title: A prospective study of muscular strength and all-cause mortality in men with hypertension.
abstract: OBJECTIVE
  This study sought to assess the impact of muscular strength on mortality in men with hypertension.
  
  
  BACKGROUND
  Muscular strength is inversely associated with mortality in healthy men, but this association has not been examined in men with hypertension.
  
  
  METHODS
  We followed 1,506 hypertensive men age 40 years and older enrolled in the Aerobics Center Longitudinal Study from 1980 to 2003. Participants received an extensive medical examination at baseline. Muscular strength was quantified by combining 1 repetition maximum (1-RM) measures for leg and bench press and cardiorespiratory fitness assessed by maximum exercise test on a treadmill.
  
  
  RESULTS
  During an average follow-up of 18.3 years, 183 deaths occurred. Age-adjusted death rates per 10,000 person-years across incremental thirds of muscular strength were 81.8, 65.5, and 52.0 (p < 0.05 for linear trend). Multivariable Cox regression hazard ratios were 1.0 (reference), 0.81 (95% confidence interval [CI]: 0.57 to 1.14), and 0.59 (95% CI: 0.40 to 0.86) across incremental thirds of muscular strength. After further adjustment for cardiorespiratory fitness, those participants in the upper third of muscular strength still had a lower risk of death (hazard ratio [HR]: 0.66; 95% CI: 0.45 to 0.98). In the muscular strength and CRF combined analysis, men simultaneously in the upper third of muscular strength and high fitness group had the lowest mortality risk among all combination groups (HR: 0.49; 95% CI: 0.30 to 0.82), with men in the lower third of muscular strength and low fitness group as reference.
  
  
  CONCLUSIONS
  High levels of muscular strength appear to protect hypertensive men against all-cause mortality, and this is in addition to the benefit provided by cardiorespiratory fitness.
authors.affiliation: Department of Medical Physiology, School of Medicine, University of Granada, Granada, Spain. artero@ugr.es
authors.forename: Enrique G
authors.initials: EG
authors.lastname: Artero
authors.forename: Duck-chul
authors.initials: DC
authors.lastname: Lee
authors.forename: Jonatan R
authors.initials: JR
authors.lastname: Ruiz
authors.forename: Xuemei
authors.initials: X
authors.lastname: Sui
authors.forename: Francisco B
authors.initials: FB
authors.lastname: Ortega
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Church
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Lavie
authors.forename: Manuel J
authors.initials: MJ
authors.lastname: Castillo
authors.forename: Steven N
authors.initials: SN
authors.lastname: Blair
mesh_terms: D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000453:epidemiology; D003971:Diastole; D005080:Exercise Test; D006801:Humans; D006973:Hypertension / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D053580:Muscle Strength; D010809:Physical Fitness; D011446:Prospective Studies; D057185:Sedentary Behavior; D013599:Systole; D014481:United States / Q000453:epidemiology
chemical_list: D001786:Blood Glucose