Lifestyle Score and Genetic Factors With Hypertension and Blood Pressure Among Adults in Rural China

Abstract

Background: Although high genetic risk and unhealthful lifestyles are associated with a high risk of hypertension, but the combined relationship between lifestyle score and genetic factors on blood pressure remains limited, especially in resource-constrained areas. Aim: To explore the separate and joint effects between genetic and lifestyle factors on blood pressure and hypertension in rural areas. Methods: In 4,592 adults from rural China with a 3-year of follow-up, a genetic risk score (GRS) was established using 13 single nucleotide polymorphisms (SNPs) and the lifestyle score was calculated including factors diet, body mass index (BMI), smoking status, drinking status, and physical activity. The associations of genetic and lifestyle factors with blood pressure and hypertension were determined with generalized linear and logistic regression models, respectively. Results: The high-risk GRS was found to be associated with evaluated blood pressure and hypertension and the healthful lifestyle with diastolic blood pressure (DBP) level. Individuals with unhealthful lifestyles in the high GRS risk group had an odds ratio (OR) (95% CI) of 1.904 (1.006, 3.603) for hypertension than those with a healthful lifestyle in the low GRS risk group. Besides, the relative risk (RR), attributable risk (AR), and population attributable risk (PAR) for unhealthful lifestyle are 1.39, 5.87, 0.04%, respectively, and the prevented fraction for the population (PFP) for healthful lifestyle is 9.47%. Conclusion: These results propose a joint effect between genetic and lifestyle factors on blood pressure and hypertension. The findings provide support for adherence to a healthful lifestyle in hypertension precision prevention. Clinical Trial Registration: The Henan Rural Cohort Study has been registered at the Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). http://www.chictr.org.cn/showproj.aspx?proj=11375.

Keywords: blood pressure; genetic risk score; hypertension; joint effect; lifestyle score.

Figure 1

Distribution of SBP and DBP levels in genetic and lifestyle risk groups. The box plot shows the location of the quantile and the external shape shows the density at any location. DBP, diastolic blood pressure; GRS, genetic risk score; SBP, systolic blood pressure.

Figure 2

Combined effect of genetic and lifestyle on hypertension, SBP, and DBP. Low, intermediate, and high GRS risk were tertile 1, tertile 2, and tertile 3 of GRS, respectively; unhealthful, intermediate, and healthful lifestyle group were composed of LS for 0 and 1, LS for 2 and 3, and LS for 4 and 5, respectively. Hypertension, SBP level, and DBP level were the outcomes at the 3-year follow-up. Logistic regression was used to analyze the association of lifestyle and GRS with outcomes because of the short follow-up period. Take the participants with low risk of GSR and healthful lifestyle as the reference. The data in each square represent the effect size of each outcome [odds ratio (95% CI) for hypertension, β (95% CI) for SBP and DBP]. Covariates: age, sex, antihypertensive medicine, family history of hypertension, educational level, marriage, income, baseline SBP, and baseline DBP. The color bars on the right correspond to different effect values. No significant additive interaction effect of GRS and lifestyle score was observed (95% CI of RERI included 0). DBP, diastolic blood pressure; GRS, genetic risk score; SBP, systolic blood pressure.