NEW YORK (Reuters Health) – Prehypertensive men who are physically fit are likely to live longer as a result, according to a long-term follow-up study published in the American Journal of Hypertension for July.

Prehypertension – resting untreated systolic blood pressure (BP) of 120-139 mm Hg and/or diastolic BP of 80-89 mm Hg – affects about a third of the US adult population, but there is no consensus on use of medications to lower BP in these individuals. Professional guidelines advise lifestyle modification as a first-line approach.

In 4478 men referred for exercise tests who were found to be free of coronary heart disease, Dr. Peter Kokkinos at the Veterans Affairs Medical Center in Washington, DC, and co-investigators examined the prognostic value of exercise capacity according to peak metabolic equivalents (MET).

Using the peak MET level achieved by the entire cohort, the researchers categorized the subjects by quartile: Very-Low-Fit (6 MET or less), Low-Fit (6.1-8.0 MET), Moderate-Fit (8.1-10 MET) and High-Fit (> 10 MET).

Over a mean follow-up of 9.0 years, there were 916 deaths (average annual mortality rate = 2.26%).

After adjustment for age, BMI, race, diabetes, resting systolic BP, and aspirin use, every 1-MET increase in exercise capacity was associated with all-cause mortality risk reductions of 15% for the entire cohort (p < 0.001), 18% for men no older than 60 years (p < 0.001), and 12% for men over 60 (p < 0.001). The time to death was prolonged by about 1 year in the two highest fitness categories vs the two lower categories. Given this “strong, inverse and graded association between exercise capacity and all-cause mortality” in their study population, Dr. Kokkinos and his colleagues urge health care providers to “pay close attention to the fitness level of prehypertensive individuals and make efforts to improve exercise capacity, particularly in the least fit.” Reference:
Am J Hypertens 2009;22:735-741.