The contributions of unhealthy lifestyle factors to apparent resistant hypertension: findings from the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study
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OBJECTIVES: Unhealthy lifestyle factors may contribute to apparent treatment resistant hypertension (aTRH). We examined associations of unhealthy lifestyle factors with aTRH in individuals taking antihypertensive medications from three or more classes. METHODS: Participants (n = 2602) taking three or more antihypertensive medication classes were identified from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) study. aTRH was defined as having SBP/DBP at least 140/90 mmHg despite the use of three or more antihypertensive medication classes or the use of four or more classes to achieve blood pressure control. Lifestyle factors included obesity, physical inactivity, current smoking, heavy alcohol consumption, a low Dietary Approaches to Stop Hypertension (DASH) diet score and high sodium-to-potassium (Na/K) intake. RESULTS: Among participants taking three or more antihypertensive medication classes, 1293 (49.7%) participants had aTRH. The prevalence of unhealthy lifestyle factors in participants with and without aTRH was 55.2 and 51.7%, respectively, for obesity, 42.2 and 40.5% for physical inactivity, 11.3 and 11.5% for current smoking, 3.1 and 4.0% for heavy alcohol consumption, 23.1 and 21.5% for low-DASH diet score, and 25.4 and 24.4% for high Na/K intake. After adjustment for age, sex, race, and geographic region of residence, none of the unhealthy lifestyle factors were associated with aTRH. The associations between each unhealthy lifestyle factor and aTRH remained nonsignificant after additional adjustment for education, income, depressive symptoms, total calorie intake, and comorbidities. CONCLUSIONS: Unhealthy lifestyle factors did not have independent associations with aTRH among individuals taking three or more antihypertensive medication classes.
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Both reduced physical activity and lower physical fitness are independent risk factors for hypertension.
“Both reduced physical activity and lower physical fitness are independent risk factors for hypertension.166–171”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [166]
A low DASH diet questionnaire score was not independently associated with apparent treatment-resistant hypertension in the REGARDS cohort.
“Nonetheless, as with other lifestyle factors in the REGARDS cohort, a low DASH diet questionnaire score was not independently associated with aTRH.166”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [166]
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- Authors
- Shimbo, D., Levitan, E. B., Booth, J. N., Calhoun, D. A., Judd, S. E., Lackland, D. T., Safford, M. M., Oparil, S., & Muntner, P.
- Affiliations
- Columbia University Irving Medical Center (US)
- University of Alabama at Birmingham (US)
- University of Chicago (US)
- Medical University of South Carolina (US)
- Corresponding author
- Shimbo, Daichi
- ORCID
- Venue
- Journal of Hypertension
- Published
- 2013-02
- Volume
- 31
- Issue
- 2
- Pages
- 370-376
- ISSN
- 0263-6352 (ISSN-L)
- PMC
- PMC3838894
- OpenAlex
- W2007954189
- Cited by
- 60
- References
- 33
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 3 · 2023: 4 · 2022: 5 · 2021: 3 · 2020: 7 · 2019: 4 · 2018: 4 · 2017: 7 · 2016: 3 · 2015: 5 · 2014: 8 · 2013: 1
- FWCI
- 3.85
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL080477)
- National Institute of Neurological Disorders and Stroke (U01NS041588, R01NS041588)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Keywords
- obesity, physical inactivity, smoking, heavy alcohol consumption, DASH diet, Na+/K+ ratio, antihypertensive medication use, blood pressure control, REGARDS study
- MeSH terms
- Aged, Female, Geography, Humans, Hypertension, Life Style, Male, Middle Aged, Health Behavior, Population Groups
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