Meeting Minimum Exercise Guidelines Not Sufficient to Reduce Risk of Hypertension Later in Life

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Young adults who exercise up to 5 hours per week have a reduced risk of developing hypertension (HTN) later in life, according to a new study published April 15, 2021, in the American Journal of Preventive Medicine.

Current guidelines from the Department of Health and Human Services (HHS) indicate that adults need a minimum of 150 minutes (or 2.5 hours) of moderate-intensity physical activity (PA) every week, but researchers from the University of California San Francisco (UCSF) found:

“Achieving at least twice the current minimum adult PA guidelines may be more beneficial for the prevention of hypertension than simply meeting the minimum guidelines. Public health interventions may emphasize longer durations of PA to prevent hypertension.”

To determine the association between levels of exercise through the adult life course and the onset of HTN, researchers analyzed 5115 participants from the Coronary Artery Risk Development in Young Adults study.

The cohort included Black and White men and women aged 18-30 years at baseline at 4 urban US sites (Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota, and Oakland, California) who have been followed for 30 years. Just over half of participants were Black (51.6%) and just under half were men (45.5%)

The participants were asked about their exercise habits, medical history, smoking status, and alcohol use. Blood pressure and weight were monitored, as well as cholesterol and triglyceride levels.

HTN was defined per 2017 American College of Cardiology/American Heart Association guidelines as 130/80 mmHg. Individual PA trajectories were developed for each participant using linear mixed models.

Overall, lower PA score (per 100 units) at age 18 was associated with 4% (95% confidence interval [CI]=1-7, p=0.002) higher odds of HTN incidence. Each additional 1-unit reduction per year in PA score was associated with 2% (95% CI=1-3, p=0.001) higher annual odds of HTN incidence.

Researchers also found that meeting approximately the current minimum PA guideline levels at age 18 and through follow-up was not protective of HTN incidence; however, meeting twice the current minimum at age 18 years (odds ratio [OR]=0.82, 95% CI=0.71-0.93, p=0.002) through age 60 years (OR=0.78, 95% CI=0.66-0.91, p=0.002) was protective of HTN incidence.

Black women had the least exercise throughout the study period and Black men reported the highest PA levels among all race and gender groups in young adulthood but had the greatest declines through middle age.

By age 60, 73.1% of participants developed HTN, and Black men had the highest incidence of HTN from young adulthood through middle age, according to study authors.

“Nearly half of our participants in young adulthood had suboptimal levels of physical activity, which was significantly associated with the onset of hypertension, indicating that we need to raise the minimum standard for physical activity,” said first author Jason Nagata, MD, assistant professor, UCSF Division of Adolescent and Young Adult Medicine, in a press release. “This might be especially the case after high school when opportunities for physical activity diminish as young adults transition to college, the workforce and parenthood, and leisure time is eroded.”

Nagata also emphasized that patients should be asked about PA levels just as they are routinely evaluated for blood pressure, glucose and lipid profiles, obesity, and smoking. Black women in particular, he noted, have high rates of obesity and tobacco use, and low rates of PA, and so should be a key group for targeted intervention.