Healthy lifestyle provides stroke prevention across hypertensive states

By Andrew Czyzewski, MedWire Reporter

Maintaining a healthy lifestyle significantly decreases the risk for stroke in both men and women who differ in their hypertension status and use of antihypertensive drug treatments, a study shows.

Indeed, there was some evidence that having three or more healthy lifestyle factors may actually provide "more significant" stroke prevention than antihypertensive drugs.

"Our study disentangles the effect of healthy lifestyle from hypertension to further demonstrate the importance of promoting healthy lifestyle in the primary prevention of stroke," Gang Hu (Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA) and colleagues comment in Hypertension.

In a previous study, Hu and team demonstrated a graded inverse association between the number of healthy lifestyle indicators and the risks for total, ischemic, and hemorrhagic stroke.

However, to date little is known about the effect of the joint association between healthy lifestyle and antihypertensive drug treatment on the risk for stroke.

To address this, Hu et al prospectively evaluated 36,686 Finnish participants aged 25 to 74 years who were enrolled in five independent cross sectional population studies and were free of coronary heart disease and stroke at baseline.

Based on questionnaire data, a healthy lifestyle was defined as adhering to three or more healthy lifestyle factors, including never smoking; maintaining a BMI of less than 25 kg/m²; moderate/ high level of physical activity; vegetable consumption at least three times a week; and light/moderate alcohol drinking (1-209 g/wk in men and 1-139 g/wk in women).

During a mean follow-up of 13.7 years, 1478 people developed a stroke event (1167 ischemic and 311 hemorrhagic).

As expected, people who adhered to less than three healthy lifestyle factors faced a greater risk for total stroke than their peers who maintained a healthy lifestyle (men, hazard ratio [HR]=1.43; women, HR=1.84).

Likewise, compared with people with normal blood pressure, those with hypertension had a significantly increased risk for stroke, irrespective of if they were aware of their status, were taking antihypertensives, or the hypertension was controlled (HR range=1.56-3.19).

Notably, the beneficial effect of a healthy lifestyle on stroke prevention was seen within different hypertensive states across stroke subtypes and gender.

For example, people with hypertension who used antihypertensive drugs but did not adhere to a healthy lifestyle had an increased stroke risk relative to their hypertensive peers who did not use antihypertensive drugs but adhered to a healthy lifestyle (HRs, 1.37-1.42 for total, ischemic, and hemorrhagic stroke in men and 2.21-2.31 in women).

"The protective effects of healthy lifestyle on stroke risk may directly decrease high blood pressure and also improve other risk factors, such as total and low-density lipoprotein cholesterol, diabetes mellitus, smoking habits, and some inflammatory biomarkers (such as C-reactive protein)," Hu et al comment.

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