Key result
Engaging in ≥50% vigorous-intensity physical activity is linked to ~15% lower all-cause mortality in hypertension.
Why the study?
Whether higher volumes of physical activity and a greater proportion of vigorous-intensity physical activity within total volume reduce risks of MACE and mortality in hypertensive adults remains unclear.
Does higher physical activity volume and proportion of vigorous-intensity physical activity reduce all-cause mortality and MACE in adults with hypertension?
Cohort (n=124,370)
Yes
Does higher physical activity volume and proportion of vigorous-intensity physical activity reduce all-cause mortality and MACE in adults with hypertension?
Hazard Ratio: 0.85 (95% CI 0.78–0.93)
In adults with hypertension, both higher total physical activity volume and a greater proportion of vigorous-intensity activity are associated with reduced risks of mortality and major adverse cardiovascular events.
Supports vigorous activity emphasis in hypertension; hypothesis-generating pending randomized confirmation of mortality benefit.
Background: Whether higher volumes of physical activity (PA) and a greater proportion of vigorous-intensity physical activity (VPA) within total PA volume are associated with lower risks of major adverse cardiovascular events (MACE) and mortality remains unclear. This study aimed to examine the associations of total PA volume and the proportion of VPA within total PA volume with all-cause mortality and MACE among adults with hypertension. Methods: This nationwide cohort study included 124,370 adults with hypertension from the Korean National Health Insurance Service database (2009-2012), with follow-up through 2019. MACE was defined as a composite of cardiovascular disease (CVD) mortality, myocardial infarction (MI), and ischemic stroke. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause mortality and MACE. Results: During a median follow-up of 9.1 years, 11,063 deaths occurred. Higher PA volumes were associated with stepwise reductions in all-cause and CVD mortality. In contrast, risk reductions for ischemic stroke plateaued at higher volumes, whereas reductions in MI risk were evident primarily at the highest volumes. Among 91,113 participants who engaged in any PA, a higher proportion of VPA was associated with lower risks of all-cause mortality (HR, 0.92; 95% confidence interval [CI], 0.87-0.98 for < 50% VPA and HR, 0.85; 95% CI, 0.78-0.93 for ≥ 50% VPA), MI (HR, 0.77; 95% CI, 0.67-0.89 and HR, 0.71; 95% CI, 0.58-0.86, respectively), and ischemic stroke (HR, 0.84; 95% CI, 0.76-0.92 for ≥ 50% VPA) after adjusting for total PA volume. No significant associations were observed between the proportion of VPA and CVD mortality. Conclusions: Among adults with hypertension, a higher PA volume was associated with lower risks of all-cause and CVD mortality. Additionally, a greater proportion of VPA, after accounting for total PA volume, was associated with lower risks of MI and ischemic stroke. These findings suggest that both PA volume and intensity composition may be relevant for cardiovascular risk reduction in individuals with hypertension.
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Choi et al. (2026) conducted a cohort in hypertension (n=124,370). Higher proportion of vigorous-intensity physical activity (VPA) vs. Lower proportion of VPA was evaluated on All-cause mortality and MACE (composite of cardiovascular disease mortality, myocardial infarction, and ischemic stroke) (HR 0.85, 95% CI 0.78-0.93). Among adults with hypertension, engaging in ≥50% vigorous-intensity physical activity was associated with lower all-cause mortality (HR 0.85; 95% CI 0.78-0.93).
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