Objective To investigate the association of the healthy lifestyle index (HLI) with blood pressure and hypertension risk among adults in Huai'an City, providing a scientific foundation for developing policies on preventing and controlling hypertension through promoting healthy lifestyles.

Methods Questionnaire survey, physical examination and laboratory measurement were conducted among 11 189 subjects from the chronic disease risk factor surveillance project in Huai'an City in 2022. The HLI was constructed based on smoking, drinking, diet, exercise, body mass index (BMI) and waist circumference. Binomial logistic regression analysis was used to analyze the association between different HLI groups and the risk of hypertension, and multiple linear regression analysis was used to analyze the association between HLI groups and blood pressure levels.

Results A total of 11 189 subjects were included. The prevalence of hypertension was 57.49% (6432/11189), and the mean HLI was 3.47±1.26. The prevalence of hypertension in people with HLI of 0–1, 2, 3, 4, and 5–6 was 68.90%, 67.15%, 61.99%, 54.15%, and 45.30%, respectively, and the difference was statistically significant (χ²=289.25, P＜0.01). There were statistically significant differences in the levels of systolic blood pressure, diastolic blood pressure, pulse pressure, and mean arterial pressure among different HLI groups (P＜0.01). Binomial logistic regression analysis showed that HLI was negatively correlated with the risk of hypertension. After adjusting for confounding factors, compared with people with HLI of 0–1, the risk of hypertension in people with HLI of 3, 4, and 5–6 decreased by 29% (OR=0.71, 95%CI 0.59–0.86), 47% (OR=0.53, 95%CI 0.43–0.64), and 61% (OR=0.39, 95%CI 0.32–0.48), respectively, and 1-point increase in HLI was associated with a 21% reduction (OR=0.79, 95%CI 0.76–0.81) in hypertension risk. Compared with those with HLI of 0–1, the risk of hypertension in men with HLI of 3, 4, and 5–6 decreased by 32% (OR=0.68, 95%CI 0.56–0.84), 47% (OR=0.53, 95%CI 0.43–0.65), and 55% (OR=0.45, 95%CI 0.36–0.56), respectively, and in women with HLI of 5–6 decreased by 60% (OR=0.40, 95%CI 0.20–0.82). For each point increase in HLI, the risk of hypertension decreased by 17% (OR=0.83, 95%CI 0.79–0.86) in men and 26% (OR=0.74, 95%CI 0.70–0.78) in women. The results of multiple linear regression showed that HLI was negatively correlated with systolic blood pressure, diastolic blood pressure, pulse pressure, and mean arterial pressure. After adjusting for confounding factors, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were significantly lower in groups with HLI greater than 1 than those with HLI of 0–1 (P＜0.05). Meanwhile, pulse pressure reduction was significant in those with HLI of 4 and 5–6 (P＜0.05). HLI increased by 1 point, systolic blood pressure, diastolic blood pressure, pulse pressure, and mean pressure decreased by 1.11 (B=–1.11), 0.34 (B=–0.34), 0.77 (B=–0.77) and 0.60 mmHg (B=–0.60), respectively (all P＜0.05). The association between HLI and blood pressure in men was similar to that in the overall population. In women, compared with those with HLI of 0–1, there were significant differences in the reduction of diastolic blood pressure in those with HLI of 3 (P＜0.05), the reduction of mean arterial pressure in those with HLI of 4 (P＜0.05), and the reduction of systolic blood pressure, diastolic blood pressure, and mean arterial pressure in those with HLI of 5–6 (P＜0.05).

Conclusion  Higher HLI is associated with lower hypertension risk and blood pressure level. The effect of increasing the number of healthy lifestyles on reducing the risk of hypertension and blood pressure level may be better in men than in women.