Abstract / Summary
Hypertension (HTN) is a major cause of cardiovascular morbidity and mortality worldwide. The American Heart Association’s Life’s Essential 8 (LE8) framework highlights modifiable behavioral and biological factors for cardiovascular health (CVH). This study investigated the association between LE8 behavioral factors and incident HTN among Kurdish adults in Iran. In this prospective cohort study, 7,208 adults aged 35–65 years from the Ravansar Non-Communicable Diseases (RaNCD), free of HTN and cardiovascular disease at baseline, were followed for a median of 9.3 years. LE8 behavioral factors—diet, physical activity, nicotine exposure, and sleep health—were assessed using validated tools and combined into overall CVH scores (low, moderate, high). Incident HTN was defined as physician diagnosis, hospitalization, or use of antihypertensive medications. Cox proportional hazards models estimated hazard ratios and 95% confidence intervals. During a median 9.3-year follow-up, 1,006 participants (13.95%) developed HTN. Poor diet and insufficient physical activity were associated with higher HTN risk, whereas nicotine exposure and sleep duration were not. Among men, low CVH was associated with a 47% higher HTN risk compared with high CVH (HR: 1.47; 95% CI: 1.05–2.05), while no significant association was observed among women. Each 10-point increase in behavioral LE8 score was associated with a 7% lower HTN risk in men (HR: 0.93; 95% CI: 0.88–0.99), but not in women (HR: 0.99; 95% CI: 0.94–1.05). Poor diet and insufficient physical activity were associated with higher HTN risk, while higher behavioral CVH was protective primarily among men. These findings support sex-specific and culturally appropriate hypertension prevention strategies. Not applicable.