Controlled hypertension confers CV event risk, but physical activity may help
Controlled hypertension was associated with higher risk for major adverse cardiac and cerebrovascular events and all-cause mortality compared with normotension, according to results published in Heart.
However, physical activity mitigated some of the risk in the controlled hypertension population, according to the researchers.
“Current guidelines suggest moderate or moderate to vigorous physical activity as one of the lifestyle modification strategies for patients with hypertension. On the other hand, evidence showing whether physical activity should be equally emphasized even for patients with controlled hypertension is relatively scarce,” Sehoon Park, MD, from the department of biomedical sciences at Seoul National University College of Medicine, South Korea, and the department of internal medicine at the Armed Forces Capital Hospital in Gyeonggi-do, South Korea, and colleagues wrote. “Our findings suggest that reducing average BP values may not be the sole benefit of exercising, and the benefits of physical activity may be present in those who already achieved normal BP values or even in those without hypertension.”
For the observational cohort study, researchers evaluated 220,026 individuals aged 40 to 60 years from the prospective UK Biobank (UKB) cohort and from the retrospective Korean National Health Insurance Service (KNHIS) cohort. Both study groups were stratified into normotension (UKB, n = 161,405; KNHIS, n = 3,122,890), controlled hypertension (systolic BP < 140 mm Hg and diastolic BP < 90 mm Hg; UKB, n = 18,844; KNHIS, n = 383,828) and uncontrolled hypertension (UKB, n = 39,777; KNHIS, n = 86,484).
The primary outcomes were major adverse cardiac and cerebrovascular events and all-cause mortality. Major adverse cardiac and cerebrovascular events were defined as MI, cardiac death and ischemic stroke in the UKB cohort and MI, revascularization and acute ischemic stroke in the KNHIS cohort.
In the controlled hypertension group, compared with individuals with normotension, there was a significantly higher risk for major adverse cardiac and cerebrovascular events in the UKB cohort (adjusted HR = 1.73; 95% CI, 1.55-1.92) and the KNHIS cohort (aHR = 1.46; 95% CI, 1.43-1.49) and all-cause mortality in the UKB cohort (aHR = 1.28; 95% CI, 1.18-1.39) and the KNHIS cohort (aHR = 1.29; 95% CI, 1.26-1.32).
Participants in the controlled hypertension group not involved in any moderate or moderate to vigorous physical activity had elevated risk for poor outcomes (P < .001 for all except P = .08 for major adverse cardiac and cerebrovascular events in frequent exercisers in the UKB cohort), which was similar to or higher than the risk for poor outcomes in patients with uncontrolled hypertension who were involved in physical activity, according to the researchers.
“The importance of moderate or moderate to vigorous physical activity may be consistently emphasized, even for patients with hypertension who have reached target BP levels or for individuals with normotension,” the researchers wrote.