Healthy Lifestyle After Hypertension Diagnosis Linked to Lower Cardiometabolic Disease Risk

Maintaining or improving a healthy lifestyle after a hypertension diagnosis significantly lowers the risk of developing cardiovascular disease (CVD) and type 2 diabetes (T2D), according to a new study.¹

This prospective, population-based cohort study is published in JAMA Network Open.

“In this prospective cohort study among individuals living with hypertension with over 30 years of follow-up, our findings underscored the substantial opportunity for CVD and T2D prevention through adopting a healthy lifestyle in people with hypertension, with and without the use of antihypertensive medication,” wrote the researchers of the study.

The investigators conducted a prospective cohort study using data from the Nurses’ Health Study (NHS) and the Health Professionals Follow-Up Study (HPFS) between 1986 and 2014, including 25,820 US adults who developed incident hypertension during follow-up. Participants’ lifestyle behaviors were assessed every 2 to 4 years and used to calculate a healthy lifestyle score (HLS) ranging from 0 to 5, based on 5 factors: high-quality diet, nonsmoking status, moderate-to-vigorous physical activity, moderate alcohol consumption, and maintaining a healthy body mass index. Each factor contributed 1 point to the overall score.

The researchers examined how lifestyle adherence before and after hypertension diagnosis was associated with incident CVD and T2D. Participants were followed for CVD outcomes through June 30, 2020, in NHS and June 30, 2016, in HPFS and for T2D through December 31, 2019. Multivariable-adjusted hazard ratios were calculated to estimate associations between time-varying lifestyle scores and cardiometabolic outcomes while accounting for medication use and other covariates.

Over a median (IQR) follow-up of 24 (23-25) years, researchers identified 3300 incident CVD events and 2529 cases of T2D among the participants (mean age [SD], 60.6 [0.1] years; 72.6% women).

Individuals with the highest healthy lifestyle score (HLS=5) had substantially lower risks of cardiometabolic disease compared with those with the lowest scores (0 or 1), with an adjusted hazard ratio (AHR) of 0.49 (95% CI, 0.39-0.61) for CVD and 0.21 (95% CI, 0.14-0.30) for T2D.

Additionally, participants who improved their HLS from 0 to 3 before diagnosis to 4 or 5 afterward had a 12% lower risk of CVD (AHR, 0.88; 95% CI, 0.79-0.98) and a 44% lower risk of T2D (AHR, 0.56; 95% CI, 0.48-0.65) compared with those who consistently maintained lower scores. In contrast, individuals whose lifestyle scores declined following diagnosis experienced higher risks of CVD (AHR, 1.14; 95% CI, 1.00-1.30) and T2D (AHR, 1.75; 95% CI, 1.45-2.10). Higher HLS was associated with reduced cardiometabolic risk regardless of antihypertensive medication use.

Additional evidence supports the protective role of healthy lifestyle behaviors among individuals with hypertension.² One study found that adherence to multiple healthy lifestyle factors—including a balanced diet, regular physical activity, maintaining a healthy body mass index, not smoking, moderate alcohol consumption, and healthy sleep—was associated with a substantially lower risk of incident type 2 diabetes among hypertensive participants. Specifically, those adhering to 5 to 6 healthy lifestyle factors had a multivariable-AHR of 0.14 (95% CI, 0.10-0.19) for developing T2D compared with individuals with no healthy lifestyle factors.

However, the researchers noted several limitations.¹ Lifestyle behaviors were self-reported, introducing potential measurement error. The cohorts consisted primarily of health professionals, which may limit generalizability to more diverse populations. In addition, the binary healthy lifestyle score may not capture the full range of lifestyle behaviors, and residual confounding—such as differences in medication adherence or dietary programs—cannot be fully ruled out.

Despite these limitations, the researchers believe these findings emphasize that lifestyle modification is a critical complement to medication in managing hypertension and preventing cardiometabolic complications.

References

1. Qiu Z, Liu G, Hu Y, et al. Adherence to healthy lifestyle and risk of cardiometabolic diseases in individuals with hypertension. JAMA Netw. 2026;9(3):e260937. doi:10.1001/jamanetworkopen.2026.0937

2. Johnson AM, Brimhall AS, Johnson ET, et al. A systematic review of the effectiveness of patient education through patient portals. JAMIA Open. 2023;6(1):ooac085. doi:10.1093/jamiaopen/ooac085