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Highly walkable neighborhoods reduce incident hypertension by half
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ORLANDO, Fla. — People who moved from a low-walkability neighborhood to a high-walkability neighborhood saw a drop in their chance of getting hypertension, according to findings presented at the American Heart Association Scientific Sessions.
According to a press release from the AHA, the study is the first to assess whether moving to a walking-friendly neighborhood impacts BP.
Maria Chiu, MSc, PhD, a scientist at the Institute for Clinical Evaluative Sciences, Toronto, and colleagues analyzed 1,057 pairs of propensity-score matched adults from the Canadian Community Health Survey, conducted between 2001 and 2010. During the study period, all participants moved from a low-walkability neighborhood to a high-walkability neighborhood or another low-walkability neighborhood. Walkability was assessed by the Walk Score index, which measures walking distance from a geographic location to amenities ranging from schools to parks to restaurants.
Maria Chiu
The researchers obtained BP data from health administrative databases and followed participants for up to 11 years. Median follow-up was 4 years.
Chiu and colleagues found that the incidence rates of hypertension were 8.6 per 1,000 person-years for those who moved to a high-walkability neighborhood and 18 per 1,000 person-years for those who moved to a low-walkability neighborhood (P < .001).
Chiu said at a press conference that compared with the low-walkability group, the high-walkability group had a 54% reduced risk for developing hypertension (HR = 0.46; 95% CI, 0.26-0.81).
“Low-to-high movers had significantly lower risk of incident hypertension, which would suggest that high-walking neighborhoods can in fact positively influence your health,” she said. “Therefore, we need to raise awareness of the importance of neighborhood walkability, not only to physicians and health care providers, but also to the public. We’ve already started to do this.”
Limitations of the study include no serial measurement of BP and little information on diet and environmental attributes, according to the researchers.
Further analyses indicated a dose-response relationship between incident hypertension and Walk Score index, Chiu said. “We did further analysis that looked at a dose-response relationship not only with 70 as a cutpoint and 50 as a cutpoint, but also on a continuous scale,” she said. “We looked at moving from a low-walkability neighborhood to one with a higher score in increments of 10 and we saw a very clear dose-response relationship.” ˗ by Erik Swain
References:
Chiu M, et al. Abstract 134. Presented at: American Heart Association Scientific Sessions; Nov. 7-11, 2015; Orlando, Fla.
Chiu M, et al. Environ Health Perspect. 2015;doi:10.1289/ehp.1510425.
Disclosure: Chiu reports no relevant financial disclosures.
Perspective
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Robert H. Eckel, MD
It’s clear that being less sedentary and engaging in more physical activity is good. The concept is that living in a neighborhood where you walk more has benefits downstream, but it may be not adequately validated yet by the existing literature. So I found this to be a unique study. It’s a difficult database to access because you have to make sure people live in an area with low activity to begin with, and then relocate. The question is, these people may be motivated to move to these areas because their decision is ‘I have to get more active.’ Or, is this circumstantial, where people happened to move to these areas and now must walk? No, I think there’s probably some choice that people relocate, perhaps for health reasons. These are observational data, but the interventions here that would be necessary for a randomized controlled trial would be impossible.
What physicians can do is to implement a 3-minute lifestyle interview during a session with a patient to modify lifestyle matters, leading to recommendations on diet and physical activity. They need to be much more involved.
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