Adherence to Healthy Lifestyle and Risk of Cardiometabolic Diseases in Individuals With Hypertension.

Higher healthy lifestyle scores were associated with substantially lower risk of total CVDs among individuals with hypertension.

• The adjusted hazard ratio (AHR) for total CVDs when comparing the highest HLS category (5) with the lowest (0 or 1) was 0.49 (95% CI, 0.39-0.61).
• A total of 25,820 individuals were included with a median follow-up of 24 years (IQR, 23-25 years).
• 3,300 incident CVD cases were identified during follow-up.
• Analyses were adjusted for medication use and other relevant covariates.
• The healthy lifestyle score (HLS) ranged from 0 (least healthy) to 5 (most healthy), based on diet quality, smoking status, physical activity, alcohol consumption, and BMI.

Higher healthy lifestyle scores were associated with markedly lower risk of type 2 diabetes among individuals with hypertension.

• The AHR for T2D when comparing the highest HLS category (5) with the lowest (0 or 1) was 0.21 (95% CI, 0.14-0.30).
• 2,529 incident T2D cases were identified during follow-up.
• The median HLS at hypertension diagnosis was 3 (IQR, 2-4).
• Follow-up for incident T2D ended December 31, 2019, in both cohorts.
• The association represented a roughly 79% lower risk for those with the highest versus lowest lifestyle scores.

Improving lifestyle from lower to higher scores after hypertension diagnosis was associated with reduced risk of both CVDs and T2D.

• Participants who improved from lower HLS (0-3) to higher (4 or 5) after hypertension diagnosis had an AHR of 0.88 (95% CI, 0.79-0.98) for CVDs compared with those who consistently had lower HLS.
• The corresponding AHR for T2D among those who improved their HLS was 0.56 (95% CI, 0.48-0.65).
• These findings suggest that lifestyle improvement after diagnosis confers meaningful risk reduction.

Declining lifestyle scores after hypertension diagnosis was associated with increased risk of both CVDs and T2D.

• Those whose HLS declined after diagnosis had an AHR of 1.14 (95% CI, 1.00-1.30) for CVDs compared with those who consistently maintained a higher HLS.
• The AHR for T2D among those with declining HLS was 1.75 (95% CI, 1.45-2.10) compared with consistent higher HLS maintainers.
• The effect of lifestyle decline was particularly pronounced for T2D risk.

The protective association of higher healthy lifestyle scores with cardiometabolic disease risk was independent of antihypertensive medication use.

• Among nonusers of antihypertensive medication, those with an HLS of 5 versus 0-2 had an AHR of 0.62 (95% CI, 0.42-0.93) for CVDs.
• Among users of antihypertensive medication, those with an HLS of 5 versus 0-2 had an AHR of 0.63 (95% CI, 0.50-0.80) for CVDs.
• For T2D, the AHR was 0.32 (95% CI, 0.13-0.78) among nonusers and 0.44 (95% CI, 0.30-0.67) among users of antihypertensive medication, both compared with participants with HLS 0-2 and no medication use.
• Higher HLS was associated with lower risk of cardiometabolic diseases irrespective of antihypertensive medication use.

The study population consisted of participants from two large US prospective cohorts who developed incident hypertension during follow-up.

• 25,820 individuals were included with a mean (SD) age of 60.6 (0.1) years; 18,742 were female (72.6%).
• Data came from the Nurses' Health Study (1986-2014) and Health Professionals Follow-Up Study (1986-2014).
• Lifestyle factors were reassessed every 2 to 4 years using a time-varying approach.
• Follow-up for incident CVDs continued through June 30, 2020, in NHS or June 30, 2016, in HPFS.
• Data were analyzed from November 2024 to April 2025.