Exercise capacity and mortality in hypertensive men with and without additional risk factors.
Open accessAbstract
We assessed the association between exercise capacity and mortality in hypertensive men with and without additional cardiovascular risk factors. A cohort of 4631 hypertensive veterans, who successfully completed a graded exercise test at the Veterans Affairs Medical Center in Washington, DC, and Palo Alto, California, was followed for 7.7±5.4 years (35 629 person-years) for all-cause mortality. Fitness categories were established based on peak metabolic equivalent (MET) levels achieved. In each fitness category, we defined individuals with and without additional cardiovascular risk factors. Exercise capacity was the strongest predictor of all-cause mortality. The adjusted mortality risk was 13% lower for every 1-MET increase in exercise capacity. Compared with the very low fit (≤5.0 MET), the adjusted risk was 34% lower for those achieving 5.1 to 7.0 MET (low fit; hazard ratio: 0.66; CI: 0.58 to 0.76; P <0.001), 59% lower for the moderate fit (7.1 to 10.0 MET; hazard ratio: 0.41; CI: 0.35 to 0.50; P <0.001), and 71% lower for the high-fit category (>10.0 MET; hazard ratio: 0.29; CI: 0.21 to 0.40; P <0.001). Within the very-low-fit category, mortality risk was 47% higher for those with additional risk factors compared with individuals with no risk factors. This risk was eliminated for those in the next fitness category (5.1 to 7.0 MET) and was progressively reduced for the moderate and high-fit categories regardless of the presence or absence of additional risk factors. In conclusion, exercise capacity was the strongest predictor of all-cause mortality in hypertensive men. The increased risk imposed by low fitness and additional cardiovascular risk factors was eliminated by relatively small increases in exercise capacity and declined progressively with higher exercise capacity.
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The benefit of elite performance in patients with hypertension is consistent with previous data showing cardiorespiratory fitness to be the strongest factor associated with survival in these patients.
“The benefit of elite performance in patients with hypertension is consistent with previous data showing CRF to be the strongest factor associated with survival in these patients, more so than any other clinical risk factors.9”
From Association of Cardiorespiratory Fitness with Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing (2018) · cites this paper as [9]
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- Authors
- Kokkinos, P., Manolis, A., Pittaras, A., Doumas, M., Giannelou, A., Panagiotakos, D. B., Faselis, C., Narayan, P., Singh, S., & Myers, J.
- Affiliations
- Georgetown University (US)
- ORCID
- Venue
- Hypertension
- Published
- 2009-03
- Volume
- 53
- Issue
- 3
- Pages
- 494-499
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2096662870
- Cited by
- 120
- References
- 40
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 5 · 2023: 6 · 2022: 8 · 2021: 4 · 2020: 6 · 2019: 7 · 2018: 5 · 2017: 6 · 2016: 12 · 2015: 10 · 2014: 18 · 2013: 5 · 2012: 8
- FWCI
- 17.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs (IK6 RX002477)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- exercise capacity, all-cause mortality, cardiovascular risk factors, peak metabolic equivalents, physical fitness, veterans, incremental exercise test, cardiovascular risk stratification
- MeSH terms
- Adult, Aged, Antihypertensive Agents, Blood Pressure, California, Cardiovascular Diseases, District of Columbia, Follow-Up Studies, Hospitals, Veterans, Humans, Hypertension, Longitudinal Studies, Male, Middle Aged, Physical Endurance, Physical Fitness, Risk Factors, Exercise Tolerance
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