title: The joint effects of cardiorespiratory fitness and adiposity on mortality risk in men with hypertension.
abstract: BACKGROUND
  Whether higher cardiorespiratory fitness (CRF) attenuates the mortality risk associated with higher adiposity in adults with hypertension (HTN) is poorly understood.
  
  
  METHODS
  Participants were 13,155 men (mean age, 47.7 (s.d., 9.9) years) who completed a baseline health examination and maximal treadmill exercise test during 1974-2003. All men had HTN at baseline based on resting systolic blood pressure of > or =140 mm Hg or diastolic blood pressure > or =90 mm Hg. CRF was quantified as the duration of a symptom-limited maximal treadmill exercise test, and was grouped for analysis as low (lowest 20%), moderate (middle 40%), and high (upper 40%). Distributions of body mass index (BMI), waist circumference (WC), and percent body fat (%BF) were grouped according to standard clinical guidelines.
  
  
  RESULTS
  During a mean follow-up of 12 years, 883 deaths (355 cardiovascular disease (CVD)) were recorded. Multivariate hazard ratios (HRs) (95% confidence interval) for all-cause mortality, using low-fitness as the reference group, were 0.58 (0.48-0.69) and 0.43 (0.35-0.54) for moderate-fit and high-fit groups, respectively. We observed a similar pattern for CVD mortality. High-fit/obese men had no greater risk of all-cause (1.59 (0.95-2.67)) or CVD (1.23 (0.44-3.41)) death, high-fit/abdominal-obese men had no greater risk for all-cause (1.20 (0.80-1.78)) or CVD (0.62 (0.25-1.53)) death, and high-fit/percent body fat (%BF)-obese men had no greater risk for all-cause (1.19 (0.90-1.56)) or CVD (0.86 (0.52-1.43)) death compared with their high-fit/normal counterparts.
  
  
  CONCLUSIONS
  Fitness is a powerful effect modifier in the association of adiposity to mortality in men with HTN, negating the all-cause and CVD mortality risk associated with obesity.
authors.affiliation: Department of Human Performance and Sport Sciences, Winston-Salem State University, Winston-Salem, North Carolina, USA. mcauleypa@wssu.edu
authors.forename: Paul A
authors.initials: PA
authors.lastname: McAuley
authors.forename: Xuemei
authors.initials: X
authors.lastname: Sui
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Church
authors.forename: James W
authors.initials: JW
authors.lastname: Hardin
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Myers
authors.forename: Steven N
authors.initials: SN
authors.lastname: Blair
mesh_terms: D050154:Adiposity; D000328:Adult; D015444:Exercise; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012307:Risk Factors; D044465:White People