Stroke Incidence in Patients With Hypertension According to Cardiorespiratory Fitness

Authors

Peter Kokkinos, Veterans Affairs Medical Center, Washington, DC (P.K., C.F., A.P., R.M.).
Charles Faselis, Veterans Affairs Medical Center, Washington, DC (P.K., C.F., A.P., R.M.).
Andreas Pittaras, Veterans Affairs Medical Center, Washington, DC (P.K., C.F., A.P., R.M.).
Immanuel Babu Samuel, War Related Illness and Injury Study Center, Veterans Affairs Medical Center, Washington, DC (I.B.H.S.).
Carl J. Lavie, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA (C.J.L.).
Robert Ross, School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada (R.R.).
Michael LaMonte, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Getzville, NY (M.L.).
Barry A. Franklin, Corewell Health East, William Beaumont University Hospital, Royal Oak, MI (B.A.F.).
Charalampos Grassos, Saint Anargiroi General Oncology Hospital, Kifissia, Greece (C.G.).
Edward Zaprini, Irvine Clinical Research, Irvine, CA (E.Z.).
Rayelynn Murphy, Veterans Affairs Medical Center, Washington, DC (P.K., C.F., A.P., R.M.).
Jonathan Myers, Veterans Affairs Medical Center Palo Alto Health Care System (J.M.).

Document Type

Journal Article

Publication Date

6-6-2024

Journal

Hypertension (Dallas, Tex. : 1979)

DOI

10.1161/HYPERTENSIONAHA.124.23066

Keywords

cardiorespiratory fitness; exercise test; hypertension; metabolic equivalent; stroke

Abstract

BACKGROUND: Hypertension and physical inactivity are risk factors for stroke. The effect of cardiorespiratory fitness (CRF) on stroke risk in patients with hypertension has not been assessed. We evaluated stroke incidence in patients with hypertension according to CRF and changes in CRF. METHODS: We included 483 379 patients with hypertension (mean age±SD; 59.4±9.0 years) and no evidence of unstable cardiovascular disease as indicated by a standardized exercise treadmill test. Patients were assigned to 5 age- and sex-specific CRF categories based on peak metabolic equivalents achieved at the initial exercise treadmill test and in 4 categories based on metabolic equivalent changes over time (n=110 576). Multivariable Cox models, adjusted for age, and comorbidities were used to estimate hazard ratios and 95% CIs for stroke risk. RESULTS: During a median follow-up of 10.6 (interquartile range, 6.6-14.6) years, 15 925 patients developed stroke with an average yearly rate of 3.1 events/1000 person-years. Stroke risk declined progressively with higher CRF and was 55% lower for the High-fit individuals (hazard ratio, 0.45 [95% CI, 0.42-0.48]) compared with the Least-fit. Similar associations were observed across the race, sex, and age spectra. Poor CRF was the strongest predictor of stroke risk of all comorbidities studied (hazard ratio, 2.24 [95% CI, 2.10-2.40]). Changes in CRF reflected inverse and proportional changes in stroke risk. CONCLUSIONS: Poor CRF carried a greater risk than any of the cardiac risk factors in patients with hypertension, regardless of age, race, or sex. The lower stroke risk associated with improved CRF suggests that increasing physical activity, even later in life, may reduce stroke risk.

APA Citation

Kokkinos, Peter; Faselis, Charles; Pittaras, Andreas; Samuel, Immanuel Babu; Lavie, Carl J.; Ross, Robert; LaMonte, Michael; Franklin, Barry A.; Grassos, Charalampos; Zaprini, Edward; Murphy, Rayelynn; and Myers, Jonathan, "Stroke Incidence in Patients With Hypertension According to Cardiorespiratory Fitness" (2024). GW Authored Works. Paper 5139.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5139

Department

Clinical Research and Leadership