Physical activity and incident hypertension in relation to anthropometric and liver-related indices during 5-year follow-up in the Azar Cohort Study

Q: What are the key findings of this study?

Higher physical activity was associated with a lower risk of incident hypertension (RR 0.91), an association that was partially mediated by anthropometric and liver-related indices.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension (n=11754). Intervention: Physical activity vs. Lower physical activity. Primary outcome: Incident hypertension (RR 0.91, 95% CI 0.89-0.94, p=<0.001).

Q: What does this research mean for the field?

Higher physical activity is inversely associated with incident hypertension, an association partially mediated by anthropometric and liver-related indices, with anthropometric measures showing a stronger mediating effect. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess the association between physical activity and incident hypertension, and to evaluate the mediating roles of anthropometric and liver-related indices over a 5-year follow-up.

Rouhollah Haghshenas; Mohammad Hossein Somi; Elnaz Faramarzi

doi:10.1038/s41598-026-75551-8

October 11, 2026Scientific ReportsOpen Access

Physical activity and incident hypertension in relation to anthropometric and liver-related indices during 5-year follow-up in the Azar Cohort Study

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Key result

Higher physical activity linked to ~9% lower risk of incident hypertension.

RR 0.91
95% CI 0.89-0.94
P<0.001
n=11,754

Why the study?

The association between physical activity and incident hypertension and the mediating roles of anthropometric and liver-related indices were not well characterized in a large cohort.

Does higher physical activity reduce incident hypertension in adults, and is this mediated by anthropometric and liver-related indices?

Key Points

To assess the association between physical activity and incident hypertension, and to evaluate the mediating roles of anthropometric and liver-related indices over a 5-year follow-up.
Analyzed prospective data from 11,754 adults without baseline hypertension from the Azar Cohort Study.
Assessed physical activity using a validated metabolic equivalent of task questionnaire along with 15 anthropometric and 9 liver-related indices.
Applied generalized structural equation modeling to evaluate direct associations and indirect mediation effects.
Higher physical activity was associated with lower hypertension risk (RR = 0.91, 95% CI: 0.89–0.94, P < 0.001), while higher anthropometric indices (RR = 1.92, 95% CI: 1.81–1.99, P < 0.001) and liver indices (RR = 1.21, 95% CI: 1.19–1.23, P < 0.001) were associated with higher risk.
Anthropometric indices and liver indices partially mediated the relationship, accounting for 53.64% and 34.95% of the observed physical activity–hypertension association, respectively.
After adjusting for mediators, each one-unit increase in metabolic equivalent of task remained significantly associated with a 6% reduction in hypertension risk (RR = 0.94, 95% CI: 0.91–0.96, P < 0.001).

Study Design

Type

Cohort (n=11,754)

Structured PICO

Does higher physical activity reduce incident hypertension in adults, and is this mediated by anthropometric and liver-related indices?

P

Population

11,754 adults aged 35 to 70 years without baseline hypertension from the Azar cohort, followed for 5 years to evaluate the association between physical activity and incident hypertension.

E

Exposure

Higher levels of physical activity (PA), measured via a validated self-reported questionnaire to estimate energy expenditure in Metabolic Equivalent of Task (MET-hr/week).

O

Outcome

Incident hypertension (HTN) during 5-year follow-up (determined by self-reports, physician diagnoses, prescribed medications, and confirmation by the cohort physician).

Main Result

Relative Risk: 0.91 (95% CI 0.89–0.94)

p-value: p=<0.001

Limitations

Study population limited to a specific region, which may affect generalizability
Physical activity was assessed using a self-reported questionnaire, subject to recall bias and potential misclassification
Physical activity was measured only at baseline and not updated during follow-up
Residual confounding cannot be completely ruled out
Observational design does not allow for causal inference
Self-reported components in hypertension determination

Implication

Higher physical activity is independently associated with a lower incidence of hypertension, a relationship that is partially mediated by anthropometric and liver-related indices.

Abstract

Hypertension (HTN) is a major global public health concern. This study examined the association between physical activity (PA) and incident HTN, focusing on the mediating roles of anthropometric (AI) and liver-related indices (LI) in the Azar cohort. Data from 11,754 adults without baseline HTN were analyzed. Fifteen anthropometric and nine liver-related indices were assessed using standard protocols. PA was measured via a validated questionnaire based on metabolic equivalent of task (MET). Generalized Structural Equation Modeling (GSEM) was applied to evaluate direct and indirect associations. Results Individuals with HTN were older and had higher anthropometric and liver-related measures, while PA levels were lower (P < 0.001). Higher PA was associated with a lower risk of HTN (RR = 0.91, 95% CI:0.89–0.94), whereas higher AI (RR = 1.92, 95% CI:1.81–1.99) and LI (RR = 1.21, 95% CI:1.19–1.23) were associated with a higher risk of HTN. AI and LI accounted for part of the observed PA–HTN association, with a stronger contribution from AI than LI (53.64% vs. 34.95%). After accounting for the mediators, the association between PA and HTN remained significant (RR = 0.94, 95% CI:0.91–0.96). The association remained significant after adjustment; each one-unit increase in MET was linked to a 6% lower HTN risk (RR = 0.94, 95% CI: 0.91–0.96). PA was inversely associated with HTN risk, with anthropometric factors accounting for a greater proportion of the observed association than liver-related factors. The partial mediation suggests that other factors may also contribute to this association.

Discussion

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Cite This Study

Haghshenas et al. (2026) conducted a cohort in Hypertension (n=11,754). Physical activity vs. Lower physical activity was evaluated on Incident hypertension (RR 0.91, 95% CI 0.89-0.94, p=<0.001). Higher physical activity was associated with a lower risk of incident hypertension (RR 0.91), an association that was partially mediated by anthropometric and liver-related indices.

synapsesocial.com/papers/6acda56697e176cf4084dce2 https://doi.org/10.1038/s41598-026-75551-8

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Physical activity and incident hypertension in relation to anthropometric and liver-related indices during 5-year follow-up in the Azar Cohort Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Physical activity and incident hypertension in relation to anthropometric and liver-related indices during 5-year follow-up in the Azar Cohort Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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