According to the World Health Organization, hypertension is the leading cause of mortality in the world, contributing annually to over 7 million deaths (about 15% of all deaths). Therefore, prevention of hypertension is essential to improving health and preventing morbidity and mortality, both in developing and developed countries.
The purpose of this study was to examine whether five major cardiovascular disease related lifestyle factors – smoking, alcohol consumption, physical activity, obesity and consumption of vegetables – predict the future increase of blood pressure and development of clinical hypertension, and need for antihypertensive drug treatment.
This large prospective population-based cohort study included 9,637 Finnish men and 11,430 women who were 25 to 74 years of age and free of hypertension during the baseline measurements (1982-2002). Healthy lifestyle factors were defined as: (1) not smoking, (2) alcohol consumption less than 50g per week, (3) leisure time physical activity at least 3 times per week, (4) daily consumption of vegetables, and (5) normal weight (BMI<25kg/m2).
Data on the development of hypertension during the follow-up period were obtained from the Social Insurance Institution of Finland register of people entitled to special reimbursement for antihypertensive drugs. During a mean follow-up of 16 years, 709 men and 890 women developed hypertension.
Smoking was omitted from the final analysis. Professor Jousilahti said: “Even though smoking is a major risk factor for cardiovascular disease, it was not associated with the development of hypertension in our analyses, which is in accordance with previous studies.”
The four remaining healthy lifestyle factors were included in the analysis. Hazard ratios for hypertension associated with adherence to 0 (the reference group), 1, 2, 3, and 4 healthy lifestyle factors were calculated after adjusting for age, year of entering the study, education, and smoking.
The hazard ratios for hypertension associated with adherence to 0, 1, 2, 3, and 4 healthy lifestyle factors were 1.00, 0.74, 0.51, 0.34, and 0.33 for men, and 1.00, 0.89, 0.68, 0.41, and 0.37 for women. “The risk of hypertension was only one third among those having all four healthy lifestyle factors compared to those having none,” said Professor Jousilahti. “Even having one to three healthy lifestyle factors reduced the risk of hypertension remarkably. For example having two healthy lifestyle factors reduced the risk of hypertension by nearly 50% in men and by more than 30% in women.”
”Our analysis suggests that adherence to healthy lifestyle factors may have more of an impact on risk of hypertension in men than women,” he added. “This could be because of the stronger association of obesity and alcohol consumption with the risk of hypertension in men than in women.”
“Four modifiable lifestyle factors: alcohol consumption, physical activity, consumption of vegetables and keeping normal weight have a remarkable effect on the development of hypertension,” said Professor Jousilahti. “Lifestyle modification has a huge public health potential to prevent hypertension. While our research suggests that lifestyle modification may produce greater reductions in hypertension in men than women, it also shows large benefits in women, and adherence to all four healthy lifestyle factors had a nearly similar effect in both sexes. Both men and women should take steps towards a healthier lifestyle to decrease their risk of hypertension.”
He concluded: “Our study was focused on prevention of hypertension and therefore included subjects who did not have hypertension at baseline. But the results should apply to the treatment of patients with hypertension, who can reduce their blood pressure by modifying the four lifestyle factors alone, or by making these modifications while taking blood pressure lowering medication.”
Dr Yujie Wang1; Professor Gang Hu1; Professor Jaakko Tuomilehto2; Professor Riitta Antikainen2; Professor Pekka Jousilahti2
1Pennington Biomedical Research Centre, Batton Rouge, USA
2National Institute for Health and Welfare (THL), Helsinki, Finland