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  1. Laukkanen, Jari A. MD, PhD
  2. Kunutsor, Setor K. MD, PhD


Purpose: There are inverse and independent associations between cardiorespiratory fitness (CRF) and several adverse cardiometabolic outcomes including hypertension (HTN). The prospective relationship between percentage of age-predicted CRF and risk of HTN has not been previously investigated. We aimed to assess the association of percentage of age-predicted CRF with incident HTN in a long-term prospective cohort study.


Methods: Cardiorespiratory fitness, as measured by peak oxygen uptake, was assessed using the gold standard respiratory gas exchange analyzer in 1602 men who underwent cardiopulmonary exercise testing. The age-predicted CRF estimated from a regression equation for age was converted to percentage of age-predicted CRF ([achieved CRF/age-predicted CRF] x 100). The HR with 95% CI were estimated for HTN.


Results: During a median follow-up of 26.8 yr, 308 HTN cases were recorded. There was a linear relationship between age-predicted CRF and incident HTN (P value for nonlinearity = .68). A 1-SD increase in percentage of age-predicted CRF was associated with a decreased risk of HTN in analysis adjusted for established risk factors (HR = 0.79: 95% CI, 0.69-0.90), which remained consistent on further adjustment for several other potential confounders including alcohol consumption, physical activity, socioeconomic status, and inflammation (HR = 0.83: 95% CI, 0.72-0.95). The corresponding adjusted HRs were 0.55 (95% CI, 0.38-0.80) and 0.63 (95% CI, 0.43-0.91), respectively, when comparing extreme quartiles of percentage of age-predicted CRF levels.


Conclusions: Percentage of age-predicted CRF is linearly, inversely, and independently associated with risk of incident HTN, and it is comparable to absolute CRF as a risk indicator for HTN in a general population of middle-aged men.