Key result
Vigorous physical activity linked to ~21% lower CV event risk in high-risk hypertension.
Why the study?
Physical activity is recommended to lower morbidity and mortality in hypertension, but its association with clinical outcomes in high-risk hypertension is understudied.
Does engaging in minimum thresholds of vigorous or moderate physical activity reduce cardiovascular events and all-cause mortality in older adults with high-risk hypertension?
Cohort (n=8,320)
Yes
Does engaging in minimum thresholds of vigorous or moderate physical activity reduce cardiovascular events and all-cause mortality in older adults with high-risk hypertension?
Hazard Ratio: 0.79 (95% CI 0.65–0.94)
Absolute Event Rate: 7% vs 8.9%
p-value: p=0.009
Even low thresholds of physical activity (≥1 vigorous session/month or ≥15 mins moderate activity/day) offer significant cardiovascular and mortality benefits for older adults with high-risk hypertension.
May support minimal vigorous activity thresholds in high-risk hypertension; leaves open prospective confirmation before practice change.
Objective: Engaging in physical activity (PA) is recommended to reduce the risk of morbidity and mortality in patients with hypertension. However, the association between PA and clinical outcomes in individuals with high-risk hypertension is understudied. We examined the relationship between PA and clinical outcomes in the Systolic Blood Pressure Intervention Trial (SPRINT). SPRINT investigated the benefit of intensive (vs. standard) blood pressure treatment in patients with high-risk hypertension. Methods: Baseline data on PA was self-reported. Vigorous-intensity PA (VPA) was categorized into 2 groups based on frequency of "Rarely or Never" and 1 or more sessions/month. Moderate-intensity PA (MPA) was also categorized into 2 groups based on average duration/day of <15 min and 15 or more minutes. Using multivariable Cox regression, we estimated the associations between PA the primary outcome which was a composite of cardiovascular events, and all-cause mortality. Results: A total of 8,320 (age 67.8 ± 9.3, 34.9% women) of SPRINT participants with data on PA were included. During a median follow-up of 3.8 years, 619 primary outcome, and 419 all-cause mortality events occurred. Compared to not engaging in VPA, the risk of the primary outcome, myocardial infarction, and all-cause mortality (HR 95% CIs) associated with VPA of ≥1sessions/month was 0.79(0.65-0.94; p=0.009), 0.70(0.52-0.93; p=0.014) and 0.75(0.60-0.94; p=0.011), respectively. Similarly, the risk of the primary outcome and all-cause mortality (HR 95% CI) associated with engaging in MPA for ≥15 min/day, relative to <15 min/day was 0.76(0.63-0.93; p=0.008) and 0.80(0.62-1.02; p=0.066), respectively. Conclusion: Among individuals with hypertension from the SPRINT study, VPA and MPA at a threshold of ≥1sessions/month and MPA of ≥15 min/day respectively, were both associated with a lower risk for cardiovascular events, and VPA was also associated with a reduced risk for all-cause mortality. Further studies are required to identify the optimal volume and intensity of PA in high-risk hypertension.
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Kazibwe et al. (2023) conducted a cohort in High-risk hypertension (n=8,320). Vigorous-intensity physical activity (VPA) ≥1 session/month vs. Rarely or never engaging in vigorous-intensity physical activity was evaluated on Composite of myocardial infarction, other acute coronary syndromes, stroke, acute decompensated heart failure, or death from cardiovascular causes (HR 0.79, 95% CI 0.65-0.94, p=0.009). Engaging in vigorous-intensity physical activity for ≥1 session per month was associated with a 21% lower risk of composite cardiovascular events compared to rare or no vigorous physical activity (HR 0.79) in individuals with high-risk hypertension.
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