Key result
Obesity accounts for ~6% of incident hypertension cases, the highest population attributable fraction.
Why the study?
Large-scale data on the population attributable fraction for a comprehensive range of modifiable risk factors for incident hypertension in the Japanese population were scarce.
What is the population attributable fraction of modifiable risk factors for incident hypertension in a Japanese population?
Cohort (n=1,069,948)
Yes
What is the population attributable fraction of modifiable risk factors for incident hypertension in a Japanese population?
Effect estimate: Obesity PAF 6.36%, Sleep disorder PAF 4.11%, Current smoking PAF 3.39%, Dyslipidemia PAF 2.74%, Alcohol consumption PAF 2.10%, Physical inactivity PAF 1.93%, Diabetes mellitus PAF 1.55%
Obesity is the largest modifiable contributor to incident hypertension in the Japanese population, particularly among younger adults and men, highlighting it as a primary target for public health interventions.
Supports prioritizing obesity reduction for hypertension prevention in Japanese adults; extends modifiable risk PAF evidence to East Asian populations.
Identifying and prioritizing modifiable risk factors is crucial for the primary prevention of hypertension. However, large-scale data on the population attributable fraction (PAF) for a comprehensive range of modifiable risk factors for incident hypertension in the Japanese population have been scarce. This study analyzed 1,069,948 participants (median age 56, 43.7% men) without a history of hypertension from the DeSC database. Using Cox proportional hazards models, we evaluated the association between modifiable risk factors (obesity, diabetes mellitus, dyslipidemia, smoking, habitual alcohol consumption, physical inactivity, and sleep disorders) and incident hypertension to calculate their PAFs. Over a median follow-up of 3.64 years, 116,690 new hypertension diagnoses were recorded. Obesity had the highest PAF at 6.36%, followed by sleep disorder (4.11%), current smoking (3.39%), dyslipidemia (2.74%), habitual alcohol consumption (2.10%), physical inactivity (1.93%), and diabetes mellitus (1.55%). The PAF of obesity for incident hypertension decreased with age, from 15.10% among individuals aged <40 years to 7.93% among those aged 40–64 years and 3.70% among those aged ≥65 years. Similarly, obesity’s PAF was higher in men (7.93%) than in women (5.02%). The total PAF for all evaluated modifiable risk factors showed a more pronounced contribution among younger adults and men. In conclusion, this research reveals that obesity is the largest modifiable contributor to incident hypertension in the Japanese population. Furthermore, the impact of modifiable risk factors for hypertension is more significant in younger adults and men. These findings offer valuable insights for developing effective public health policies aimed at preventing hypertension.
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Nishikawa et al. (2026) conducted a cohort in Adults in Japan without prior hypertension at baseline, median age 56, 43.7% male, evaluated for incident hypertension (n=1,069,948). Elimination/reduction of modifiable risk factors (obesity, diabetes mellitus, dyslipidemia, smoking, habitual alcohol consumption, physical inactivity, sleep disorders) vs. Population with risk factors present was evaluated on Incident (new-onset) hypertension identified by ICD-10 codes I10-I15 (Obesity PAF 6.36%, Sleep disorder PAF 4.11%, Current smoking PAF 3.39%, Dyslipidemia PAF 2.74%, Alcohol consumption PAF 2.10%, Physical inactivity PAF 1.93%, Diabetes mellitus PAF 1.55%). Obesity contributed the largest population attributable fraction of 6.36% to incident hypertension among Japanese adults without prior hypertension over 3.64 years follow-up.
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