title: Changes in cardiorespiratory fitness predict incident hypertension: A population-based long-term study.
abstract: OBJECTIVE
  We investigated whether long-term changes in cardiorespiratory fitness (CRF) predict the risk of incident hypertension, independent of risk factors, in initially normotensive men.
  
  
  METHODS
  This prospective study from the Kuopio Ischemic Heart Disease Study included 431 male participants without hypertension who underwent symptom-limited maximal cardiopulmonary exercise testing at baseline and during a second examination, 11-years later, who were re-evaluated for hypertension at 20-year follow-up. Changes in CRF (%) were calculated as the difference in directly measured maximal oxygen uptake (VO2max) between the baseline and second examination, and classified into decreasing tertiles as percentages. Hypertension was defined as systolic and/or diastolic blood pressure ≥140/90 mmHg or hypertension that required antihypertensive medication as diagnosed by a physician.
  
  
  RESULTS
  During a 10-year follow-up after the second examination, 165 men (38%) developed hypertension. Men who demonstrated the largest decline in CRF between evaluations (-62.1% to -20.2%) had a 4.33-fold (95% CI 2.32-8.07, P < .001) risk of incident hypertension compared to men with the smallest decrease or improvement in CRF (-8.8% to 82.0%), after adjusting for age, follow-up duration, alcohol consumption, cigarette smoking, serum low and high density lipoprotein cholesterol, body mass index, daily energy expenditure (kcal) via physical activity, glomerular filtration rate, and baseline systolic blood pressure and VO2max.
  
  
  CONCLUSIONS
  The present findings indicate that more marked decreases in measured CRF over time are independently associated with the risk of incident hypertension in men, suggesting that CRF should be considered a causal risk factor to predict future hypertension.
authors.affiliation: Department of Sport Science, University of Seoul, Seoul, South Korea.
authors.forename: Sae Young
authors.initials: SY
authors.lastname: Jae
authors.affiliation: Department of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Kurl
authors.affiliation: Preventive Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Royal Oak, Missouri.
authors.forename: Barry A
authors.initials: BA
authors.lastname: Franklin
authors.affiliation: Department of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
authors.forename: Jari A
authors.initials: JA
authors.lastname: Laukkanen
mesh_terms: D000328:Adult; D000072599:Cardiorespiratory Fitness; D005080:Exercise Test; D005387:Finland / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: cardiorespiratory fitness; exercise testing; hypertension