Research led by Harvard T.H. Chan School of Public Health confirms that leading a healthy lifestyle can reduce risk for cardiovascular disease and diabetes in people with high blood pressure independent of medication use.

People with hypertension who improved their lifestyle from a low healthy living score to a high one reduced their risk for heart disease and diabetes by 12–44% over a 25 year period, according to the research.

“Hypertension affects approximately one-third of the world’s adult population and is a major cause of cardiometabolic diseases and premature deaths worldwide despite substantial advances in pharmacologic treatment,” write Qi Sun, MD, a researcher at Harvard T.H. Chan School of Public Health, and colleagues in JAMA Network Open.

“Abundant data have suggested that adhering to a healthy lifestyle, such as physical activity, weight management, no smoking, no more than moderate alcohol use, and eating a healthy diet, may prevent the majority of cardiometabolic diseases in the general population. In contrast, data are sparse regarding how healthy lifestyle is associated with health status among individuals living with chronic conditions such as hypertension.”

The current study included 25,820 people enrolled in either the Nurse’s Health Study or the Health Professionals Follow-Up Study who had high blood pressure diagnosed between 1986 and 2014. The participants were aged 61 years on average and 73% were female.

The researchers checked for incident cardiovascular disease and diabetes over 23–25 years of follow up. During this time, 3300 cases of cardiovascular disease and 2529 cases of type 2 diabetes were recorded.

A healthy lifestyle was determined by the following factors: eating a high-quality diet, not smoking, engaging in 150 minutes of moderate-to-vigorous intensity physical activity per week, consuming no alcohol or only up to a moderate level, and having a healthy body mass index. Each of these factors was assigned a point if adhered to up to a maximum of five points.

When comparing people with five points with people with zero points the risk for cardiovascular disease was 51% lower and the risk for type 2 diabetes 79% lower.

The team found that participants who raised their score from 0–3 to 4–5 after being diagnosed with hypertension had a 12% reduced risk of cardiovascular disease and a 44% reduction in risk for type 2 diabetes compared with those who did not change their score.

In contrast, people whose healthy living score declined after their hypertension diagnosis had a 14–75% increased risk for cardiovascular disease and type 2 diabetes.

Notably, use of antihypertensive medication did not seem to greatly change the association between healthy lifestyle and cardiovascular disease or diabetes with similar risks seen regardless of whether people were taking medication or not.

“These findings align with recent American Heart Association and American College of Cardiology guidelines that underscore the importance of integrating lifestyle counseling with medication to optimize long-term cardiometabolic outcomes, and they support the advice of conducting trials to examine the effects of lifestyle modification followed by timely initiation of antihypertensive therapy on cardiometabolic health,” conclude the investigators.