title: Usefulness of cardiorespiratory fitness as a predictor of all-cause and cardiovascular disease mortality in men with systemic hypertension.
abstract: There is an inverse gradient of mortality across levels of cardiorespiratory fitness in healthy adults; however, the association of fitness to mortality in persons with comorbidities such as hypertension is not fully understood. This study quantifies the relation of cardiorespiratory fitness to all-cause mortality and cardiovascular disease (CVD) mortality in hypertensive men. In this observational cohort study, we calculated death rates for low, moderate, and high fitness categories in normotensive (n = 15,726) and hypertensive (n = 3,184) men, and in men without a history of hypertension but with elevated blood pressure (BP) (systolic BP > or = 140 or diastolic BP > or = 90 mm Hg) at baseline (n = 3,257). The participants were 22,167 men (average age 42.6 +/- 9.2 years [mean +/- SD]) who underwent a medical examination that included a maximal exercise test during 1970 to 1993, with mortality follow-up to December 31, 1994. We identified 628 deaths (188 from CVD) during 224,173 man-years of observation. There was an inverse linear trend across fitness groups for all-cause and CVD mortality. The relative risk (95% confidence interval [CI]), using the low fitness group as reference, for all-cause mortality in hypertensive men was 0.45 (95% CI 0.31 to 0.65) and 0.42 (95% CI 0.27 to 0.66) for moderate and high fitness groups, respectively, and in men with elevated BP, 0.49 (95% CI 0.34 to 0.70) and 0.44 (95% CI 0.29 to 0.68) for moderate and high fitness groups, respectively. The pattern of results was similar for CVD mortality. There was an inverse linear relation between fitness and death rate for all-cause mortality in both the uncontrolled and controlled hypertensive groups. This study provides evidence that moderate to high levels of cardiorespiratory fitness provide protection against all-cause and CVD mortality in hypertensive men and men without a history of hypertension but with elevated BP at examination.
authors.affiliation: The Cooper Institute, Dallas, Texas 75230, USA. tchurch@cooperinst.org
authors.forename: T S
authors.initials: TS
authors.lastname: Church
authors.forename: J B
authors.initials: JB
authors.lastname: Kampert
authors.forename: L W
authors.initials: LW
authors.lastname: Gibbons
authors.forename: C E
authors.initials: CE
authors.lastname: Barlow
authors.forename: S N
authors.initials: SN
authors.lastname: Blair
mesh_terms: D000328:Adult; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000517:prevention & control; D002320:Cardiovascular Physiological Phenomena; D002423:Cause of Death; D005080:Exercise Test; D006801:Humans; D006973:Hypertension / Q000401:mortality* / Q000517:prevention & control; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012143:Respiratory Physiological Phenomena; D013781:Texas / Q000453:epidemiology