title: Physical fitness and hypertension in a population at risk for cardiovascular disease: the Henry Ford ExercIse Testing (FIT) Project.
abstract: BACKGROUND
  Increased physical fitness is protective against cardiovascular disease. We hypothesized that increased fitness would be inversely associated with hypertension.
  
  
  RESULTS
  We examined the association of fitness with prevalent and incident hypertension in 57 284 participants from The Henry Ford ExercIse Testing (FIT) Project (1991–2009). Fitness was measured during a clinician‐referred treadmill stress test. Incident hypertension was defined as a new diagnosis of hypertension on 3 separate consecutive encounters derived from electronic medical records or administrative claims files. Analyses were performed with logistic regression or Cox proportional hazards models and were adjusted for hypertension risk factors. The mean age overall was 53 years, with 49% women and 29% black. Mean peak metabolic equivalents (METs) achieved was 9.2 (SD, 3.0). Fitness was inversely associated with prevalent hypertension even after adjustment (≥12 METs versus <6 METs; OR: 0.73; 95% CI: 0.67, 0.80). During a median follow‐up period of 4.4 years (interquartile range: 2.2 to 7.7 years), there were 8053 new cases of hypertension (36.4% of 22 109 participants without baseline hypertension). The unadjusted 5‐year cumulative incidences across categories of METs (<6, 6 to 9, 10 to 11, and ≥12) were 49%, 41%, 30%, and 21%. After adjustment, participants achieving ≥12 METs had a 20% lower risk of incident hypertension compared to participants achieving <6 METs (HR: 0.80; 95% CI: 0.72, 0.89). This relationship was preserved across strata of age, sex, race, obesity, resting blood pressure, and diabetes.
  
  
  CONCLUSIONS
  Higher fitness is associated with a lower probability of prevalent and incident hypertension independent of baseline risk factors.
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Juraschek
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.forename: Seamus P
authors.initials: SP
authors.lastname: Whelton
authors.forename: Roger
authors.initials: R
authors.lastname: Blumenthal
authors.forename: Steven R
authors.initials: SR
authors.lastname: Jones
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Keteyian
authors.forename: John
authors.initials: J
authors.lastname: Schairer
authors.forename: Clinton A
authors.initials: CA
authors.lastname: Brawner
authors.forename: Mouaz H
authors.initials: MH
authors.lastname: Al-Mallah
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005080:Exercise Test; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control*; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D010809:Physical Fitness; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents