Healthy Lifestyle Factors and Risk of Cardiovascular Events and Mortality in Treatment-Resistant Hypertension: The Reasons for Geographic and Racial Differences in Stroke Study
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Few data exist on whether healthy lifestyle factors are associated with better prognosis among individuals with apparent treatment-resistant hypertension, a high-risk phenotype of hypertension. The purpose of this study was to assess the association of healthy lifestyle factors with cardiovascular events, all-cause mortality, and cardiovascular mortality among individuals with apparent treatment-resistant hypertension. We studied participants (n=2043) from the population-based Reasons for Geographic and Racial Differences in Stroke (REGARDS) study with apparent treatment-resistant hypertension (blood pressure ≥140/90 mm Hg despite the use of 3 antihypertensive medication classes or the use of ≥4 classes of antihypertensive medication regardless of blood pressure control). Six healthy lifestyle factors adapted from guidelines for the management of hypertension (normal waist circumference, physical activity ≥4 times/week, nonsmoking, moderate alcohol consumption, high Dietary Approaches to Stop Hypertension diet score, and low sodium-to-potassium intake ratio) were examined. A greater number of healthy lifestyle factors were associated with lower risk for cardiovascular events (n=360) during a mean follow-up of 4.5 years. Multivariable-adjusted hazard ratios [HR (95% confidence interval)] for cardiovascular events comparing individuals with 2, 3, and 4 to 6 versus 0 to 1 healthy lifestyle factors were 0.91 (0.68–1.21), 0.80 (0.57–1.14), and 0.63 (0.41–0.95), respectively ( P -trend=0.020). Physical activity and nonsmoking were individual healthy lifestyle factors significantly associated with lower risk for cardiovascular events. Similar associations were observed between healthy lifestyle factors and risk for all-cause and cardiovascular mortality. In conclusion, healthy lifestyle factors, particularly physical activity and nonsmoking, are associated with a lower risk for cardiovascular events and mortality among individuals with apparent treatment-resistant hypertension.
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Among treated adults with hypertension, prevalent apparent treatment-resistant hypertension occurs in approximately 12% to 15% of population-based samples.
“Among treated adults with hypertension, prevalent aTRH occurs in ≈12% to 15% of population-based13–16 and 15% to 18% of clinic-based reports.17–20”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [15]
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Research works printed but not linked: 1
- [23]Parikh A1 Lipsitz SR Natarajan S Critchley JA Capewell S Association between a DASH-like diet and mortality in adults with hypertension: findings from a population-based follow-up study Am J Hypertens 2009 22 409 416 19197247
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- Authors
- Diaz, K. M., Booth, J. N., Calhoun, D. A., Irvin, M. R., Howard, G., Safford, M. M., Muntner, P., & Shimbo, D.
- Affiliations
- Columbia University Irving Medical Center (US)
- ORCID
- Venue
- Hypertension
- Published
- 2014-09
- Volume
- 64
- Issue
- 3
- Pages
- 465-471
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- PMC
- PMC4134352
- OpenAlex
- W2167336472
- Cited by
- 72
- References
- 42
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 4 · 2023: 9 · 2022: 8 · 2021: 2 · 2020: 9 · 2019: 9 · 2018: 5 · 2017: 4 · 2016: 5 · 2015: 9 · 2014: 1
- FWCI
- 4.35
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Public Health Service (K23SK082793)
- National Institute on Aging (AG023629, K01AG039387)
- National Heart, Lung, and Blood Institute (R01HL080477, P01HL047540, HL080295)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK079626)
- National Institute of Neurological Disorders and Stroke (U01NS041588)
- National Institute on Minority Health and Health Disparities (P20MD006899)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- treatment-resistant hypertension, healthy lifestyle factors, cardiovascular events, cardiovascular mortality, all-cause mortality, physical activity, waist circumference, alcohol consumption, DASH diet, Na+/K+ ratio, REGARDS study
- MeSH terms
- Aged, Antihypertensive Agents, Blood Pressure, Cardiovascular Diseases, Demography, Drug Resistance, Female, Follow-Up Studies, Humans, Hypertension, Life Style, Male, Motor Activity, Phenotype, Prognosis, Risk Factors, Survival Rate, Smoking Cessation, Stroke, Racial Groups
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