle score were assessed additively and multiplicatively.

Over an average follow-up of 13.5 years, 19,281 participants (14.7%) developed EH. After adjusting for confounders, participants with intermediate (5,–7) and high (≥ 8) PsRS exhibited increased EH risks with HRs of 1.06 (95% CI: 1.02–1.10) and 1.15 (95% CI: 1.11–1.20), respectively, compared to those with low PsRS (≤ 4). In the fully adjusted model, every one-point increase in PsRS was associated with a 7.0% higher risk of EH (HR = 1.07, 95% CI: 5.0–9.0, P for trend < 0.001). Intermediate (2–3) and favorable (4–5) lifestyle scores were associated with lower EH risks, with HRs of 0.86 (95% CI: 0.82–0.90) and 0.77 (95% CI: 0.73–0.81), respectively, compared to an unfavorable lifestyle score (0–1). Each one-point decrement in lifestyle score was corresponded to a 14% reduced in EH risk (HR = 0.86, 95% CI: 0.84–0.89, P for trend < 0.001). Joint effects analysis revealed significant synergistic interactions with individuals possessing both high PsRS and unfavorable lifestyles experienced the greatest risk (HR = 1.47,95% CI: 1.37–1.58). Additive interaction metrics confirmed this synergy, indicating 66% of EH risk in this subgroup stemmed from PsRS-lifestyle interaction. Multiplicative interactions were likewise significant (Pinteraction<0.001).

An unhealthy lifestyle may exacerbate the impact of social vulnerability on EH risk. Modifying both social vulnerability and lifestyle factors could reduce EH incidence.

The online version contains supplementary material available at 10.1186/s12872-025-04930-2.

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