# The associations between healthy lifestyle scores, their long-term changes, and incident hypertension risk in adults: a prospective cohort study

## TL;DR

This study shows that maintaining a healthy lifestyle over time significantly lowers the risk of developing hypertension in adults in China.

## Contribution

The study provides new evidence on the long-term associations between healthy lifestyle scores and hypertension risk in a Chinese population.

## Key findings

- Higher healthy lifestyle scores were linked to a 14% reduced risk of hypertension.
- Maintaining a high healthy lifestyle score over time was associated with a significantly lower hypertension risk.
- Quantile regression confirmed a negative relationship between lifestyle scores and blood pressure levels.

## Abstract

Several modifiable healthy lifestyle factors have been demonstrated to exert an effect of blood pressure lowering. However, there remains limited evidence regarding the association between healthy lifestyle scores (HLS) and hypertension, particularly within the Chinese population. The present prospective cohort study was designed to systematically investigate the relationships between HLS, their long-term dynamic changes, and the incident risk of hypertension.

A total of 3,743 participants aged ≥18 years who were free of hypertension at baseline were included in the study and followed up prospectively. The HLS was calculated based on the number of healthy lifestyle factors. The Cox proportional hazards regression model was employed to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs) for evaluating the associations between HLS, their long-term changes, and the risk of incident hypertension. In addition, a quantile regression (QR) approach was applied to assess the associations of HLS with blood pressure levels.

During a median follow-up period of 6.46 years, 857 cases of hypertension were identified. The HLS was significantly associated with a reduced risk of hypertension, with a 14% risk reduction observed (HR: 0.86, 95% CI: 0.80–0.92). Compared with the low HLS group (0–3), the HRs (95% CIs) for incident hypertension were 0.80 (95% CI: 0.66–0.97), 0.78 (95% CI: 0.64–0.95), and 0.61 (95% CI: 0.49–0.75) for the HLS groups with 4, 5, and ≥6, respectively (P for trend <0.001). In comparison with participants maintaining a HLS of 0–3, those maintaining a HLS of 4 (HR: 0.60, 95% CI: 0.43–0.85), 5 (HR: 0.47, 95% CI: 0.32–0.69), and ≥6 (HR: 0.34, 95% CI: 0.23–0.51) exhibited a significantly lower risk of incident hypertension (P for trend <0.001). QR showed a significant negative association between HLS and blood pressure levels.

As the HLS increased, the risk of hypertension showed a gradual downward trend. Furthermore, long-term maintenance of a high HLS was associated with a reduced risk of hypertension. Our findings provide additional evidence from China supporting the necessity of sustaining healthy lifestyles across the life course.