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Minor lifestyle improvements may decrease high BP risk in black adults
Black adults who followed a healthy lifestyle had decreased risk for high BP, according to a study published in Hypertension.
“The Life’s Simple 7, an approach used by the American Heart Association to monitor [CV] health, can also be used to monitor high [BP] risk in African Americans, a major risk factor for [CVD],” John N. Booth III, MS, a PhD student in the department of epidemiology at the University of Alabama in Birmingham, said in a press release. “We found that even small improvements in [CV] health can reduce risk for developing high [BP].”
Researchers reviewed data from 1,878 black participants from the Jackson Heart Study. Participants with hypertension or self-reported physician diagnosis of stroke or MI at baseline were excluded. Researchers followed up with participants for a median of 8 years.
Incident hypertension was defined as systolic BP of at least 140 mm Hg, diastolic BP of at least 90 mm Hg or self-reported use of antihypertensive medication.
The AHA’s Life’s Simple 7 components consisted of three health factors, including total cholesterol, BP and fasting glucose, and four health behaviors, defined as diet, BMI, physical activity and cigarette smoking. Participants were categorized by the number of ideal components they had: zero or one (7%), two (21.9%), three (35.1%), four (24.6%), five (9.9%) and six (1.5%). No participants had all seven components.
At 8 years, 50.3% (n = 944) participants were diagnosed with hypertension. Patients with more ideal components were less likely to have hypertension (P for trend < .001). Among those with one or no ideal components 81.3% of those developed hypertension, compared with 11.1% of participants with six ideal components.
After adjustment, compared with those with one or zero ideal components, participants with two (HR = 0.79; 95% CI, 0.62-1.02), three (HR = 0.57; 95% CI, 0.45-0.73), four (HR = 0.3; 95% CI, 0.23-0.4), five (HR = 0.26; 95% CI, 0.18-0.37) and six (HR = 0.1; 95% CI, 0.03-0.32) ideal components were at lower risk for incident hypertension (P for trend < .001).
“Several individual Life’s Simple 7 components have been associated with an increased risk for hypertension, including higher BMI, physical inactivity, a less healthy diet, cigarette smoking and higher BP, cholesterol and fasting glucose levels,” Booth and colleagues wrote. “The presence of multiple less than ideal Life’s Simple 7 components may accelerate the development of hypertension.” – by Darlene Dobkowski
Disclosures: Booth reports no relevant financial disclosures. Please see the full study for a list of the other researchers’ relevant financial disclosures.
Perspective
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The American Heart Association’s ‘Life’s Simple 7’ is well-known and adapted in communities, but few studies have utilized the steps as a correlate to assess CVD outcomes, especially in the black community. This very elegant clinical study is important, as it is among the first to look at the AHA's Simple 7 and its impact on incident BP development in a large cohort of black individuals. Although all the guidelines stress that engaging in healthy lifestyle interventions will promote better CV outcomes, being able to look at how it correlates with the Simple 7 is important and impactful.
The findings can have important implications for clinical practices to add to their toolkit of treatment for hypertension. Studies show that while most people (~80%), including blacks, are aware of high BP, less than 50% of black adults are at goal on medications (Go AS, et al. Circulation. 2013;doi:10.1161/CIR.0b013e31828124ad). Clearly lifestyle or other interventions are critical to achieve control.
Using the Simple 7 as a guide to implementing healthy lifestyles in patients can add to better outcomes for hypertension and other CVD conditions or disorders in medical practices. The steps can provide a simple checklist, which even primary practitioners can use, to track their patients similarly to the methods implemented in the study.
While the study is well done in design, sample size and the questions, it would be important to assess other important factors that may be contributory, and then also compare directly with a white cohort with similar baseline characteristics. Additionally, other factors which may play a huge role in the lives of black individuals should be considered, such as work and family stressors, socioeconomic factors, level of education beyond high school, etc.
It may be important to look at other groups of black individuals other than this cohort that are based in the South, which is a high-risk group located in the so-called ‘Stroke Belt.’ There is evidence suggesting that other groups of blacks (from the African continent, the Caribbean or the North) may have varying prevalence of hypertension. While it may be difficult to test these various populations, it may be helpful to analyze why certain groups of blacks have a lower prevalence of hypertension compared with others (Cooper R, et al. Am J Hypertens. 1997;doi:10.1016/S0895-7061(97)00211-2).