Exercise capacity and mortality in hypertensive men with and without additional risk factors.
We assessed the association between exercise capacity and mortality in hypertensive men with and without additional cardiovascular risk factors. A cohort of 4631 hypertensive veterans, who successfully completed a graded exercise test at the Veterans Affairs Medical Center in Washington, DC, and Palo Alto, California, was followed for 7.7+/-5.4 years (35,629 person-years) for all-cause mortality. Fitness categories were established based on peak metabolic equivalent (MET) levels achieved. In each fitness category, we defined individuals with and without additional cardiovascular risk factors. Exercise capacity was the strongest predictor of all-cause mortality. The adjusted mortality risk was 13% lower for every 1-MET increase in exercise capacity. Compared with the very low fit (< or =5.0 MET), the adjusted risk was 34% lower for those achieving 5.1 to 7.0 MET (low fit; hazard ratio: 0.66; CI: 0.58 to 0.76; P<0.001), 59% lower for the moderate fit (7.1 to 10.0 MET; hazard ratio: 0.41; CI: 0.35 to 0.50; P<0.001), and 71% lower for the high-fit category (>10.0 MET; hazard ratio: 0.29; CI: 0.21 to 0.40; P<0.001). Within the very-low-fit category, mortality risk was 47% higher for those with additional risk factors compared with individuals with no risk factors. This risk was eliminated for those in the next fitness category (5.1 to 7.0 MET) and was progressively reduced for the moderate and high-fit categories regardless of the presence or absence of additional risk factors. In conclusion, exercise capacity was the strongest predictor of all-cause mortality in hypertensive men. The increased risk imposed by low fitness and additional cardiovascular risk factors was eliminated by relatively small increases in exercise capacity and declined progressively with higher exercise capacity.
Kokkinos
Peter
P
Veterans Affairs Medical Center/Cardiology Division, 50 Irving St, NW, Washington, DC 20422, USA. peter.kokkinos@med.va.gov
Manolis
Athanasios
A
Pittaras
Andreas
A
Doumas
Michael
M
Giannelou
Angeliki
A
Panagiotakos
Demosthenes B
DB
Faselis
Charles
C
Narayan
Puneet
P
Singh
Steven
S
Myers
Jonathan
J
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002140:California / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D004219:District of Columbia / Q000453:epidemiology; D017079:Exercise Tolerance / Q000502:physiology*; D005500:Follow-Up Studies; D006787:Hospitals, Veterans; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010807:Physical Endurance / Q000502:physiology*; D010809:Physical Fitness / Q000502:physiology; D012307:Risk Factors
D000959:Antihypertensive Agents