Hypertension affects over one-third of the global adult population and is a leading contributor to early death from cardiovascular and other chronic diseases. While treatments for high blood pressure are widely available, many patients still face elevated health risks due to poor management of other contributing factors, such as obesity, high cholesterol, diabetes, and sedentary lifestyles.

Past studies have examined how individual risk factors affect mortality, but few have looked at the cumulative effect of controlling multiple risks simultaneously. Based on these challenges, there is a pressing need to investigate whether managing a broader range of health risks can reduce or eliminate premature mortality among individuals with hypertension.

The study (DOI: 10.1093/pcmedi/pbaf006), published on March 19, 2025, in Precision Clinical Medicine, was conducted by researchers from Tulane University, Harvard T.H. Chan School of Public Health, and Central South University. Led by Dr. Jian Zhou and Professor Lu Qi, the research analysed data from nearly 71,000 hypertensive participants in the UK Biobank. By examining eight modifiable risk factors, the team sought to determine whether better overall health management could offset the heightened risk of premature death associated with hypertension.

The researchers evaluated eight modifiable risk factors: blood pressure, body mass index, waist circumference, LDL cholesterol, glycated haemoglobin, albuminuria, smoking status, and physical activity. Participants were grouped based on how many of these factors they successfully controlled. Over a 13.7-year median follow-up, those with more controlled risk factors had significantly lower risks of premature death.

Specifically, controlling all eight factors reduced all-cause premature mortality by 40%, cancer-related deaths by 39%, cardiovascular deaths by 53%, and other deaths by 29%. Moreover, hypertensive participants with at least four controlled risk factors had no greater risk of early death than their non-hypertensive counterparts.

These findings emphasise the importance of a holistic approach: rather than focusing on blood pressure alone, managing multiple health behaviors and conditions synergistically can produce profound benefits. Notably, only 7.3% of participants managed to control seven or more risk factors, highlighting the gap in current hypertension care.

“Our study provides compelling evidence that effective joint management of health risks can neutralise the elevated mortality risks typically associated with hypertension,” said Prof. Lu Qi, corresponding author of the study. “This reinforces the need for more comprehensive clinical strategies that go beyond blood pressure control.

Addressing multiple risk factors simultaneously may offer the best chance of reducing early death among hypertensive individuals.”The findings support a shift in hypertension treatment toward multi-factorial prevention strategies. Clinical guidelines and health policies should encourage integrated care that addresses weight, blood sugar, cholesterol, kidney function, smoking, and exercise in addition to blood pressure.

This approach could be especially impactful for ageing populations and those with existing comorbidities. Public health efforts should also focus on education and resources that help patients achieve and maintain these risk factor targets. Future studies are needed to determine how best to implement such strategies across diverse populations and healthcare systems.