The purpose of this study was to determine the relationship between dietary and lifestyle factors and the incidence of hypertension. In the second Nurses’ Health Study, 830 882 adult women (27 to 44 years) who did not have hypertension, cardiovascular disease, diabetes or cancer and had normal blood pressure were followed for 14 years for incidence of hypertension. The low risk factors for hypertension included a body mass index (BMI) < 25 kg/m2, a daily mean of 30 min of vigorous exercise, a high score on the Dietary Approaches to Stop Hypertension (DASH) diet questionnaire, modest alcohol intake, use of nonnarcotic analgesics less than one per week and an intake of 400 ug/day or more of supplemental folic acid. Overall, these 6 modifiable risk factors were independently associated with the risk of developing hypertension even after adjusting for age, race, family history of hypertension, smoking status and use of oral contraceptives. In women with the 6 low-risk factors, the hazard ratio (HR) for incident hypertension was 0.22 and the hypothetical PAR was 78% for women who lacked these low-risk factors. BMI was found to be the most powerful predictor of hypertension as women with a BMI > 25 kg/m2 had an adjusted PAR of 40% compared to women with a BMI 25 < kg/m2. Thus, adherence to low-risk dietary and lifestyle factors was associated with a remarkably lower incidence of self-reported hypertension. In an Editorial discussing the paper, Roger VL commented on the significance of the message carried by this study as to the importance of a healthy lifestyle to reduce hypertension and cardiovascular disease. However, she suggested that adherence to a healthy lifestyle is a shared responsibility of individuals and communities and that health policies and clinical care should join forces to achieve effective disease prevention.
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