EFFECT OF PHYSICAL ACTIVITY ON CLINICAL OUTCOMES IN HIGH-RISK HYPERTENSION. POST-HOC ANALYSIS OF THE SYSTOLIC BLOOD PRESSURE INTERVENTION TRIAL (SPRINT)

Abstract

Therapeutic Area: CVD Prevention – Primary and Secondary Background: Engaging in physical activity (PA) is an important modifiable risk factor to improve health in hypertension. However, the association between PA and outcomes in high-risk hypertension remains understudied. The aim of this study was to examine the relationship between the intensity and amount of PA and outcomes in SPRINT. SPRINT investigated the benefit of intensive blood pressure treatment on cardiovascular outcomes and all-cause mortality among individuals with high-risk hypertension. Methods: This analysis included 8,320 (age 67.8±9.3, 34.9% women) participants from SPRINT on whom data was available on self-reported PA. Vigorous-intensity PA (VPA) included activities associated with sweating, increased heart rate or breathing. Moderate-Intensity PA (MPA) included activities such as brisk walking, climbing stairs or vacuuming. VPA was categorized into 2 groups based on frequency of “rarely or never” and ≥1 times/month. MPA was also categorized into 2 groups based on average duration/day of <15 minutes and ≥15minutes. Using multivariable Cox regression models, we examined the associations between VPA and MPA, and the primary outcome (defined as the composite of myocardial infarction, other acute coronary syndromes, stroke, acute decompensated heart failure, or death from cardiovascular causes) and all-cause mortality. Results: Over a median follow-up of 3.8 years, 619 primary outcome and 419 all-cause mortality events occurred. Compared to participants who reported not engaging in VPA, those who engaged in VPA ≥ 1timess/month had an 18% and a 23% lower risk of the primary outcome and all-cause mortality; hazard ratio (HR) and 95% CIs of 0.82(0.69 -0.98; p=0.031) and 0.77(0.62-0.95, p=0.016) respectively. Similarly, those who did an average of ≥15 minutes/day of MPA compared to those who did <15 minutes/day, had a 21% and a 23% lower risk of the primary outcome and all-cause mortality; HR (95%CI) 0.79(0.65-0.96; p =0.0180) and 0.77(0.61-0.98; p=0.033) respectively (Figure). Conclusions: Among individuals with high-risk hypertension but without diabetes mellitus, engaging in VPA at a threshold of ≥1 times/month and MPA at a threshold of ≥15 minutes/day, were both significantly associated with reduced risk of cardiovascular events and all-cause mortality. Further studies are required to identify the optimal volume and intensity of PA in high-risk hypertension.