Kazibwe Richard, Singleton Matthew J, Chevli Parag A, Kaze Arnaud D, Namutebi Juliana H, Shapiro Michael D, Yeboah Joseph
Department of Medicine, Section on Hospital Medicine, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA.
Department of Medicine, Section on Cardiovascular Medicine, WellSpan Health, York, PA, USA.
Am J Prev Cardiol. 2023 Jul 26;16:100524. doi: 10.1016/j.ajpc.2023.100524. eCollection 2023 Dec.
Engaging in physical activity (PA) is recommended to reduce the risk of morbidity and mortality in patients with hypertension. However, the association between PA and clinical outcomes in individuals with high-risk hypertension is understudied. We examined the relationship between PA and clinical outcomes in the Systolic Blood Pressure Intervention Trial (SPRINT). SPRINT investigated the benefit of intensive (vs. standard) blood pressure treatment in patients with high-risk hypertension.
Baseline data on PA was self-reported. Vigorous-intensity PA (VPA) was categorized into 2 groups based on frequency of "Rarely or Never" and 1 or more sessions/month. Moderate-intensity PA (MPA) was also categorized into 2 groups based on average duration/day of <15 min and 15 or more minutes. Using multivariable Cox regression, we estimated the associations between PA the primary outcome which was a composite of cardiovascular events, and all-cause mortality.
A total of 8,320 (age 67.8 ± 9.3, 34.9% women) of SPRINT participants with data on PA were included. During a median follow-up of 3.8 years, 619 primary outcome, and 419 all-cause mortality events occurred. Compared to not engaging in VPA, the risk of the primary outcome, myocardial infarction, and all-cause mortality (HR 95% CIs) associated with VPA of ≥1sessions/month was 0.79(0.65-0.94; p=0.009), 0.70(0.52-0.93; p=0.014) and 0.75(0.60-0.94; p=0.011), respectively. Similarly, the risk of the primary outcome and all-cause mortality (HR 95% CI) associated with engaging in MPA for ≥15 min/day, relative to <15 min/day was 0.76(0.63-0.93; p=0.008) and 0.80(0.62-1.02; p=0.066), respectively.
Among individuals with hypertension from the SPRINT study, VPA and MPA at a threshold of ≥1sessions/month and MPA of ≥15 min/day respectively, were both associated with a lower risk for cardiovascular events, and VPA was also associated with a reduced risk for all-cause mortality. Further studies are required to identify the optimal volume and intensity of PA in high-risk hypertension.
建议进行体育活动（PA）以降低高血压患者发病和死亡风险。然而，PA与高危高血压个体临床结局之间的关联研究较少。我们在收缩压干预试验（SPRINT）中研究了PA与临床结局之间的关系。SPRINT调查了强化（与标准）血压治疗对高危高血压患者的益处。
PA的基线数据通过自我报告获得。剧烈强度PA（VPA）根据“很少或从不”以及每月1次或更多次分为2组。中等强度PA（MPA）也根据平均每日持续时间<15分钟和15分钟或更长时间分为2组。我们使用多变量Cox回归估计PA与主要结局（心血管事件的综合指标）和全因死亡率之间的关联。
共纳入8320名（年龄67.8±9.3岁，34.9%为女性）有PA数据的SPRINT参与者。在中位随访3.8年期间，发生了619例主要结局事件和419例全因死亡事件。与不进行VPA相比，每月≥1次VPA相关的主要结局、心肌梗死和全因死亡风险（HR 95%CI）分别为0.79（0.65 - 0.94；p = 0.009）、0.70（0.52 - 0.93；p = 0.014）和0.75（0.60 - 0.94；p = 0.011）。同样，相对于每天<15分钟，每天进行≥15分钟MPA相关的主要结局和全因死亡风险（HR 95%CI）分别为0.76（0.63 - 0.93；p = 0.008）和0.80（0.62 - 1.02；p = 0.066）。
在SPRINT研究的高血压个体中，每月≥1次的VPA和每天≥15分钟的MPA分别与较低的心血管事件风险相关，且VPA还与降低的全因死亡风险相关。需要进一步研究以确定高危高血压中PA 的最佳量和强度。
