• Stephen P Juraschek, Michael J Blaha, Seamus P Whelton, Roger Blumenthal, Steven R Jones, Steven J Keteyian, John Schairer, Clinton A Brawner, and Mouaz H Al-Mallah.
• The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore
• J Am Heart Assoc. 2014 Dec 1; 3 (6): e001268.

BackgroundIncreased physical fitness is protective against cardiovascular disease. We hypothesized that increased fitness would be inversely associated with hypertension.Methods And ResultsWe examined the association of fitness with prevalent and incident hypertension in 57 284 participants from The Henry Ford ExercIse Testing (FIT) Project (1991–2009). Fitness was measured during a clinician‐referred treadmill stress test. Incident hypertension was defined as a new diagnosis of hypertension on 3 separate consecutive encounters derived from electronic medical records or administrative claims files. Analyses were performed with logistic regression or Cox proportional hazards models and were adjusted for hypertension risk factors. The mean age overall was 53 years, with 49% women and 29% black. Mean peak metabolic equivalents (METs) achieved was 9.2 (SD, 3.0). Fitness was inversely associated with prevalent hypertension even after adjustment (≥12 METs versus <6 METs; OR: 0.73; 95% CI: 0.67, 0.80). During a median follow‐up period of 4.4 years (interquartile range: 2.2 to 7.7 years), there were 8053 new cases of hypertension (36.4% of 22 109 participants without baseline hypertension). The unadjusted 5‐year cumulative incidences across categories of METs (<6, 6 to 9, 10 to 11, and ≥12) were 49%, 41%, 30%, and 21%. After adjustment, participants achieving ≥12 METs had a 20% lower risk of incident hypertension compared to participants achieving <6 METs (HR: 0.80; 95% CI: 0.72, 0.89). This relationship was preserved across strata of age, sex, race, obesity, resting blood pressure, and diabetes.ConclusionsHigher fitness is associated with a lower probability of prevalent and incident hypertension independent of baseline risk factors.

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