Association of Lifestyle Factors and Antihypertensive Medication Use With Risk of All-Cause and Cause-Specific Mortality Among Adults With Hypertension in China

IMPORTANCE: The joint association of antihypertensive medication use and healthy lifestyle with mortality among individuals with hypertension is unclear. OBJECTIVE: To examine the association of lifestyle factors combined with antihypertensive medication use, as well as changes in lifestyle, with all-cause and cause-specific mortality among individuals with hypertension. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Dongfeng-Tongji cohort, a long-term, prospective cohort including employees at a manufacturer in China, with baseline from 2008 to 2010. Participants with hypertension were followed up for a median (IQR) of 7.3 (5.7-10.3) years, ending in 2018. Data were analyzed from February to April 2021. EXPOSURES: Lifestyle factors, including body mass index, smoking status, diet, physical activity, and sleep duration, were coded on a 3-point scale (range, 0-2, with higher score indicating a healthier lifestyle). Lifestyle was evaluated according to the total score of all 5 factors, and categorized into 3 groups: unfavorable (scores 0-4), intermediate (scores 5-7), and favorable (scores 8-10). Antihypertensive medication use was defined as use within the last 2 weeks. MAIN OUTCOMES AND MEASURES: All-cause, cardiovascular, and cancer mortality were identified by linking the cohort database with the health care system through December 31, 2018. RESULTS: A total of 14 392 participants (mean [SD] age, 65.6 [7.4] years; 7277 [50.6%] men and 7115 [49.4%] women) with hypertension were included, and 2015 deaths were documented, including 761 cardiovascular deaths and 525 cancer deaths. Compared with individuals not using antihypertensive medication and with a lifestyle score of 0 to 4, the combination of using antihypertensive medication and having a lifestyle score of 8 to 10 was associated with the lowest risk of all-cause mortality (hazard ratio [HR], 0.32; 95% CI, 0.25-0.42), cardiovascular mortality (HR, 0.33; 95% CI, 0.21-0.53), and cancer mortality (HR, 0.30; 95% CI, 0.19-0.47). In addition, improvement in lifestyle score after hypertension diagnosis was associated with lower risk of all-cause mortality (HR, 0.52; 95% CI, 0.36-0.76) and cardiovascular mortality (HR, 0.53; 95% CI, 0.30-0.94). CONCLUSIONS AND RELEVANCE: These findings suggest that adherence to healthy lifestyle and antihypertensive medication treatment were associated with lower risk of mortality among adults with hypertension. These findings further support that, in addition to antihypertensive medication use, adopting a healthy lifestyle is associated with benefits in the prevention of premature death among individuals with hypertension.