title: Ideal cardiovascular health behaviors and factors prevent the development of hypertension in prehypertensive subjects.
abstract: BACKGROUND
  Seven ideal health metrics were defined by AHA to monitor cardiovascular health. This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects.
  
  
  METHODS
  Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke, myocardial infarction or malignancy. Cox proportional hazards regression was used to calculate hazard ratios and 95% confidence intervals [CI] for the development of hypertension.
  
  
  RESULTS
  During a follow-up of 52.2 months, 15,500 prehypertensive participants developed hypertension. The cumulative incidence of hypertension decreased with the number of ideal health metrics increased. It was 78.61%, 71.08%, 63.15%, 56.07% and 61.62% in prehypertensive individuals carrying ≤ 1, 2, 3, 4 and ≥ 5 ideal health behaviors or factors, respectively. After adjustment for age, gender, family history of hypertension, alcohol consumption, resting heart rate, plasma triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and high-sensitivity C-reactive protein, the risk ratios of incident hypertension in the subjects who carried 2, 3, 4, and ≥ 5 ideal health metrics were 0.833 (95%CI: 0.789-0.880), 0.710 (95%CI: 0.672-0.749), 0.604 (95%CI: 0.568-0.642), and 0.581 (95%CI: 0.524-0.643), respectively, in comparison to those with ≤ 1 ideal health metric. A similar trend was also observed in male and female populations. Poor health metrics, including body mass index, diet (salt intake), physical activity, total cholesterol, and smoking, were predictors for the development of hypertension in prehypertensive individuals.
  
  
  CONCLUSIONS
  Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension.
authors.affiliation: a Department of Cardiology , Kailuan Hospital, Hebei United University , Tangshan , China .
authors.forename: Jingsheng
authors.initials: J
authors.lastname: Gao
authors.affiliation: b Department of Cardiology , Jinan Central Hospital Affiliated to Shandong University , Jinan , Shandong Province , China .
authors.forename: Hui
authors.initials: H
authors.lastname: Sun
authors.affiliation: a Department of Cardiology , Kailuan Hospital, Hebei United University , Tangshan , China .
authors.forename: Xin
authors.initials: X
authors.lastname: Liang
authors.affiliation: a Department of Cardiology , Kailuan Hospital, Hebei United University , Tangshan , China .
authors.forename: Ming
authors.initials: M
authors.lastname: Gao
authors.affiliation: a Department of Cardiology , Kailuan Hospital, Hebei United University , Tangshan , China .
authors.forename: Hongtao
authors.initials: H
authors.lastname: Zhao
authors.affiliation: a Department of Cardiology , Kailuan Hospital, Hebei United University , Tangshan , China .
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Qi
authors.affiliation: a Department of Cardiology , Kailuan Hospital, Hebei United University , Tangshan , China .
authors.forename: Yanxiu
authors.initials: Y
authors.lastname: Wang
authors.affiliation: a Department of Cardiology , Kailuan Hospital, Hebei United University , Tangshan , China .
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.affiliation: a Department of Cardiology , Kailuan Hospital, Hebei United University , Tangshan , China .
authors.forename: Jinfeng
authors.initials: J
authors.lastname: Li
authors.affiliation: a Department of Cardiology , Kailuan Hospital, Hebei United University , Tangshan , China .
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: c Department of Geriatric Cardiology , Provincial Hospital Affiliated to Shandong University , Jinan , Shandong Province , China , and.
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: d Department of Evidence-Based Medicine , Cardiovascular Institute and Fuwai Hospital , Beijing , China.
authors.forename: Wen
authors.initials: W
authors.lastname: Wang
authors.affiliation: d Department of Evidence-Based Medicine , Cardiovascular Institute and Fuwai Hospital , Beijing , China.
authors.forename: Liyuan
authors.initials: L
authors.lastname: Ma
authors.affiliation: a Department of Cardiology , Kailuan Hospital, Hebei United University , Tangshan , China .
authors.forename: Shouling
authors.initials: S
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002319:Cardiovascular System / Q000503:physiopathology*; D002681:China / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D015438:Health Behavior; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058246:Prehypertension / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D055815:Young Adult
keywords: Cardiovascular health; gender; hypertension; ideal health metrics; prehypertension