title: Exercise capacity and all-cause mortality in male veterans with hypertension aged ≥70 years.
abstract: Aging, even in otherwise healthy subjects, is associated with declines in muscle mass, strength, and aerobic capacity. Older individuals respond favorably to exercise, suggesting that physical inactivity plays an important role in age-related functional decline. Conversely, physical activity and improved exercise capacity are associated with lower mortality risk in hypertensive individuals. However, the effect of exercise capacity in older hypertensive individuals has not been investigated extensively. A total of 2153 men with hypertension, aged ≥70 years (mean, 75 ± 4) from the Washington, DC, and Palo Alto Veterans Affairs Medical Centers, underwent routine exercise tolerance testing. Peak workload was estimated in metabolic equivalents (METs). Fitness categories were established based on peak METs achieved, adjusted for age: very-low-fit, 2.0 to 4.0 METs (n=386); low-fit, 4.1 to 6.0 METs (n=1058); moderate-fit, 6.1 to 8.0 METs (n=495); high-fit >8.0 METs (n=214). Cox proportional hazard models were applied after adjusting for age, body mass index, race, cardiovascular disease, cardiovascular medications, and risk factors. All-cause mortality was quantified during a mean follow-up period of 9.0 ± 5.5 years. There were a total of 1039 deaths or 51.2 deaths per 1000 person-years of follow-up. Mortality risk was 11% lower (hazard ratio, 0.89; 95% confidence interval, 0.86-0.93; P<0.001) for every 1-MET increase in exercise capacity. When compared with those achieving ≤4.0 METs, mortality risk was 18% lower (hazard ratio, 0.82; 95% confidence interval, 0.70-0.95; P=0.011) for the low-fit, 36% for the moderate-fit (hazard ratio, 0.64; 95% confidence interval, 0.52-0.78; P<0.001), and 48% for the high-fit individuals (hazard ratio, 0.52; 95% confidence interval, 0.39-0.69; P<0.001). These findings suggest that exercise capacity is associated with lower mortality risk in elderly men with hypertension.
authors.affiliation: From the Department of Medicine, Veterans Affairs Medical Center, Washington, DC (C.F., M.D., A.P., P.N., A.T., P.K.); Department of Cardiology, School of Medicine, Georgetown University, Washington, DC (P.K.); Department of Medicine, School of Medicine, George Washington University, Washington, DC (C.F., M.D., A.P., P.N., P.K.); and Department of Cardiology, Veterans Affairs Palo Alto Health Care System and Stanford University, CA (J.M.).
authors.forename: Charles
authors.initials: C
authors.lastname: Faselis
authors.affiliation: From the Department of Medicine, Veterans Affairs Medical Center, Washington, DC (C.F., M.D., A.P., P.N., A.T., P.K.); Department of Cardiology, School of Medicine, Georgetown University, Washington, DC (P.K.); Department of Medicine, School of Medicine, George Washington University, Washington, DC (C.F., M.D., A.P., P.N., P.K.); and Department of Cardiology, Veterans Affairs Palo Alto Health Care System and Stanford University, CA (J.M.).
authors.forename: Michael
authors.initials: M
authors.lastname: Doumas
authors.affiliation: From the Department of Medicine, Veterans Affairs Medical Center, Washington, DC (C.F., M.D., A.P., P.N., A.T., P.K.); Department of Cardiology, School of Medicine, Georgetown University, Washington, DC (P.K.); Department of Medicine, School of Medicine, George Washington University, Washington, DC (C.F., M.D., A.P., P.N., P.K.); and Department of Cardiology, Veterans Affairs Palo Alto Health Care System and Stanford University, CA (J.M.).
authors.forename: Andreas
authors.initials: A
authors.lastname: Pittaras
authors.affiliation: From the Department of Medicine, Veterans Affairs Medical Center, Washington, DC (C.F., M.D., A.P., P.N., A.T., P.K.); Department of Cardiology, School of Medicine, Georgetown University, Washington, DC (P.K.); Department of Medicine, School of Medicine, George Washington University, Washington, DC (C.F., M.D., A.P., P.N., P.K.); and Department of Cardiology, Veterans Affairs Palo Alto Health Care System and Stanford University, CA (J.M.).
authors.forename: Puneet
authors.initials: P
authors.lastname: Narayan
authors.affiliation: From the Department of Medicine, Veterans Affairs Medical Center, Washington, DC (C.F., M.D., A.P., P.N., A.T., P.K.); Department of Cardiology, School of Medicine, Georgetown University, Washington, DC (P.K.); Department of Medicine, School of Medicine, George Washington University, Washington, DC (C.F., M.D., A.P., P.N., P.K.); and Department of Cardiology, Veterans Affairs Palo Alto Health Care System and Stanford University, CA (J.M.).
authors.forename: Jonathan
authors.initials: J
authors.lastname: Myers
authors.affiliation: From the Department of Medicine, Veterans Affairs Medical Center, Washington, DC (C.F., M.D., A.P., P.N., A.T., P.K.); Department of Cardiology, School of Medicine, Georgetown University, Washington, DC (P.K.); Department of Medicine, School of Medicine, George Washington University, Washington, DC (C.F., M.D., A.P., P.N., P.K.); and Department of Cardiology, Veterans Affairs Palo Alto Health Care System and Stanford University, CA (J.M.).
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tsimploulis
authors.affiliation: From the Department of Medicine, Veterans Affairs Medical Center, Washington, DC (C.F., M.D., A.P., P.N., A.T., P.K.); Department of Cardiology, School of Medicine, Georgetown University, Washington, DC (P.K.); Department of Medicine, School of Medicine, George Washington University, Washington, DC (C.F., M.D., A.P., P.N., P.K.); and Department of Cardiology, Veterans Affairs Palo Alto Health Care System and Stanford University, CA (J.M.). peter.kokkinos@va.gov.
authors.forename: Peter
authors.initials: P
authors.lastname: Kokkinos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000401:mortality* / Q000503:physiopathology*; D008297:Male; D010809:Physical Fitness / Q000502:physiology; D012306:Risk; D014728:Veterans
keywords: hypertension; mortality