Liverpool Centre for Cardiovascular Science, Research Institute for Sport and Exercise Science, Liverpool John Moore's University, United Kingdom (H.L.M.L., E.A.D., D.H.J.T.).
Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, the Netherlands (T.M.H.E., D.H.J.T., E.A.B.).
Stroke. 2024 Sep;55(9):2231-2239. doi: 10.1161/STROKEAHA.123.045870. Epub 2024 Aug 8.
Regular physical activity is associated with a reduced stroke risk. However, this relationship might be attenuated in the presence of hypertension and antihypertensive medication use. We examined the dose-response relationship between physical activity and stroke in normotensive and hypertensive individuals.
A Dutch population-based cohort including 139 930 individuals (41% men; mean age, 44±13) was performed (median follow-up, 6.75 years). Participants were stratified at baseline as hypertensive (44%) or normotensive (56%) and categorized into quartiles of the lowest (Q1) to the highest (Q4) moderate-to-vigorous, self-reported physical activity. The primary outcome was incident stroke (fatal and nonfatal). Cox regression estimated hazard ratios and 95% CIs. The main analyses were stratified on baseline blood pressure and adjusted for confounders. Hypertensives were stratified into medicated (21%) or non-medicated (79%).
Compared with Q1, adjusted hazard ratios were 0.87 (0.69-1.10; =0.23), 0.75 (0.59-0.95; =0.02), and 0.94 (0.74-1.20; =0.64) for Q2 to Q4, respectively in the total population. Hazard ratios for normotensives were 0.79 (0.50-1.25; =0.32), 0.75 (0.48-1.18; =0.22), 0.97 (0.62-1.51; =0.90) for Q2 to Q4, respectively. In hypertensives, hazard ratios were 0.89 (0.68-1.17; =0.41), 0.74 (0.56-0.98; =0.03), 0.92 (0.69-1.23; =0.56) for Q2 to Q4, respectively. There was no significant interaction between hypertension status for the relation between physical activity and stroke risk. The stratified analysis revealed a smaller benefit of moderate-to-vigorous physical activity in medicated hypertensives compared with nonmedicated hypertensives, but no significant interaction effect was found.
Regular moderate-to-vigorous physical activity is beneficial for stroke risk reduction (Q3 compared with Q1), which is not affected by hypertension. Antihypertensive medication may be associated with a smaller benefit of moderate-to-vigorous physical activity on the risk of stroke, but further research is warranted.
有规律的体育活动与降低中风风险有关。然而，这种关系在存在高血压和使用抗高血压药物的情况下可能会减弱。我们研究了体育活动与血压正常和高血压个体中风之间的剂量-反应关系。
进行了一项荷兰基于人群的队列研究，共纳入 139930 名参与者（41%为男性；平均年龄 44±13 岁）（中位随访时间为 6.75 年）。参与者在基线时分为高血压（44%）或血压正常（56%），并按最低（Q1）至最高（Q4）的中等至剧烈、自我报告的体育活动四分位数进行分层。主要结局为首发卒中（致死性和非致死性）。Cox 回归估计了危险比和 95%置信区间。主要分析按基线血压分层，并调整了混杂因素。高血压患者分为服药组（21%）和未服药组（79%）。
与 Q1 相比，总人群中 Q2 至 Q4 的调整后危险比分别为 0.87（0.69-1.10；=0.23）、0.75（0.59-0.95；=0.02）和 0.94（0.74-1.20；=0.64）。血压正常者的危险比分别为 0.79（0.50-1.25；=0.32）、0.75（0.48-1.18；=0.22）和 0.97（0.62-1.51；=0.90）。高血压患者中，危险比分别为 0.89（0.68-1.17；=0.41）、0.74（0.56-0.98；=0.03）和 0.92（0.69-1.23；=0.56）。在高血压状态与体育活动和卒中风险之间的关系中，没有发现显著的交互作用。分层分析显示，与未服药的高血压患者相比，服药的高血压患者中，中等至剧烈体育活动的获益较小，但未发现显著的交互作用效应。
有规律的中等至剧烈体育活动有益于降低卒中风险（与 Q1 相比，Q3 ），且不受高血压的影响。抗高血压药物可能与中等至剧烈体育活动对卒中风险的获益较小有关，但需要进一步研究。
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