Data Sheet 1_Healthy lifestyle and its change attenuated the risk of hypertension among rural population: evidence from a prospective cohort study.docx

ObjectivesLifestyle may potentially influence blood pressure level, but the association of multiple healthy lifestyles with hypertension was limited, especially for rural population. The study aimed to explore the relationship of healthy lifestyles on hypertension, and then whether lifestyle change could influence hypertension in rural adults.
MethodsA total of 16,454 participants were enrolled from the Henan Rural Cohort study, in China. The healthy lifestyles score (HLS) was concluded by smoking status, alcohol consumption, physical activity, diet status and body mass index. Associations of HLS and lifestyle change with systolic blood pressure (SBP) and diastolic blood pressure (DBP) were analyzed by generalized linear models, and with hypertension were analyzed by logistic regression model and restricted cubic spline plots.
ResultsThe results from the generalized linear models showed SBP and DBP levels decreased with the HLS increasing (Ptrend < 0.01). Compared with participants with lower HLS (scored 0–2), the odds ratios (OR) and 95% confidence intervals (CIs) for hypertension in those with HLS = 3, 4, or 5 were 0.853 (0.737, 0.987), 0.881 (0.754, 1.029), and 0.658 (0.519, 0.834), respectively. And compared with participants with unhealthy lifestyle consistently, those changing lifestyle from unhealthy to healthy had lower levels of blood pressure [β (95% CI): SBP: −1.603 (−2.539, −0.668). DBP: −1.713 (−2.326, −1.100)] and hypertension risk [OR (95%CI): 0.744 (0.594, 0.931)]. Similar results could be found by the sensitivity analysis.
ConclusionThe findings showed that healthy lifestyles could reduce blood pressure and hypertension risk, and that implementing healthier lifestyle changes could be an effective strategy to prevent hypertension in rural area.

**研究目的**：生活方式或可对血压水平产生影响，但现有研究关于多种健康生活方式与高血压的关联探讨仍较为匮乏，针对农村人群的相关研究尤其有限。本研究旨在分析健康生活方式与高血压的关联，并探究生活方式改变能否影响农村成年人的高血压发病风险。**研究方法**：本研究纳入中国河南农村队列研究（Henan Rural Cohort Study）的16454名参与者。健康生活方式评分（Healthy Lifestyles Score, HLS）基于吸烟状态、饮酒情况、身体活动水平、饮食状况以及体质量指数（Body Mass Index, BMI）进行计算。采用广义线性模型分析HLS及生活方式改变与收缩压（Systolic Blood Pressure, SBP）、舒张压（Diastolic Blood Pressure, DBP）的关联，采用logistic回归模型及限制性立方样条图分析其与高血压的关联。**研究结果**：广义线性模型分析结果显示，随着HLS评分升高，参与者的收缩压与舒张压水平均显著降低（趋势检验P<0.01）。与HLS评分较低（0~2分）的参与者相比，HLS评分为3、4、5分者的高血压优势比（Odds Ratio, OR）及95%置信区间（95% Confidence Interval, 95%CI）分别为0.853（0.737, 0.987）、0.881（0.754, 1.029）以及0.658（0.519, 0.834）。与始终维持不健康生活方式的参与者相比，生活方式从不健康转为健康的参与者血压水平更低[β值（95%CI）：收缩压：-1.603（-2.539, -0.668）；舒张压：-1.713（-2.326, -1.100）]，且高血压发病风险更低[OR（95%CI）：0.744（0.594, 0.931）]。敏感性分析得到了一致的研究结果。**研究结论**：本研究结果表明，健康的生活方式可降低血压水平与高血压发病风险，通过践行健康的生活方式改变，可成为农村地区预防高血压的有效策略。