The association of cardiorespiratory fitness and the risk of hypertension: a systematic review and dose-response meta-analysis

Established evidence has indicated a negative correlation between cardiorespiratory fitness (CRF) and hypertension risk. In this study, we performed a meta-analysis to investigate the categorical and dose-response relationship between CRF and hypertension risk and the effects of CRF changes on hypertension risk reduction. The PubMed, Web of Science, and Embase databases were searched for relevant studies. The summarized relative risk (RR) and 95% confidence interval (95% CI) were estimated using the DerSimonian and Laird random effect model, and the dose-response relationship between CRF and hypertension risk was characterized using generalized least-squares regression and restricted cubic splines. Nine cohorts describing 110,638 incident hypertension events among 1,618,067 participants were included in this study. Compared with the lowest category of CRF, the RR of hypertension was 0.63 (95% CI: 0.56-0.70) for the highest CRF category and 0.85 (95% CI: 0.80-0.91) for the moderate category of CRF. For a 1-metabolic equivalent increment in CRF, the pooled RR of hypertension was 0.92 (95% CI: 0.90-0.94) in the total population. The RR of hypertension was 0.71 (95% CI: 0.64-0.79) for participants with CRF increased compared with those whose CRF was decreased over time. In conclusion, our meta-analysis supports the widely held notion of a negative dose-dependent relationship between CRF and hypertension risk.