Healthy Lifestyle May Attenuate Diabetes-Associated Risk for Hypertension

Senior woman exercising in home gym
A population-based, cross-sectional study was conducted to evaluate the effect of lifestyle on the risk for hypertension in patients with diabetes.

A cross-sectional study found that diabetes was an independent predictor for hypertension but that a healthy lifestyle attenuated some of the risk. These findings were published in the American Journal of Preventive Medicine.

Workers (N=451,157) insured by a large occupational risk prevention company in Spain and who underwent a physical examination annually between 2012 and 2016 were included in the study. Risk for hypertension was evaluated on the basis of participant demographic characteristics, clinical status, lifestyle habits, and diabetes status.

The mean age of the study population was 44.5±9.2 years, 33.1% were women; body mass index (BMI) was 26.1±4.3 kg/m2, 31.4% had hypercholesterolemia, 29.3% had hypertension, 29.1% were smokers, 9.9% consumed alcohol daily, and 63.7% were inactive. A total of 14,438 participants had diabetes. Participants in the diabetic cohort were older and had higher BMI and blood pressure, lower estimated glomerular filtration rate (eGFR), more had hyperlipidemia and hypertension, more were frequent consumers of alcohol, more had abnormal sleeping hours, and fewer were physically active.

After adjusting for lifestyle characteristics, hypercholesterolemia, and eGFR, a diagnosis of diabetes was found to be associated with increased risk for hypertension (adjusted odds ratio [aOR], 1.44; 95% CI, 1.43-1.48).

Compared with the cohort without diabetes, risk for hypertension among those with diabetes was associated with an unhealthy lifestyle profile (aOR, 2.71; 95% CI, 1.36-4.79; P <.001), abnormal sleep (<6 or >9 h/d; aOR, 2.09; 95% CI, 1.96-2.29; P <.001), consuming at least 1 alcoholic beverage daily (aOR, 2.19; 95% CI, 2.11-2.76; P <.001), smoking (aOR, 2.06; 95% CI, 1.92-2.20; P <.001), being overweight (aOR, 1.90; 95% CI, 1.80-2.50; P <.001) or obese (aOR, 4.10; 95% CI, 4.04-4.75; P <.001), and being insufficiently active (aOR, 1.80; 95% CI, 1.72-2.19; P <.001) or inactive (aOR, 2.20; 95% CI, 2.11-2.50; P <.001).

Although unhealthy lifestyle habits increased the risk for hypertension by a larger magnitude, unhealthy habits remained significant predictors for hypertension (aOR range, 1.07-2.12; all P <.001) in patients with vs without diabetes.

The risk for hypertension was attenuated in patients with diabetes who demonstrated an optimal healthy lifestyle profile (aOR, 0.29; 95% CI, 0.18-0.53; P <.001), normal weight compared with overweight/obesity (aOR, 0.49; 95% CI, 0.42-0.53; P <.001), overweight compared with obesity (aOR, 0.72; 95% CI, 0.66-0.80; P <.001), regular activity compared with inactivity (aOR, 0.79; 95% CI, 0.74-0.82; P <.001), and insufficient activity compared with inactivity (aOR, 0.85; 95% CI, 0.80-0.90; P =.002). Consuming little or no alcohol was associated with increased risk for hypertension compared with drinking alcohol daily (aOR, 1.07; 95% CI, 1.00-1.20; P =.040).

These findings may have been biased as the study relied on self-reported lifestyle habits.

The investigators found that diabetes was a strong predictor for hypertension but that some of that risk was attenuated by maintaining a healthy lifestyle.


Valenzuela PL, Santos-Lozano A, Castillo-García A, Ruilope LM, Lucia A. Diabetes, hypertension, and the mediating role of lifestyle: a cross-sectional analysis in a large cohort of adults. Am J Prev Med. Published online March 24, 2022. doi:10.1016/j.amepre.2022.01.014