Abstract Body: Background:
Hypertension remains a leading modifiable risk factor for cardiovascular disease, yet many U.S. adults fail to achieve adequate blood pressure (BP) control. The American Heart Association’s Life’s Essential 8 (LE8) provides a comprehensive measure of cardiovascular health: diet, physical activity, smoking, sleep health, body mass index, blood lipids, blood glucose, and blood pressure. This study evaluates the association between LE8 and BP control among hypertensives in the newest NHANES cycle. To avoid circularity with the outcome, we excluded BP from the LE8 composite (LE8_noBP).

Methods:
We analyzed 6,317 U.S. adults aged ≥18 years with hypertension in NHANES 2021–2023. Hypertension was defined as mean systolic BP ≥130 mmHg, diastolic BP ≥80 mmHg, or self-reported diagnosis/medication use. Uncontrolled hypertension was defined categorically as systolic BP ≥130 or diastolic BP ≥80 mmHg despite diagnosis or treatment. LE8 scores (0–100) were calculated for all components. Analyses used the LE8_noBP composite, categorizing scores as Low (<50), Moderate (50–79), and High (≥80). Survey-weighted logistic regression estimated associations between LE8_noBP and uncontrolled hypertension, adjusting for age, sex, race/ethnicity, education, and income-to-poverty ratio.

Results:
Of 6,317 adults with hypertension, 1,714 had uncontrolled hypertension (unweighted prevalence: 27.1%). The weighted prevalence of uncontrolled hypertension was 24.7% (SE 0.8%). Mean LE8_noBP scores were lower among adults with uncontrolled vs controlled hypertension (59.2 vs 63.5). In adjusted models, each 10-point higher LE8_noBP score was associated with 15% lower odds of uncontrolled hypertension (OR 0.85, 95% CI 0.82–0.89). Compared with the Low group, Moderate (OR 0.62, 95% CI 0.52–0.74) and High (OR 0.35, 95% CI 0.23–0.54) categories had significantly lower odds of uncontrolled hypertension, demonstrating a dose-response relationship.

Conclusion:
Among U.S. adults with hypertension in NHANES 2021-2023, higher LE8_noBP scores were strongly associated with greater BP control. By excluding blood pressure from the composite, we ensured that associations reflect the contribution of lifestyle and non-blood pressure cardiovascular health metrics. These findings underscore the importance of promoting comprehensive cardiovascular health behaviors to improve hypertension control.