Higher adherence to a healthy lifestyle following a hypertension diagnosis was associated with substantially lower risks of cardiovascular disease and type 2 diabetes over long-term follow-up, according to a study published in JAMA Network Open.
The findings also highlight what editorial authors described as an underused opportunity to improve outcomes through sustained lifestyle change alongside medication therapy.
In the study, patients with the highest postdiagnosis healthy lifestyle scores had a 51% lower risk of cardiovascular disease and a 79% lower risk of type 2 diabetes compared with those with the lowest scores, supporting benefits not fully explained by antihypertensive medication use alone.
Study Design and Population
Researchers led by Zixin Qiu, MBBS, of Harvard T.H. Chan School of Public Health, analyzed data from the Nurses’ Health Study and Health Professionals Follow-Up Study, including 25,820 patients with incident hypertension and no major chronic disease at baseline (mean age, 60.6 years; 73% women).
Lifestyle factors—diet quality, smoking status, physical activity, alcohol intake, and body mass index—were assessed every 2 to 4 years and combined into a 5-point healthy lifestyle score (range, 0 to 5).
Patients were followed for a median of 24 years for incident cardiovascular disease and type 2 diabetes.
Key Findings
During follow-up, researchers documented 3,300 cardiovascular events and 2,529 cases of type 2 diabetes.
Compared with patients in the lowest healthy lifestyle score category (0 or 1), those in the highest category (5) had substantially lower risks of both outcomes. Risk reductions followed a dose-response pattern, with progressively lower risk observed as healthy lifestyle scores increased.
Population-attributable risk estimates suggested that 27% of cardiovascular disease cases and 75% of type 2 diabetes cases might theoretically have been prevented if all patients achieved the highest lifestyle score.
Life expectancy analyses showed an estimated gain of 8.2 years at age 40 among patients with the highest vs lowest scores.
Lifestyle Changes Following Diagnosis
Changes in behavior following diagnosis were also associated with outcomes.
Compared with patients who consistently maintained low scores, those who improved to high scores had lower risks of cardiovascular disease and type 2 diabetes, whereas those whose scores declined had higher risks of both outcomes.
Each one-point increase in healthy lifestyle score following diagnosis was associated with lower cardiometabolic risk.
Medication Use and Consistent Benefits
Higher lifestyle scores were associated with lower risks of both outcomes regardless of antihypertensive medication use, with similar associations observed among medication users and nonusers.
Editorial authors noted that these findings reinforce that lifestyle and pharmacologic therapy provide complementary benefits rather than serving as alternatives.
A Gap Between Evidence and Practice
Despite longstanding recommendations for lifestyle modification as first-line therapy, implementation remains limited.
In the study cohort—composed of health professionals—only a minority of patients achieved high adherence to healthy lifestyle factors, highlighting substantial room for improvement.
More broadly, hypertension control rates have declined in recent years, even as pharmacologic options have expanded, suggesting that lifestyle factors may be underemphasized in clinical care.
Clinical Implications
The findings suggest that a hypertension diagnosis may represent an important window for intervention.
“Hypertension diagnosis presents a critical opportunity to intensify support for diet, physical activity, weight management, and other behavioral interventions,” the editorial authors wrote, noting that these changes can yield benefits independent of medication use.
They also cautioned that increasing reliance on medications could shift attention away from lifestyle modification, even though behavioral risk factors often remain the underlying drivers of hypertension.
Individual Lifestyle Components
Among individual factors, nonsmoking and higher physical activity were independently associated with lower risks of both cardiovascular disease and type 2 diabetes, while higher body mass index was strongly associated with increased diabetes risk.
The combined lifestyle score showed the strongest associations, supporting the importance of adopting multiple healthy behaviors.
Study Limitations
The researchers noted several limitations, including reliance on self-reported lifestyle measures, potential residual confounding, and limited generalizability due to the predominantly White population of health professionals.
Editorial authors also noted that the observational design precludes conclusions about causality.
Takeaway
The findings highlight the substantial potential for preventing cardiometabolic disease among patients with hypertension through sustained lifestyle change.
The results suggest that treatment of hypertension should integrate long-term lifestyle support with pharmacologic therapy, positioning diagnosis as the beginning—not the end—of efforts to improve health behaviors.
Disclosures can be found in the published investigation and commentary.
Source: JAMA Network Open, Invited Commentary
