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