Association of Cardiovascular Risk Factors and Lifestyle Behaviors With Hypertension: A Mendelian Randomization Study

Hypertension. 2020 Dec;76(6):1971-1979. doi: 10.1161/HYPERTENSIONAHA.120.15761. Epub 2020 Nov 2.


Hypertension is a major risk factor for cardiovascular disease and mortality. To identify targets for the prevention of hypertension and its associated disease burden, we used the 2-sample Mendelian randomization method to investigate the causal associations of 18 cardiovascular risk factors and lifestyle behaviors with hypertension. From European-descent genome-wide association studies, we selected genetic variants (P<5×10-8) for type 2 diabetes, fasting glucose, lipids, body mass index, smoking, alcohol and coffee consumption, physical activity, sleep duration, insomnia, and educational level. We extracted the genetic associations with hypertension from 2 European cohorts: the FinnGen Study (15 870 cases and 74 345 controls) and UK Biobank (54 358 cases and 408 652 controls). The inverse-variance weighted method was used as main analysis method. Genetically predicted triglycerides (pooled odds ratio [OR] per 1 SD, 1.17 [1.10-1.25]), body mass index (OR per 1 SD, 1.42 [1.37-1.48]), alcohol dependence (OR, 1.10 [1.06-1.13]), and insomnia (OR, 1.17 [1.13-1.20]) were associated with a higher odds of hypertension. Higher genetically predicted high-density lipoprotein cholesterol (OR per 1 SD, 0.88 [0.83-0.94]) and educational level (OR per 1 SD, 0.56 [0.54-0.59]) were associated with a lower odds of hypertension. Suggestive evidence was obtained for type 2 diabetes, smoking initiation and alcohol consumption with a higher hypertension odds, and longer sleep duration with a lower hypertension odds. This Mendelian randomization study identified high-density lipoprotein cholesterol, triglycerides, body mass index, alcohol dependence, insomnia, and educational level as causal risk factors for hypertension. This implicates that these modifiable risk factors are important targets in the prevention of hypertension.

Keywords: education; hypertension; lifestyle; risk factors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Alcohol Drinking
  • Body Mass Index
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / genetics*
  • Cardiovascular Diseases / physiopathology
  • Diabetes Mellitus, Type 2 / genetics*
  • Diabetes Mellitus, Type 2 / physiopathology
  • European Continental Ancestry Group / genetics
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Genetic Predisposition to Disease / genetics*
  • Genome-Wide Association Study / methods*
  • Heart Disease Risk Factors
  • Humans
  • Hypertension / diagnosis
  • Hypertension / genetics
  • Hypertension / physiopathology
  • Life Style*
  • Lipids / blood
  • Male
  • Mendelian Randomization Analysis / methods*
  • Polymorphism, Single Nucleotide
  • Smoking


  • Lipids