Association Between Aerobic Physical Activity and Hypertension Among U.S. Adults: A Cross-Sectional Analysis of NHANES (National Health and Nutrition Examination Survey) 2021-2023

Background Hypertension continues to be a principal modifiable risk factor for cardiovascular disease and premature mortality in the United States. Current clinical guidelines recommend regular aerobic physical activity for the prevention and management of hypertension; however, contemporary population-level estimates from recent nationally representative data remain useful for evaluating whether established associations persist. This study evaluated the association between leisure-time aerobic physical activity and blood pressure-defined hypertension among U.S. adults. Methods We conducted a cross-sectional analysis of adults aged ≥18 years using data from the National Health and Nutrition Examination Survey (NHANES) 2021-2023. Participants with complete physical activity data and valid blood pressure measurements were included. Aerobic physical activity was categorized according to adherence to the Physical Activity Guidelines for Americans (≥150 minutes/week of moderate-intensity equivalent activity). Hypertension was defined as a mean systolic blood pressure ≥130 mmHg or a mean diastolic blood pressure ≥80 mmHg, based on up to three standardized oscillometric measurements. Antihypertensive medication use was not assessed and was not incorporated into this case definition. Survey-weighted multivariable logistic regression was performed to evaluate the association between meeting aerobic physical activity recommendations and hypertension after adjustment for age, sex, race/ethnicity, smoking status, alcohol consumption, household income, and educational attainment. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Results The analytic sample included 6,123 participants, representing approximately 245 million U.S. adults. Overall, 3,254 participants (54.7% weighted) met recommended aerobic physical activity guidelines, and 2,465 participants (37.5% weighted) met criteria for hypertension. Hypertension prevalence was lower among adults meeting activity recommendations than among those who did not (1,210 participants, 34.4% weighted vs. 1,255 participants, 41.2% weighted). In unadjusted analyses, meeting aerobic activity guidelines was associated with lower odds of hypertension (OR, 0.75; 95% CI, 0.67-0.84). This association remained statistically significant after multivariable adjustment (adjusted OR, 0.79; 95% CI, 0.62-0.99; p=0.044). Age demonstrated the strongest association with hypertension, with adults aged ≥60 years having significantly greater odds of hypertension than those aged 18-39 years (adjusted OR, 2.35; 95% CI, 1.44-3.82). No significant effect modification was found across the subgroups examined. Conclusions In this nationally representative sample of U.S. adults, leisure-time aerobic physical activity meeting recommended levels was independently associated with lower adjusted odds of blood pressure-defined hypertension after adjustment for demographic, socioeconomic, and behavioral factors. Although the cross-sectional design precludes causal inference, physical activity was self-reported, and antihypertensive medication use was not incorporated into the hypertension case definition, these data support current guideline recommendations advocating regular aerobic physical activity as an important component of cardiovascular health.