Cardiorespiratory fitness, exercise, and blood pressure.

F indings from well-designed large epidemiological studies and diverse populations support a robust, inverse, and independent association between physical activity, cardiore-spiratory fitness, and cardiovascular and overall mortality risk. The association is independent of age, race, sex, documented cardiovascular disease, or comorbidities, including hyperten-sion. In prehypertension and hypertension, cardiorespiratory fitness exhibits preventive, prognostic, and therapeutic properties. 1–4 Thus, appropriate lifestyle interventions, including increased physical activity designed to enhance cardiorespira-tory fitness, are recommended by the Eight Report of the Joint Treatment of High Blood Pressure (JNC 8) and the European Society of Hypertension/European Society of Hypertension of Cardiology recent guidelines as initial therapy to prevent, treat, and control hypertension. 5,6 This review presents evidence on the preventive, prognostic, and therapeutic aspects of exercise and fitness status of the individual on blood pressure (BP). The age-related progressive increase in BP is accompanied by an incremental increase in cardiovascular risk evident beyond BP levels of 115/75 mm Hg. 7 Evidence suggests that this increase in BP is preceded by arterial stiffness, an important and independent contributor to hypertension. To some extent, the age-related increase in arterial stiffness and BP is inevitable (biological aging). However, a substantial portion of the pronounced increase observed in industrialized societies is pathological and more likely a consequence of lifestyle characterized by high-fat and salt diets and physical inactivity than an inevitable outcome of aging. 13–19 Indigenous populations living a relatively traditional hunter-gatherer lifestyle exhibit only a modest and substantially lower increase in arterial stiffness and BP compared with individuals living in westernized environments. Additionally, vascular health is improved by habitual physical activity and exercise intervention programs implemented in westernized populations 16–19 and diminished by inactivity and bed rest. The exercise-induced increase in shear stress appears to provide the physiological stimulus for the adaptations in endothelial function and vascular remodel-ing observed after exercise training in healthy subjects. 20 Prehypertension, defined as systolic BP levels of 120 to 139 mm Hg or diastolic BP of 80 to 89 mm Hg, 21 is frequently a precursor of hypertension. 22 The aforementioned findings suggest that cardiorespiratory fitness may attenuate the rate of progression from prehypertension to hypertension. This concept was investigated in 2303 prehypertensive, middle-aged, male veterans followed for 9.2 years. Higher cardiorespiratory fitness, as reflected by peak metabolic equivalents (METs; 1 MET=3.5 ml of oxygen consumption per kg of body weight per minute), achieved during a standardized exercise test, was inversely associated …