Maintaining a favorable oxidative balance may be key to longer survival in hypertension, with new evidence linking it to reduced all-cause and cardiovascular mortality.

A cohort study published in Frontiers in Cardiovascular Medicine investigated the relationship between oxidative balance and mortality in adults with hypertension using NHANES data from 1999 to 2018. Mortality outcomes were obtained from the National Death Index. Oxidative Balance Score (OBS) incorporated 20 nutrition and lifestyle factors. Low-grade systemic inflammation (NLR, SIRI) and multi-organ function (eGFR, UACR, FIB-4, SUA) were evaluated as potential mediators.

Participants in the highest OBS quartile (Q4) had lower all-cause mortality (HR 0.72; 95% CI 0.59–0.88; P = 0.001) and cardiovascular mortality (HR 0.64; 95% CI 0.42–0.99; P = 0.044) compared with in Q1. Risk reduction was more pronounced in individuals with controlled hypertension (all-cause HR 0.43; 95% CI 0.27–0.69) than in uncontrolled hypertension (all-cause HR 0.82; 95% CI 0.66–0.87), with a significant interaction confirmed by sensitivity analyses. Nutrition-OBS reduced all-cause mortality by 31%, and Lifestyle-OBS decreased cardiovascular mortality by 45%. Mediation analysis revealed partial contribution from systemic inflammation and multi-organ function.

The findings suggest that higher oxidative balance is associated with improved survival in hypertensive adults, particularly when blood pressure is controlled. The results also highlight inflammation and organ health as potential pathways in this association.