High levels of physical fitness may reduce the risk of death from cardiovascular disease in men with high blood pressure, according to a 29-year study published today in the European Journal of Preventive Cardiology , a journal of the ESC.
"This was the first study to evaluate the joint effects of physical fitness and blood pressure on the risk of dying from cardiovascular disease," said study author Professor Jari Laukkanen of the University of Eastern Finland, Kuopio. , Finland. "The results suggest that being fit helps protect against some of the negative effects of high blood pressure."
Nearly 1.3 billion adults ages 30 to 79 worldwide have high blood pressure.
Hypertension is a major risk factor for heart attack and stroke and a leading cause of premature death worldwide. Previous studies have shown that high cardiorespiratory fitness is related to greater longevity. This study examined the interaction between blood pressure, physical fitness, and the risk of death from cardiovascular disease.
The study included 2,280 men aged 42 to 61 years who lived in eastern Finland and were enrolled in the Kuopio Ischemic Heart Disease Risk Factor Study. Baseline measurements were taken between 1984 and 1989. These included blood pressure and cardiorespiratory fitness, which was assessed as maximal oxygen consumption while riding a stationary bicycle. Blood pressure was classified as normal or high , and physical condition was classified as low, medium, or high .
The average age at the beginning of the study was 53 years . Participants were followed until 2018. During a median follow-up of 29 years , there were 644 deaths from cardiovascular disease. The risk of death from cardiovascular disease was analyzed after adjusting for age, body mass index, cholesterol levels, smoking, type 2 diabetes, coronary heart disease, use of antihypertensive medication, alcohol consumption, physical activity, socioeconomic status, and high sensitivity. C-reactive protein (a marker of inflammation).
Considering blood pressure alone , compared with normal values, high blood pressure was associated with a 39% increased risk of cardiovascular mortality (hazard ratio [HR] 1.39; confidence interval [CI] 95% 1.17–1.63). Considering fitness alone , compared with high levels, low fitness was associated with a 74% elevated odds of cardiovascular death (HR 1.74, 95% CI 1.35–2.23) .
To evaluate the joint associations of blood pressure and physical fitness with the risk of cardiovascular death, participants were classified into four groups:
1) Normal blood pressure and high physical status (this was the reference group for comparison).
2) Normal blood pressure and poor physical condition.
3) High blood pressure and good physical condition.
4) High blood pressure and poor physical condition.
Men with high blood pressure and low fitness had more than twice the risk of cardiovascular death compared to those with normal blood pressure and good fitness (HR 2.35, 95% CI 1.81–3.04) .
When men with high blood pressure had high levels of physical fitness , their elevated cardiovascular risk persisted but was weaker: it was 55% higher than those with normal blood pressure and high physical fitness (HR 1.55, 95% CI 1 ,16–2,07).
Professor Laukkanen said: “Both high blood pressure and low fitness levels were associated with an increased risk of cardiovascular death. “High levels of physical fitness attenuated, but did not eliminate, the increased risk of cardiovascular mortality in men with elevated blood pressure.”
The paper states: The inability of cardiorespiratory fitness to completely eliminate the risk of cardiovascular mortality in people with high blood pressure may be due in part to the strong, independent, and causal relationship between blood pressure and cardiovascular disease.
Professor Laukkanen concluded: “Controlling blood pressure should remain a goal for people with hypertension. Our study indicates that men with high blood pressure should also try to improve their fitness levels with regular physical activity . In addition to regular exercise, avoiding excess body weight can improve fitness.”
The ESC guidelines recommend that adults of all ages strive for at least 150 to 300 minutes per week of moderate-intensity aerobic physical activity or 75 to 150 minutes per week of vigorous-intensity aerobic physical activity, or an equivalent combination, to reduce all causes of death and cardiovascular disease.
In conclusion , high levels of systolic blood pressure (SBP) and low levels of cardiorespiratory fitness are associated with an increased risk of CVD mortality , independently of established and emerging risk factors. High levels of cardiorespiratory fitness may attenuate, but not eliminate , the increased risk of CVD mortality in people with elevated SBP. Large scale prospective studies are needed to replicate these findings and definitive trials are required to provide the highest level of evidence. |
