Healthy Habits Lower Mortality in Hypertensives

In a recent study published in the journal BMC Public Health, researchers looked into the relationship between cardiovascular health (CVH), as defined by Life’s Essential 8 (LE8), and mortality in people with hypertension with respect to healthy habits.

Hypertension affects over 1.13 billion people globally and is the major cause of cardiovascular events/death, considerably contributing to global morbidity and mortality. While significant progress has been made in the development of pharmaceutical therapies, effective hypertension management necessitates a multimodal approach that includes nonpharmacological interventions.

The American Heart Association’s LE7 is a collection of modifiable lifestyle factors that are commonly used in clinical settings. Sleep health was recently added into this project due to its importance in CVH and well-being, resulting in LE8. Evidence reveals a link between CVH, as defined by LE8, and higher quality of life, survival, and longevity. Nonetheless, fewer research have investigated the relationship between LE8 and mortality in persons with hypertension.

About the study

In this study, researchers looked into the links between LE8 and cardiovascular and all-cause mortality in hypertensive people. They analyzed data from five consecutive National Health and Nutrition Examination Survey (NHANES) cycles in the United States (US) between 2007 and 2016. Individuals who were pregnant, under the age of 20, did not have hypertension, or had missing data for LE8 components were eliminated.

Each LE8 component was rated on a scale of 0 to 100, and the average of all eight components was determined. A qualified examiner took blood pressure (BP). Three successive readings were used to estimate the average systolic (SBP) and diastolic blood pressure (DBP). Hypertension was defined as using anti-hypertensive medications, self-reported hypertension, average SBP ≥ 140 mmHg, or DBP ≥ 90 mmHg.

Covariates included age, gender, race/ethnicity, education, poverty income ratio, waist circumference, marital status, smoking status, body mass index (BMI), and a history of cancer, cardiovascular disease (CVD), or diabetes, among other things. The National Death Index provided data on mortality and causes of death. Baseline parameters were divided into three CVH groups (low, moderate, and high).

Each CVH category included age-standardized death estimates and 95% confidence intervals. Multivariable Cox proportional hazards regression models calculated hazard ratios and 95% confidence intervals for cardiovascular and all-cause mortality. The first model was unadjusted; the second was adjusted for sociodemographic and lifestyle factors; and the final model was adjusted for all variables.

Findings

The study included 8,448 people with an average age of 57.5 years, 51.2% of whom were women. The average LE8 score was 60.13. Participants’ baseline clinical and demographic parameters varied significantly among the three CVH groups. High CVH (LE8 score ≥ 80-100) was associated with lower all-cause mortality rates compared to low (score < 49) and moderate CVH (score ≥ 50-79).

During an average of 7.41 years of follow-up, 1,482 fatalities occurred, with 472 due to CVDs. Individuals with a low CVH had the greatest mortality risk. After multivariable analysis, the high and moderate CVH groups showed a reduced mortality risk than the low CVH group. Each 10-point increase in the LE8 score decreased the risk of all-cause mortality by 8%. Participants with high or moderate CVH had a decreased risk of CVD death.

Furthermore, each 10-point increase in the LE8 score reduced the risk of CVD mortality by 18%. A linear dose-response connection was found between CVH scores and all-cause and cardiovascular mortality. Subgroup analyses demonstrated consistent results regardless of age, race, BMI, gender, smoking status, marital status, education, history of CVD, diabetes, or CVDs. Similarly, the results were consistent across multiple sensitivity assessments.

Conclusions

The study found links between LE8 and cardiovascular and all-cause mortality in hypertensive people. Participants with higher LE8 scores had lower mortality rates. Thus, thorough lifestyle changes may assist hypertension individuals. Together, the findings highlight the importance of a healthy lifestyle in improving population health and imply that actions to enhance CVH may have consequences for lowering death rates.

For more information: He L, Zhang M, Zhao Y, Li W, Zhang Y. Association between new Life’s Essential 8 and the risk of all-cause and cardiovascular mortality in patients with hypertension: a cohort study. BMC Public Health, 2024, DOI: 10.1186/s12889-024-19189-z, https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-19189-z