A national U.S. analysis shows that weight, sleep, smoking, and exercise habits may matter more for hypertension than overall diet score alone, with sodium still standing out as an important dietary factor.
Study: Association Between Life’s Essential 8 Lifestyle Behaviors and Hypertension: A Cross-Sectional Analysis of NHANES Data. Image Credit: NMK-Studio / Shutterstock
In a recent study published in the Journal of Cardiovascular Nursing, researchers investigated associations between five lifestyle behaviors from the Life’s Essential 8 (LE8) framework and hypertension.
The cross-sectional study analyzed National Health and Nutrition Examination Survey (NHANES) data from 20,912 adults to examine the association between recommended lifestyle behaviors and hypertension.
Results indicated a high prevalence of hypertension (52.7%) and identified significant independent associations between hypertension and modifiable health behaviors. Adherence to healthier LE8 behaviors was associated with lower odds of hypertension, although causality and cardiovascular outcomes were not directly assessed.
Background
Hypertension, commonly referred to as high blood pressure, is a chronic condition characterized by persistently elevated force of blood against arterial walls. Often described as a “silent killer” due to its lack of overt symptoms, it is strongly associated with cardiovascular disease and increased mortality risk.
Although pharmacological treatments are widely used, growing evidence, including recommendations from the International Society of Hypertension, supports lifestyle modification as a first-line management strategy.
The American Heart Association (AHA) recently expanded its cardiovascular health framework from the Simple 7 to LE8, incorporating sleep health. However, few studies have evaluated the independent effects of these lifestyle domains using nationally representative data.
About the study
This study used a multistage probability sampling design across four NHANES cycles, including 20,912 non-pregnant adults aged 18 years or older, to examine associations between lifestyle behaviors and hypertension prevalence.
Hypertension was defined as systolic blood pressure (SBP) ≥130 mm Hg, diastolic blood pressure (DBP) ≥80 mm Hg, self-reported diagnosis, or use of antihypertensive medication.
Predictors were categorized according to LE8 recommendations and included body mass index (BMI), sleep duration, physical activity (PA), smoking status, and diet quality assessed using the Healthy Eating Index-2015 (HEI-2015).
Weighted multivariable logistic regression models were used, adjusting for sociodemographic and potential confounding factors.
Study findings
Overall, 52.7% of participants had hypertension. Prevalence was higher in males (55.5%) than in females (50.0%) and was higher among non-Hispanic Black participants than among participants in other racial groups.
Four of the five LE8 behaviors were independently associated with higher odds of hypertension. Overweight individuals had 1.65 times higher odds, and those with obesity had 3.07 times higher odds compared with normal-weight individuals.
Participants not meeting the AHA physical activity guidelines had 32% higher odds of hypertension. Both current and former smokers also had increased odds compared with never smokers.
Sleep duration showed a U-shaped association, with both short and long sleep associated with higher odds of hypertension. This association was significant only in females, although further research is needed to confirm this finding.
Overall, associations were consistent across subgroups, although smoking was not significantly associated with hypertension among Hispanic participants.
Diet quality, as measured by HEI-2015, was not significantly associated with hypertension. However, lower sodium intake was independently associated with reduced odds.
Conclusions
The findings support the importance of modifiable lifestyle factors in hypertension prevention and management. The lack of association with overall diet quality, contrasted with the sodium findings, suggests that specific nutrients may have more direct effects on blood pressure than composite dietary scores.
These results may help inform multifaceted, culturally responsive interventions targeting high-impact behaviors such as weight management and sleep hygiene. However, limitations include the cross-sectional design, reliance on self-reported data, and potential residual confounding.