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Table 14 Studies examining the relationship between physical activity and hypertension.

From: A systematic review of the evidence for Canada's Physical Activity Guidelines for Adults

Publication Country Study Design Quality Score Objective Population Methods Outcome Comments and Conclusions
Rankinen et al 2007 [75] To investigate the contributions of DNA sequence variation in candidate genes, PF and BMI, as well as their interactions to the incidence of hypertension. • n = 629 cases; 605 controls 10 year follow up PF showed the strongest association with HTN risk among all subjects as well as sex-specific models. Each 1- MET increment in PF was associated with 19% (12- 14%), 16% (9-22%), 32% (17- 45%) risk reduction in all subjects, men and women respectively. PF is a significant predictor of the risk of hypertension.
USA   • Sex: Men and women All subjects required to have 2 clinic visits at least 2 years apart.   
Case control   • Age: Case: 43.3 (9.2) yr Control: 42.7 (8.9) yr PF assessment: treadmill test (Blake protocol)   
D & B score = 13   • Characteristics: Healthy with BP 134/86 mmHg or less at their first clinic visit. Cases: those who developed hypertension during the follow-up period. Controls were those who did not develop hypertension Outcome measure: Incidence of hypertension during follow-up. Incident cases of hypertension were defined as physician diagnosed hypertension with medication or SBP ≥ 140 mmHg and/of DBP ≥ 90 mmHg t-tests and chi-square tests Logistic regression modelling When divided into quartiles on the basis of sex specific MET cut-offs, the third and fourth quartiles had a 58% (41-71%) and 63% (47-75%) lower risk of hypertension compared to the 1stquartile.  
Pereira et al 1999 [76] To examine PA and incident hypertension in men and women. • n = 7,459 PA Assessment: Questionnaire for leisure, sport and work index, divided into quartiles White Men There is an inverse association between PA and incident hypertension in White middle aged men. White men in the highest quartiles of sport and leisure activity had statistically significant reductions in the odds of developing hypertension of 23 and 34% respectively, compared to men in the lower quartiles.
USA   • Sex: Men and women Q1 = Lowest Leisure Index Model 1  
Prospective cohort   • Age: 45-65 yr Q2 • Q1 = 1.00 (referent)  
D & B score = 12   • Characteristics: No history of angina, MI, evidence of MI, angioplasty or other CV surgery or hypertension Q3 • Q2 = 0.95 (0.70-1.28)  
   • Atherosclerosis Risk in Communities Study Q4 = Highest • Q3 = 0.83 (0.63-1.09)  
    Model 1 adjusted for: Age, education, baseline BP and study centre • Q4 = 0.64 (0.46-0.89)  
    Model 2 adjusted for: Covariates in model 1 and smoking, alcohol consumption, parental history of hypertension, energy, sodium, potassium and caffeine intake, BMI, waist to hip ratio, menopausal status and hormone use Trend p = 0.01  
    Outcome Measure: Incidence of hypertension as defined as a SBP 140 mmHg and/or a DBP 90 mmHg or use of antihypertensive medications. Leisure Index Model 2  
    Unconditional logistic regression Orthogonal polynomial coefficients • Q1 = 1.00 (referent)  
     • Q2 = 0.99 (0.72-1.35)  
     • Q3 = 0.86 (0.65-1.13)  
     • Q4 = 0.66 (0.47-0.94)  
     Trend p = 0.01  
     Women  
     Sport Index Model 1  
     • Q1 = 1.00 (referent)  
     • Q2 = 1.26 (0.78-2.05)  
     • Q3 = 1.06 (0.61-1.84)  
     • Q4 = 1.92 (1.12-3.29)  
     Trend p = 0.04  
     Men  
     Sport Index Model 1  
     • Q1 = 1.00 (referent)  
     • Q2 = 1.23 (0.91-1.66)  
     • Q3 = 0.92 (0.70-1.22)  
     • Q4 = 0.74 (0.54-1.02)  
     Trend p = 0.02  
     Sport Index Model 2  
     • Q1 = 1.00 (referent)  
     • Q2 = 1.26 (0.93-1.71)  
     • Q3 = 0.95 (0.71-1.26)  
     • Q4 = 0.77 (0.55-1.08)  
     Trend p = 0.05  
Haapanen et al 1997 [77] To assess the association between PA and hypertension. • n = 732 men; 796 women 10 year follow up (1980 baseline) Age adjusted incidence rates ofhypertension Total energy expenditure High as referent: Increased EE during LTPA and increased intensity of these activities were associated with reduced risk for incident hypertension (age adjusted) in men but not women.
Finland   • Sex: Men and women PA assessement: Questionnaire for EE (kcal/wk), divided into tertiles   
Prospective cohort   • Age: 35-65 years Male Male:  
D & B score = 11   • Characteristics: Free of hypertension at baseline. Excluded those unable to participate in regular PA due to poor health    T1 = Low = 0-1100 • T1 = 1.00 (referent)  
       T2 = Medium = 1101-1900 • T2 = 1.66  
       T3 = High >1900 • T3 = 1.73  
     Trend p = 0.021  
    Female Female:  
       T1 = Low = 0-900 • T1 = 1.00 (referent)  
       T2 = Medium = 901-1500 • T2 = 0.94  
       T3 = High = >1500 • T3 = 1.16  
    Outcome measure: Incidence of hypertension through self reported diagnosis and death certificates Trend p = 0.648  
    Cox proportional HR   
Paffenbarger et al 1983 [78] To examine the relationship of student and alumnus PA patterns and other characteristics with incident hypertension. • n = 14,998 PA Assessment: Questionnaire for PA based on number of stairs ascended, blocks walked and hours per week of light and vigorous sports play, yard work etc. There was no significantly reduced risk for hypertension in men who climbed 50 plus stairs per day (compared to < 50 stairs); who walked 5 plus blocks per day (compared to < 5 blocks); or who played light sports (compared to those who did not). Contemporary vigorous exercise was inversely related to hypertension risk.
USA   • Sex: Men    
Prospective cohort   • Age: 35-74 yr Outcome measure: Diagnosis of hypertension by physicians using criteria of SBP > 160 mmHg and/or DBP > 95 mmHg The 59% of men who did engage in vigorous sports were at 35% greater risk of hypertension than the 41% who did not.  
     RR = 1.35  
     Trend p = <0.001  
D & B score = 12   • Characteristics: free of hypertension Harvard Alumni Study Multivariate estimates Alumni on the low side of the physical activity index (< 2000 kcal/wk) had a 30% increased risk of hypertension then those ≥ 2000 kcal/wk.  
     RR = 1.30  
     Trend p = 0.004  
Paffenbarger et al 1997 [79] To investigate the quantity and intensity of energy expenditure required to delay hypertension and prevent premature death. • n = 6,390 PA Assessment: Questionnaire for weekly sports play, divided into tertiles RR (95% CI) Lack of vigorous sports play independently increased the risk of developing hypertension.
USA   • Sex: Men T1 = None • T1 = 1.00 (referent)  
Prospective cohort   • Age: 45-84 yr T2 = Light Only (< 4.5 METs) • T2 = 1.04 (0.77-1.40)  
D & B score = 12   • Characteristics: Free of hypertension, CHD, diabetes, COPD and potentially malignant cancer in 1977 T3 = Moderately vigorous (≥ 4.5 METs) • T3 = 0.77 (0.62-0.96)  
   • Harvard Alumni Study Outcome measure: Incident hypertension Trend p = 0.004  
Hu et al 2004 [81] To discover whether regular PA can reduce the risk of hypertension in normal weight and overweight men and women. • n = 8,302 men; 9,139 women 11 year follow up Multivariate adjusted HR (95% CI), men Regular PA can reduce the risk of hypertension. The protective effect of PA was observed in both sexes regardless of level of obesity.
Finland   • Sex: Men and women PA assessement: Questionnaire for OPA, LTPA and commuting PA, divided into tertiles • T1 = 1.00 (referent)  
Prospective cohort   Age: 25-64 yr T1 = Low • T2 = 0.63  
D & B score = 13   Characteristics: Healthy and free of hypertension at baseline T2 = Medium • T3 = 0.59  
    T3 = High Trend p = < 0.001  
    Outcome Measure: Incidence of drug treated hypertension Multivariate adjusted HR (95% CI), women  
    Cox proportional HR • T1 = 1.00  
     • T2 = 0.82  
     • T3 = 0.71  
     Trend p = 0.005  
Gu et al 2007 [82] To determine the 8-year incidence of HTN and its risk factors among Chinese adults. • n = 10,525 Baseline Examination in 1991 with 8 year follow up RR (95% CI), men Increasing PA has the potential to reduce incidence of hypertension.
China   • Sex: Men and women PA assessment: Questionnaire administered by trained staff, divided into groups • G1 = 1.00 (referent)  
Prospective cohort   Age: ≥ 40 yr G1 = Low • G2 = 1.12 (0.86-1.46)  
D & B score = 13   Characteristics: Healthy and free from hypertension at baseline. G2 = Medium • G3 = 1.27 (1.10-1.47)  
    G3 = High RR (95% CI), women  
    Outcome measure: HTN as defined at SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg or current use of antihypertensive medication • G1 = 1.00 (referent)  
    t-tests, chi squared tests, Cochran-Armitage modeling, Modified Poisson approach • G2 = 1.14 (0.98-1.34)  
     • G3 = 1.22 (1.02-1.45)  
Hayashi et al 1999 [83] To investigate the association of the duration of the walk to work and LTPA with the risk for hypertension. • n = 6,017 PA assessment: Questionnaire on health related behaviours and exercise Walk time to work RR (95% CI) Frequency walk time to work (minutes The duration of walk to work was associated with a decreased risk of hypertension even after adjustment.
Japan   • Sex: Men T1 = 0-10 min • T1 = 1.00 (referent) Regular PA (at least once weekly) was inversely related to the risk of incident hypertension
Prospective cohort   • Age: 35-60 yr T2 = 11-20 min • T2 = 0.65 (0.47-0.90)  
D & B score = 12   • Characteristics: Free from HTN at baseline. All employees at gas company in Osaka Japan. All had sedentary jobs. T3 = ≥ 21 min • T3 = 0.72 (0.59-0.88)  
    Outcome measure: Diagnosed with hypertension (as defined by a SBP ≥ 160 mmHg, a DBP ≥ 95 mmHg, or use of antihypertensive medication) Trend p = < 0.001  
    Cox proportional HR   
Nakanishi et al 2005 [84] To examine the relationship of overall PA to the risk of developing hypertension in normotensive Japanese male office workers over a 7 year observation period. • n = 2,548 7 year follow up Multivariate adjusted RR (95% CI) by PA level only The rate of rise in both SBP and DBP in each follow-up year decreased with higher EE and that the risk of developing hypertension decreased in a dose dependent manner with higher daily life activity level.
Japan   • Sex: Men   Q1 = 1.00 (referent) Analysis stratified by the presence of or absence of a risk factor showed the negative association of daily life activity with the risk of developing hypertension for men at both low and high risk. This tendency was also observed among men in all 3 categories of normotension.
Prospective cohort   • Age: 35-59 yr PA assessment: 1-day activity record and reported the type and frequency on a weekly basis of LTPA, divided into quartiles (kcal/kg/d) Q2 = 0.84 (0.72-0.98)  
D & B score = 12   • Characteristics Healthy at baseline. No hypertension or CHD. All office workers for a Japanese company • Q1 = <33.3 • Q3 = 0.75 (0.63-0.88)  
    • Q2 = 33.3-36.9 • Q4 = 0.54 (0.45-0.64)  
    • Q3 = 37.0-40.3 Trend p = < 0.001  
    • Q4 = 40.4 Multivariate adjusted RR (95% CI) by PA level, low normal BP  
    3 categories of normotensive BP Low Normal: SBP < 120, DBP < 80 Normal: SBP 120-130, DBP 80- 85 High Normal: SBP 130-139 DBP 85-89 • Q1 = 1.00 (referent)  
    3 categories of normotensive BP Low Normal: SBP < 120, DBP < 80 Normal: SBP 120-130, DBP 80- 85 High Normal: SBP 130-139 DBP 85-89 • Q2 = 0.70 (0.47-1.05)  
    Cox proportional hazard model • Q3 = 0.55 (0.37-0.83)  
     • Q4 = 0.43 (0.28-0.65)  
     Trend p = <0.001  
     Multivariate adjusted RR (95% CI) by PA level, normal  
     BP  
     • Q1 = 1.00 (referent)  
     • Q2 = 0.89 (0.68-1.16)  
     • Q3 = 0.69 (0.52-0.91)  
     • Q4 = 0.50 (0.37-0.68)  
     Trend p = <0.001  
     Multivariate adjusted RR (95% CI) by PA level, high normal BP  
     • Q1 = 1.00 (referent)  
     • Q2 = 0.86 (0.69-1.07)  
     • Q3 = 0.88 (0.69-1.11)  
     • Q4 = 0.60 (0.46-0.78)  
     Trend p = 0.001  
Foy et al 2006 [85] To examine whether insulin resistance is associated with the effect of vigorous or moderate PA on baseline BP. • n = 1,599 Baseline examination in 1992-1993 Unadjusted OR (95% CI) Participants who meet or exceed current caloric expenditure recommendations for VPA demonstrate significantly less hypertension than do sedentary or underactive individuals.
USA   • Sex: Men and women PA assessment: VPA over the past year was determined via a 1-year recall of physical activity (kcal/d), divided into 3 groups • T1 = 1.00 (referent)  
Cross sectional   • Age: 40-69 yr • T1 = O • T2 = 0.69 (0.53-0.88)  
D & B score = 12   • Characteristics: Community dwelling adults • T2 = 1-149 kcal/day • T3 = 0.57 (0.45-0.74)  
   • Insulin Resistance Atherosclerosis Study • T3 = >150 kcal/day • Trend p = < 0.001  
     Adjusted OR (95% CI)  
     • T1 = 1.00 (referent)  
     • T2 = 0.82 (0.62-1.09)  
     • T3 = 0.73 (0.55-0.98)  
     Trend p = 0.004  
Folsom et al 1990 [270] To examine the relationship between fat distribution and the 2-yr incidence of hypertension and stroke. • n = 41,837 Baseline mailed survey in 1986: Pa assessment: Questionnaire for LTPA • 978 cases High PA reduced the risk of hypertension only before adjusting for other factors.
USA   • Sex: Women T1 = Low Age Adjusted RR (95% CI)  
Prospective cohort   • Age: 55-69 years (yr) T2 = Medium • T1 = 1.00 (referent)  
D & B score = 12   • Characteristics: All free of HTN at baseline T3 = High • T2 = 0.9 (0.7-1.1)  
    Mantel-Haenszel method • T3 = 0.7 (0.6-0.9)  
    Multiple logistic regression   
Levenstein et al 2001 [271] To examine the effects of a variety of psychosocial factors on the development of HTN in men and women in the general population. • n = 1,031 men, 1,326 women Questionnaires in 1965 and 1974, cohort followed until 1994 LTPA predictor of hypertension OR (95% CI) Risk of HTN was reduced with increases in LTPA in women.
USA   • Sex: Men and women PA assessment: LTPA rated on a scale of 0-16 points and analysed as a continuous variable • All Subjects: 0.94 (0.91-0.97)  
Prospective cohort   • Characteristics: Free of hypertension at baseline Outcome measure: Incidence of hypertension (defined as those who are taking antihypertensive medications) • Women: 0.90 (0.87-0.94)  
D & B score = 13   • Alameda cohort study Logistic regression analysis • Men: 0.98 (0.94-1.02)  
  1. D & B score, Downs and Black quality score; YR, years; PF, physical fitness; BMI, body mass index; MET, metabolic equivalent; PA, physical activity; MI, myocardial infarction; G, groups; Q, quartile or quintile; 95% CI, confidence interval; SBP, systolic blood pressure; DBP, diastolic blood pressure; EE, energy expenditure; kcal/wk, kilocalories per week; T, tertile; RR, risk ratio; HR, hazard ratio; CHD, coronary heart disease; COPD, chronic obstructive pulmonary disease; OPA, occupational physical activity; LTPA, leisure-time physical activity; BP, blood pressure; kcal/day, kilocalories per day.