Identification of modifiable risk factors is essential for the primary prevention of hypertension. However, large population-based estimates quantifying the contribution of multiple lifestyle and metabolic factors to incident hypertension remain limited. A cohort analysis using the DeSC database evaluated the population attributable fraction (PAF) for several modifiable risk factors in relation to new-onset hypertension in Japan. The study was published in the Hypertension Research.

The analysis included 1,069,948 participants without a prior diagnosis of hypertension. The median age was 56 years and 43.7% were men. Using Cox proportional hazards models, the study assessed associations between several modifiable risk factors—obesity, diabetes mellitus, dyslipidemia, smoking, habitual alcohol consumption, physical inactivity, and sleep disorders—and the development of hypertension.

During a median follow-up of 3.64 years, 116,690 participants were newly diagnosed with hypertension. Among evaluated risk factors, obesity had the largest population attributable fraction at 6.36%, followed by sleep disorders (4.11%), current smoking (3.39%), dyslipidemia (2.74%), habitual alcohol consumption (2.10%), physical inactivity (1.93%), and diabetes mellitus (1.55%). The contribution of obesity varied across demographic groups. The PAF of obesity declined with increasing age, ranging from 15.10% in individuals younger than 40 years to 7.93% among those aged 40–64 years and 3.70% among individuals aged 65 years or older. Obesity-related PAF was higher in men (7.93%) than in women (5.02%).

These findings show that obesity accounted for the largest proportion of incident hypertension by PAF in this population. The impact of modifiable risk factors appears more pronounced in younger adults and men.