Hypertension is a major cardiovascular disease. The relationship between Life's Essential 8 (LE8) score, a newly developed cardiovascular health metric, and hypertension risk remains unclear.

This study aimed to investigate the association between LE8 score and hypertension risk in the rural and pastoral population of Altay Prefecture, Xinjiang.

From October to November 2023, 27 natural villages were selected in Altay Prefecture using Proportionate to Population Size (PPS) systematic sampling. Eligible residents in the included natural villages were recruited for questionnaire surveys, physical examinations, and laboratory index tests. The LE8 score includes 4 health behaviors (diet, physical activity, nicotine exposure, sleep) and 4 health factors (BMI, blood lipids, blood glucose, blood pressure). In this study, the LE8 score was calculated based on the remaining 7 components excluding blood pressure. The LE8 score, subscales and components were divided into low group (0-49 points), medium group (50-79 points) and high group (80-100 points) according to their scores. A restrictive cubic spline plot was used to plot the dose-response curves of LE8, health factors and health behavior scores and hypertension. A multivariate logistic regression model was used to analyze its effect on the prevalence of hypertension.

A total of 2 872 study subjects were included in this study. Among the study subjects, 1 540 patients with hypertension were detected, yielding a crude prevalence of 53.62% and an age-standardized prevalence of 34.64%. The prevalence of hypertension was 61.13% in men (766/1 253) and 47.81% (774/1 619) in women, and the prevalence of hypertension in men was higher than that in women (P<0.05). In terms of LE8 score, the difference between the hypertensive group and the normal blood pressure group was statistically significant (P<0.05). After adjusting for confounders, the intermediate and high LE8 score groups had a lower risk of hypertension compared with the low score group (P<0.05). For every 10-point increase in LE8 score, the risk of hypertension decreased by 24.3% and 41.8%, respectively. A significant non-linear relationship was observed between LE8 scores and hypertension (P_{for non-linear}=0.010), while a linear relationship was found between health factor scores and hypertension (P_{for non-linear}=0.637). No significant association was observed between health behavior scores and hypertension (P>0.05). Participants with higher BMI, blood glucose, and physical activity scores had a significantly lower risk of hypertension compared to the low-score group (P<0.05). An interaction between LE8 scores and age was detected (P_{for interaction}<0.05), with a stronger effect of LE8 scores on reducing hypertension risk in individuals aged >50 years (P<0.05).

LE8 scores are non-linearly associated with hypertension risk. Maintaining higher LE8 scores can reduce the burden of hypertension, particularly in individuals aged ≥50 years.