Abstract 44: Cardiorespiratory Fitness Decreases Stroke Incidence in Hypertensive Veterans

• Published in: Circulation (New York, N.Y.) Vol. 135; no. suppl_1
• Main Authors: Kokkinos, Peter, Faselis, Charles, Narayan, Puneet, Myers, Jonathan, Karasik, Pamela, Moore, Hans
• Format: Journal Article
• Language: English
• Published: 07.03.2017
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.135.suppl_1.44

Abstract only Introduction: Stroke incidence is significantly higher in hypertensive patients compared to normotensive subjects. Cardiorespiratory fitness (CRF) is associated with a more favorable cardiovascular health. The CRF-stroke incidence association in hypertensive patients has not been fully explored. Hypothesis: We assessed the hypothesis that CRF is inversely and independently associated with stroke incidence in hypertensive patients. Methods: From 1985 to 2014, we identified 12,933 hypertensive patients (mean age: 60±11 years) with a normal response to an exercise tolerance test and no prior history of stroke. We established five fitness categories based on age-stratified quintiles of peak metabolic equivalents (MET) achieved: Least-Fit (4.1±1.0 METs; n=2,516); Low-Fit (5.6±1.0; n=2,772); Moderate-Fit (7.0±1.0 METs; n=2,803); Fit (8.4±1.3 METs; n=3,282); and High-Fit (11.4±2.0 METs; n=1,560). A multivariable Cox proportional hazards model was used to estimate hazard ratios (HR) and 95% confidence intervals [CI] for incidence of stroke across fitness categories. The model was adjusted for age, resting blood pressure, BMI, atrial fibrillation, gender, race, other cardiac risk factors, alcohol dependence and medications. The Least-fit category was used as the reference group. Results: During follow-up (median=11.4 years; 152,408 person-years), 694 individuals (4.5 events per 1,000 person-years) developed stroke. The risk for stroke was 5% lower for each 1-MET increase in exercise capacity (HR=0.95, CI: 0.92-0.98; p<0.001). When considering fitness categories, stroke risk was lower by 28% (HR=0.72; CI: 0.57-0.90) for the Moderate-Fit and Fit individuals (HR=0.72; CI: 0.58-0.89) and 33% for High-Fit individuals (HR= 0.67; CI: 0.50-0.88). Conclusions: Increased CRF was inversely related to stroke incidence in hypertensive patients. The association was independent and graded.