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Weight control, aerobic fitness early in life may prevent hypertension in adulthood
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Low aerobic capacity and high BMI in late adolescence may predict hypertension in adulthood, researchers reported in JAMA Internal Medicine.
Casey Crump, MD, PhD, from the department of medicine at Stanford University, and colleagues conducted a recent cohort study of 1,547,189 military conscripts in Sweden to measure the effects of aerobic capacity, muscular strength and BMI measurements on the risk for hypertension. Data were obtained at the men’s military conscription examination from 1969 to 1997. Follow-up continued through 2012.
According to study findings, 93,035 (6%) of the men were diagnosed with hypertension during a follow-up period of 39.7 million person-years (mean 25.7 years). The median age of participants at diagnosis of hypertension was 49.8 years. The median BMI among the men diagnosed with hypertension was 21.4 kg/m2 compared with 21.1 kg/m2 among those without hypertension. The men with hypertension also had a median aerobic capacity of 231.8 W compared with a median of 264 W in the remaining men. Median muscular strength was 2,000 N for the men with hypertension and 2,020 N for those not diagnosed with hypertension.
High BMI (incidence rate ratio [IRR] = 2.51; 95% CI, 2.46-2.55) and low aerobic capacity (IRR = 1.5; 95% CI, 1.47-1.54) were linked to increased risk for hypertension. The highest risk was observed among participants with both high BMI and low aerobic capacity (IRR = 3.53; 95% CI, 3.41-3.66). However, the researchers noted that those with normal BMI but low aerobic capacity still had a significant risk for hypertension (IRR = 1.62; 95% CI, 1.58-1.67). Muscular strength had little effect on the men’s risk for hypertension.
“In this large national cohort study, high BMI and low aerobic capacity in late adolescence were associated with higher risk of hypertension in adulthood. If confirmed, our findings suggest that interventions to prevent hypertension should begin early in life and include not only weight control but aerobic fitness, even among persons with normal BMI,” the researchers wrote.
In a related editorial, Carl J. Lavie MD, from the department of cardiovascular diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School – The University of Queensland School of Medicine, New Orleans, and colleagues emphasized the importance of cardiorespiratory fitness as a predictor of risk factors for CVDs. The editorial authors agreed with the conclusion of Crump and colleagues that “efforts to prevent hypertension need to be started early by preventing weight gain and improving levels of [cardiorespiratory fitness] in children and adolescents. Improving levels of physical activity would go a long way to accomplish these goals, which is the reason that the federal physical activity guidelines recommend that all individuals should be performing at least 150 minutes per week of moderate-intensity physical activity or 70 minutes per week of high-intensity physical activity,” they wrote.
Additionally, “the Institute of Medicine recommends that total physical activity should exceed 60 minutes on most days. Therefore, as physicians, it is imperative that we document levels of physical activity during almost all patient encounters and that we use this opportunity at nearly every visit to promote and prescribe physical activity to all of our patients,” Lavie and colleagues wrote. – by Tracey Romero
Disclosure: The researchers report no relevant financial disclosures. Lavie is the author of The Obesity Paradox and reports lecturing for the Coca Cola Company. Please see full commentary for all authors’ relevant financial disclosures.
Perspective
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George L. Bakris, MD
I agree with the study’s findings that muscular strength has little effect on risk for hypertension. There has been far too much emphasis in the youth that muscle strength equates with good physical fitness (Duck-chul Lee et al. J Am Coll Cardiol. 2014;doi:10.1016/j.jacc.2014.04.058).
The data from many prior studies indicate that the more regular daily aerobic exercise, the more efficient the cells are at handling oxidative stress and metabolic demands, so it is not just weight or muscle mass, but how efficient your body is in handling metabolic demands. Hypertension like many diseases has a genetic predisposition which will be expressed earlier in those with non-optimal lifestyle.
[Findings from this study] support the concept that you will delay the time of onset of elevated blood pressure especially if prone to hypertension by engaging in aerobic exercise. This has been known and this study provides further evidence to support this. Hypertension in most people if they live long enough is inevitable. A statistic from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) is that if a person is normotensive at age 55 years and lives to age 80 years, that person has a 90% chance of developing hypertension.
Future research should be focused on understanding the cellular response to prolonged exercise rather than further epidemiological studies.
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