title: Body mass index, exercise capacity, and mortality risk in male veterans with hypertension.
abstract: BACKGROUND
  Overweight and obesity are associated with increased risk of chronic diseases and mortality. Exercise capacity is inversely associated with mortality risk. However, little is known on the interaction between fitness, fatness, and mortality risk in hypertensive individuals. Thus, we assessed the interaction between exercise capacity, fatness, and all-cause mortality in hypertensive males.
  
  
  METHODS
  A graded exercise test was performed in 4,183 hypertensive veterans (mean age ± s.d.; 63.3 ± 10.5 years) at the Veterans Affairs Medical Center, Washington, DC. We defined three body weight categories based on body mass index (BMI): normal weight (BMI <25); overweight (BMI 25-29.9); and obese (BMI ≥30); and three fitness categories based on peak metabolic equivalents (METs) achieved: low-fit (≤5 METs); moderate-fit (5.1-7.5 MET); and high-fit (>7.5 METs).
  
  
  RESULTS
  During a median follow-up period of 7.2 years, there were 1,000 deaths. The association between exercise capacity and mortality risk was strong, inverse, and graded. For each 1-MET increase in exercise capacity the adjusted risk was 20% for normal weight, 12% for overweight, and 25% for obese (P < 0.001). When compared to normal weight but unfit individuals, mortality risks were 60% lower in the overweight/high-fit and 78% lower in the obese/high-fit individuals (P < 0.001).
  
  
  CONCLUSIONS
  Increased exercise capacity is associated with lower mortality risk in hypertensive males regardless of BMI. The risk for overweight and obese but fit individuals was significantly lower when compared to normal weight but unfit. These findings suggest that in older hypertensive men, it may be healthier to be fit regardless of standard BMI category than unfit and normal weight.
authors.affiliation: Department of Medicine, Veterans Affairs Medical Center, Washington, DC, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Faselis
authors.forename: Michael
authors.initials: M
authors.lastname: Doumas
authors.forename: Demosthenes
authors.initials: D
authors.lastname: Panagiotakos
authors.forename: Raya
authors.initials: R
authors.lastname: Kheirbek
authors.forename: Lauren
authors.initials: L
authors.lastname: Korshak
authors.forename: Athanasios
authors.initials: A
authors.lastname: Manolis
authors.forename: Andreas
authors.initials: A
authors.lastname: Pittaras
authors.forename: Costas
authors.initials: C
authors.lastname: Tsioufis
authors.forename: Vasilios
authors.initials: V
authors.lastname: Papademetriou
authors.forename: Ross
authors.initials: R
authors.lastname: Fletcher
authors.forename: Peter
authors.initials: P
authors.lastname: Kokkinos
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D004219:District of Columbia / Q000453:epidemiology; D015444:Exercise; D005080:Exercise Test; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications*; D010809:Physical Fitness; D014728:Veterans