title: A graded association of exercise capacity and all-cause mortality in males with high-normal blood pressure.
abstract: BACKGROUND
  Information regarding the effect of exercise capacity on mortality risk in individuals with high-normal blood pressure is severely limited. Thus, we evaluated the association of exercise capacity and all-cause mortality in individuals with high-normal blood pressure.
  
  
  METHODS
  Exercise test was performed in 1727 males with high-normal blood pressure at two Veteran sites (Washington, DC, and Palo Alto, CA). Fitness status was assessed in metabolic equivalents (METs) at exercise peak. All-cause mortality was recorded for a mean follow-up period of 9.8+/-6.0 years.
  
  
  RESULTS
  Exercise capacity was inversely associated with all-cause mortality, and the association was independent of traditional cardiovascular risk factors. For each 1 MET increase in exercise capacity, the adjusted mortality risk was reduced by 13%, underscoring the strong predictive value of exercise capacity that was confirmed by ROC analysis. Data analysis according to fitness levels revealed a threshold level of 4 METs, over which the mortality risk was progressively reduced by 30% (hazard ratio=0.70; CI 0.51-0.95) for those who achieved 4.1-6.0 METs and 61% (hazard ratio=0.39; CI 0.26-0.57) for those who achieved 8.1-10 METs. No additional reductions in risk were noted until the MET level achieved exceeded 12 METs.
  
  
  CONCLUSIONS
  We observed a strong, inverse, graded and independent association between exercise capacity and all-cause mortality in individuals with high-normal blood pressure. Our findings indicate that a shift of the fitness curve to the right is associated with significant survival benefits, and even slight differences in fitness levels are associated with substantial reductions in mortality risk.
authors.affiliation: Veterans Affairs Medical Center, Washington, DC 20422, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Kokkinos
authors.forename: Michael
authors.initials: M
authors.lastname: Doumas
authors.forename: Jonathan
authors.initials: J
authors.lastname: Myers
authors.forename: Charles
authors.initials: C
authors.lastname: Faselis
authors.forename: Athanasios
authors.initials: A
authors.lastname: Manolis
authors.forename: Andreas
authors.initials: A
authors.lastname: Pittaras
authors.forename: John Peter
authors.initials: JP
authors.lastname: Kokkinos
authors.forename: Vasilios
authors.initials: V
authors.lastname: Papademetriou
authors.forename: Steven
authors.initials: S
authors.lastname: Singh
authors.forename: Ross D
authors.initials: RD
authors.lastname: Fletcher
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010809:Physical Fitness; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate