Association Between Life’s Essential 8 Lifestyle Behaviors and Hypertension: A Cross-Sectional Analysis of NHANES Data

BACKGROUND: The American Heart Association's Life's Essential 8 (LE8) emphasizes key modifiable behaviors, diet, physical activity, weight management, smoking cessation, and sleep to promote cardiovascular health. Yet, the combined influence of these behaviors on hypertension remains underexplored. OBJECTIVE: In this study, our aim was to examine associations between LE8 lifestyle recommended behaviors for hypertension management among U.S. adults and assess differences by gender and race/ethnicity. METHODS: We analyzed data from the National Health and Nutrition Examination Survey from 2011 to 2018. The sample included 20,912 adults aged 18 or older, excluding pregnant women. Weighted multivariable logistic regression assessed associations between LE8 lifestyle factors and hypertension, adjusting for sociodemographic covariates. Subgroup analyses explored differences by gender and race/ethnicity. RESULTS: The prevalence of hypertension was 52.7% in the study population. Higher odds of hypertension were associated with overweight (odds ratios [ OR ] = 1.65, 95% confidence interval [CI]: 1.47-1.84), obesity ( OR = 3.07, 95% CI: 2.73-3.43), inadequate physical activity ( OR = 1.32, 95% CI: 1.19-1.46), current smoking ( OR = 1.17, 95% CI: 1.03-1.32), and suboptimal sleep duration (short: OR = 1.11, 95% CI: 1.01-1.19; long: OR = 1.25, 95% CI: 1.06-1.47). The associations between lifestyle behaviors and hypertension were consistent across gender and race/ethnic groups, although the significant association between sleep duration and hypertension was only observed in females but not in males. CONCLUSION: Four LE8 lifestyle behaviors, weight, physical activity, smoking, and sleep, were independently associated with hypertension. Public health strategies should promote multifaceted, culturally responsive interventions to address these modifiable risks and reduce hypertension disparities.