Population attributable fraction of modifiable risk factors for incident hypertension: an analysis of large-scale epidemiological cohort

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.