Unhealthy behavior and risk of uncontrolled hypertension among treated individuals–The CONSTANCES cohort study

Poor lifestyle behaviors have been identified to contribute to poor blood pressure (BP) control. We aimed to examine the individual and combined associations of unhealthy behavior with uncontrolled hypertension (HTN) among treated hypertensive adults. We conducted cross-sectional analysis using data from the CONSTANCES cohort study. Volunteer participants who have been diagnosed with HTN and were taking antihypertensive medications were included. Uncontrolled BP was defined as mean systolic BP ≥ 140 mmHg and/or mean diastolic BP ≥ 90 mmHg. Lifestyle factors were assessed using validated questionnaires. Dietary adherence assessment was done using the modified National Program on Nutrition and Health (mPNNS) score and then categorized into low, medium and high. We considered heavy alcohol drinking, sedentary level PA, low/medium dietary adherence and overweight/obese (body mass index ≥ 25 kg/m2) as unhealthy behaviors. Using logistic regression models we estimated the association between control of hypertension and unhealthy behaviors. Statistical analyses were stratified by sex and were performed with SAS 9.4 (SAS Institute). A total of 8,927 participants were analyzed. The prevalence of uncontrolled HTN was of 53.3% and it was more common in men than in women (66.3% vs. 42.6% respectively, P < 0.001). The odds of uncontrolled HTN increased with low dietary adherence in men only (P = 0.038), overweight and obese men (P < 0.001), heavy alcohol drinking in both men and women (P < 0.05 for both) compared to moderate/light (never) drinking. However, there was no statistically significant association with physical activity in both genders. The frequency of uncontrolled HTN increased with the number of unhealthy behaviors in both sexes (P < 0.001 for men and P = 0.008 for women). Men and women reporting three unhealthy behaviors had 1.53–fold and 1.73-fold increase of the odds of uncontrolled HTN, respectively. An unhealthy lifestyle including low/medium adherence to dietary recommendations, high alcohol consumption and overweight/obesity was associated with uncontrolled HTN among treated hypertensive individuals.