title: Exercise capacity and progression from prehypertension to hypertension.
abstract: Prehypertension is likely to progress to hypertension. The rate of progression is determined mostly by age and resting blood pressure but may also be attenuated by increased fitness. A graded exercise test was performed in 2303 men with prehypertension at the Veterans Affairs Medical Centers in Washington, DC. Four fitness categories were defined, based on peak metabolic equivalents (METs) achieved. We assessed the association between exercise capacity and rate of progression to hypertension (HTN). The median follow-up period was 7.8 years (mean (± SD) 9.2±6.1 years). The incidence rate of progression from prehypertension to hypertension was 34.4 per 1000 person-years. Exercise capacity was a strong and independent predictor of the rate of progression. Compared to the High-Fit individuals (>10.0 METs), the adjusted risk for developing HTN was 66% higher (hazard ratio, 1.66; 95% CI, 1.2 to 2.2; P=0.001) for the Low-Fit and, similarly, 72% higher (hazard ratio, 1.72; 95% CI, 1.2 to 2.3; P=0.001) for the Least-Fit individuals, whereas it was only 36% for the Moderate-Fit (hazard ratio, 1.36; 95% CI, 0.99 to 1.80; P=0.056). Significant predictors for the progression to HTN were also age (19% per 10 years), resting systolic blood pressure (16% per 10 mm Hg), body mass index (15.3% per 5 U), and type 2 diabetes mellitus (2-fold). In conclusion, an inverse, S-shaped association was shown between exercise capacity and the rate of progression from prehypertension to hypertension in middle-aged and older male veterans. The protective effects of fitness were evident when exercise capacity exceeded 8.5 METs. These findings emphasize the importance of fitness in the prevention of hypertension.
authors: Veterans Affairs Medical Center, 50 Irving St NW, Washington, DC 20422, USA.
authors: Charles
authors: C
authors: Faselis
authors: Michael
authors: M
authors: Doumas
authors: John Peter
authors: JP
authors: Kokkinos
authors: Demosthenes
authors: D
authors: Panagiotakos
authors: Raya
authors: R
authors: Kheirbek
authors: Helen M
authors: HM
authors: Sheriff
authors: Katherine
authors: K
authors: Hare
authors: Vasilios
authors: V
authors: Papademetriou
authors: Ross
authors: R
authors: Fletcher
authors: Peter
authors: P
authors: Kokkinos
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000503:physiopathology; D018450:Disease Progression; D017079:Exercise Tolerance / Q000502:physiology*; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness / Q000502:physiology*; D058246:Prehypertension / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors