According to findings from a study published in Hypertension, among patients with hypertension, poor cardiorespiratory fitness (CRF) is associated with an expanded risk of stroke and other cardiac risk factors regardless of age, ethnicity, or gender.

The authors wrote, “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.”

In this study, researchers assessed the incidence of stroke in patients with hypertension, according to CRF, and changes in CRF. The primary outcome was the onset of stroke.

A total of 483,379 patients with hypertension and no evidence of unstable cardiovascular disease aged between 30 and 95 years (mean age ± standard deviation [SD]: 59.4±9.0 years) with a BMI of 18.5 or higher were included in the study. The study cohort was comprised of the following: 72.1% white, 20.4% black, 4.9% Hispanic, and 0.5% were of unknown race or declined to disclose. The study participants achieved an exercise capacity of 2.0 metabolic equivalents (METs) or higher, had no overt cardiovascular disease during the exercise tolerance test, and had at least 6 months of follow-up. The average follow-up time was 10.7 (SD, 5.1) years. A total of 2,522 individuals who developed stroke within 3 years of hypertension onset were excluded.

The results revealed that compared with patients who did not develop stroke, patients who developed stroke were approximately 2 years older (61.4 [SD, 8.9] vs. 59.3 [SD, 8.9] years) and had higher systolic blood pressure (141.6 [SD, 15.6] vs. 139.0 [SD, 14.5] mmHg). Patients who developed stroke also had a greater prevalence of type 2 diabetes (27.3% vs. 20.3%), chronic kidney disease (3.5% vs. 2.6%), atrial fibrillation (3.4% vs. 2.3%), and cardiovascular disease (3.1% vs. 2.6%). However, among individuals who developed stroke, there was a lower prevalence of smoking (15.8% vs. 16.9%) and sleep apnea (6.6% vs. 9.5%).

The results also indicated that stroke risk declined progressively with higher CRF and was 55% lower for the individuals classified as “high fit” (hazard ratio [HR], 0.45; 95% CI, 0.42-0.48) compared with individuals classified as “least fit.” Comparable correlations were observed across the race, gender, and age spectra, and poor CRF was the strongest predictor of stroke risk of all comorbidities studied (HR, 2.24; 95% CI, 2.10-2.40). Additionally, variations in CRF reflected inverse and proportional changes in stroke risk.

In conclusion, the authors wrote, “Our findings strongly support that in patients with hypertension, poor CRF increases the risk of all stroke types more than any of the traditional cardiac risk factors, regardless of age, race, or sex. Furthermore, changes in CRF are associated with significant and parallel changes in stroke risk, regardless of initial fitness status.”

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