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Lifestyle, family history and progression of hypertension

Winnicki, Mikolaja,b,c; Somers, Virend Kb; Dorigatti, Francescaa; Longo, Danielea; Santonastaso, Massimoa; Mos, Lucioa; Mattarei, Mauroa; Pessina, Achille Ca; Palatini, Paoloaon behalf of the HARVEST Study Group

doi: 10.1097/01.hjh.0000239281.27938.d4
Original papers: Lifestyle
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Background Unhealthy lifestyle practices are risk factors for future hypertension.

Objectives The aim of this study was to investigate the association between lifestyle changes over a 6-year period and the risk of developing sustained hypertension in a cohort of young hypertensive individuals, and to identify the predictors of lifestyle impairment over time.

Methods Seven-hundred and eighty never-treated hypertensive HARVEST participants, 18–45 years old, were studied.

Results Only modest mean behavioral changes were observed during follow-up. This, however, was the net result of many participants improving and others worsening their lifestyle. Participants with a family history of hypertension (FH+, n = 459) had more undesirable lifestyles (P = 0.004) and higher clinic and ambulatory blood pressures (P = 0.03) at baseline than participants without a family history of hypertension (FH−). During the 6-year follow-up, FH− individuals strikingly worsened their lifestyle while FH+ participants exhibited impressive improvements (P < 0.00001). Other predictors of lifestyle impairment were male gender (P = 0.003) and age (P = 0.02). Adoption of an unfavorable lifestyle was accompanied by an increased risk of developing sustained hypertension (P = 0.04). Initiation of drug therapy for hypertension was significantly higher among FH− than FH+ individuals (53 versus 45%, respectively; P = 0.045).

Conclusions ‘Lower risk’ FH− stage 1 hypertensive individuals may initially be at higher risk of developing more severe hypertension in comparison with their FH+ counterparts. This increased risk may be attributed to worsening of their lifestyle profiles over time. Healthy lifestyles should be emphasized to all hypertensive individuals including patients with favorable lifestyle profiles.

aUniversity of Padova, Padova, Italy

bMayo Clinic, Rochester, Minnesota, USA

cMedical University of Gdansk, Gdansk, Poland

Received 11 October, 2005

Revised 6 March, 2006

Accepted 10 March, 2006

Correspondence and requests for reprints to Paolo Palatini, MD, Clinical & Experimental Medicine, University of Padova, Via Giustiniani 2, 35-126 Padova, Italy Tel: +39 49 821 2278; fax: +39 49 875 4179; e-mail: palatini@unipd.it

Sponsorship: M.W. and V.K.S. were supported by NIH grants TW05399, HL-65176, HL-61560, HL-70602, HL-14388 and MOI-RR00585. This study was also supported by Grants from the University of Padova, Italy, Italian Society of Hypertension, and the Associazione ‘18 Maggio 1370’, San Daniele del Friuli, Italy.

© 2006 Lippincott Williams & Wilkins, Inc.