Lifestyle, stress, and treatment adherence as predictors of hypertension risk: A longitudinal public health study

Hypertension remains a leading cause of morbidity and mortality globally, with substantial implications for public health, particularly in resource-limited settings. Lifestyle behaviors, psychological stress, and treatment adherence have all been recognized as modifiable risk factors influencing hypertension incidence and progression. This study investigates the longitudinal relationship between lifestyle factors (physical activity, diet, alcohol intake, and smoking), psychological stress, medication adherence, and the risk of developing hypertension. Using data from a three-wave longitudinal public health survey conducted across three Midwestern states in the United States between 2018 and 2023, we analyzed a cohort of 8,421 adults aged 25 to 64 years without baseline hypertension. Multilevel Cox proportional hazard models were used to assess the impact of predictors on incident hypertension over the five-year period. Results showed that poor lifestyle behaviors, high stress levels, and suboptimal medication adherence were independently associated with elevated hypertension risk. Notably, the combined effect of high stress and poor lifestyle choices was synergistic, significantly amplifying risk. These findings underscore the need for integrated preventive strategies that address both behavioral and psychosocial determinants of hypertension in public health policy and practice.