title: Healthy lifestyle factors and risk of cardiovascular events and mortality in treatment-resistant hypertension: the Reasons for Geographic and Racial Differences in Stroke study.
abstract: 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.
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., D.S.); and Departments of Epidemiology (J.N.B., M.R.I., P.M.), Biostatistics (G.H.), and Medicine (D.A.C., M.M.S.), University of Alabama at Birmingham. kd2442@columbia.edu.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Diaz
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., D.S.); and Departments of Epidemiology (J.N.B., M.R.I., P.M.), Biostatistics (G.H.), and Medicine (D.A.C., M.M.S.), University of Alabama at Birmingham.
authors.forename: John N
authors.initials: JN
authors.lastname: Booth
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., D.S.); and Departments of Epidemiology (J.N.B., M.R.I., P.M.), Biostatistics (G.H.), and Medicine (D.A.C., M.M.S.), University of Alabama at Birmingham.
authors.forename: David A
authors.initials: DA
authors.lastname: Calhoun
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., D.S.); and Departments of Epidemiology (J.N.B., M.R.I., P.M.), Biostatistics (G.H.), and Medicine (D.A.C., M.M.S.), University of Alabama at Birmingham.
authors.forename: Marguerite R
authors.initials: MR
authors.lastname: Irvin
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., D.S.); and Departments of Epidemiology (J.N.B., M.R.I., P.M.), Biostatistics (G.H.), and Medicine (D.A.C., M.M.S.), University of Alabama at Birmingham.
authors.forename: George
authors.initials: G
authors.lastname: Howard
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., D.S.); and Departments of Epidemiology (J.N.B., M.R.I., P.M.), Biostatistics (G.H.), and Medicine (D.A.C., M.M.S.), University of Alabama at Birmingham.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., D.S.); and Departments of Epidemiology (J.N.B., M.R.I., P.M.), Biostatistics (G.H.), and Medicine (D.A.C., M.M.S.), University of Alabama at Birmingham.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., D.S.); and Departments of Epidemiology (J.N.B., M.R.I., P.M.), Biostatistics (G.H.), and Medicine (D.A.C., M.M.S.), University of Alabama at Birmingham.
authors.forename: Daichi
authors.initials: D
authors.lastname: Shimbo
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D003710:Demography; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008019:Life Style; D008297:Male; D009043:Motor Activity; D010641:Phenotype; D011379:Prognosis; D044469:Racial Groups; D012307:Risk Factors; D016540:Smoking Cessation; D020521:Stroke / Q000175:diagnosis / Q000208:ethnology; D015996:Survival Rate
chemical_list: D000959:Antihypertensive Agents
keywords: diet; hypertension; lifestyle; smoking