Hypertension in women: More evidence for the role of lifestyle

Evidence continues to mount that healthful habits can help keep blood pressure down in women. In a new study, habits such as maintaining a normal weight, getting daily vigorous exercise, eating a diet high in fruits, vegetables, low-fat dairy products and low in sodium and taking a folic acid supplement were associated with a significantly lower incidence of self-reported hypertension among women; the results are reported in the July 22/29 issue of JAMA. Researchers at Brigham and Women's Hospital and Harvard Medical School studied data on 83,882 adult women (ages 27 to 44 years) in the second Nurses' Health Study who did not have hypertension, cardiovascular disease, diabetes or cancer in 1991, and who had normal reported blood pressure (defined as systolic blood pressure ≤120 mm Hg and diastolic blood pressure ≤80 mm Hg). There was follow-up for new hypertension for 14 years through 2005. Six modifiable lifestyle and dietary factors for hypertension were identified: (1) body mass index less than 25, (2) daily average of 30 minutes of vigorous exercise, (3) high score on the Dietary Approaches to Stop Hypertension (DASH) diet based on responses to a food frequency questionnaire, (4) modest alcohol intake, (5) use of nonnarcotic analgesics less than once per week, and (6) intake of 400 micrograms per day or more of supplemental folic acid. The association between combinations of three (normal BMI, daily vigorous exercise, and DASH-style diet), four (three low-risk factors plus modest alcohol intake), five (four low-risk factors plus avoidance of nonnarcotic analgesics), and six (folic acid supplementation ≥400 mcg/day) low-risk factors and the risk of developing hypertension was analyzed. During the follow-up, a total of 12,319 new cases of hypertension were reported. All six modifiable risk factors were independently associated with the risk of developing hypertension during follow-up after also adjusting for age, race, family history of hypertension, smoking status and use of oral contraceptives. For women who had all six low-risk factors (0.3 percent of the population), they had about an 80 percent lower risk of developing hypertension.