Strengthening clinical capacity in spinal muscular atrophy: Developing and implementing training on clinical outcome assessments.

Hypertension affects approximately one-third of the world’s adult population and is a major cause of cardiometabolic diseases and premature deaths worldwide despite substantial advances in pharmacologic treatment. The 2018 European Society of Cardiology–European Society of Hypertension (ESC-ESH) guidelines classify systolic blood pressure of 130 to 139 mm Hg as high-normal, which may lead to more individuals being diagnosed with and treated for hypertension. Given the lower thresholds for diagnosing hypertension, lifestyle interventions may become even more essential for hypertension prevention and management. Abundant data have suggested that adhering to a healthy lifestyle (such as physical activity, weight management, no smoking, no more than moderate alcohol use, and eating a healthy diet) may prevent the majority of cardiometabolic diseases in the general population. In contrast, data are sparse regarding how healthy lifestyle is associated with health status among individuals living with chronic conditions such as hypertension. Previous studies collectively suggested that adherence to multiple healthy lifestyle factors was associated with a lower risk of cardiometabolic diseases among people with hypertension, although most of these prior studies relied on a single baseline assessment of lifestyle factors with relatively short follow-up. As such, no studies to our knowledge have explicitly addressed the question of whether long-term adherence to or changes in healthy lifestyle may facilitate disease prevention among the rapidly growing population with hypertension. In addition, few studies have examined changes in healthy lifestyle practice before and after the hypertension diagnosis or the role of antihypertensive medication in the associations of interest. To address this important knowledge gap, the current study leveraged data collected from 2 large prospective cohorts with up to 15 repeated measures of self-reported lifestyle factors over 30 years of follow-up to examine healthy lifestyle practice after hypertension diagnosis as well as changes in lifestyle before and after hypertension diagnosis in relation to incident cardiovascular diseases (CVDs), type 2 diabetes (T2D), and life expectancy. We also explored whether the associations of lifestyle with cardiometabolic conditions are independent of the use of antihypertensive medication. We hypothesized that long-term adherence to a healthy lifestyle, as well as improvements in lifestyle after hypertension diagnosis, would be associated with lower risks of CVDs and T2D and with a longer life expectancy, independent of antihypertensive medication use.