ABSTRACT: To test prospectively in hypertensives whether moderate and vigorous exercise produces equivalent reductions in mortality, Cox-proportional hazard analyses were applied to energy expenditure (metabolic equivalents hours/d [METh/d]) in 6973 walkers and 3907 runners who used hypertensive medications at baseline. A total of 1121 died during 10.2-year follow-up: 695 cardiovascular disease (International Classification of Diseases, Tenth Revision [ICD10] I00-99; 465 underlying cause and 230 contributing cause), 124 cerebrovascular disease, 353 ischemic heart disease (ICD10 I20-25; 257 underlying and 96 contributing), 122 heart failure (ICD10 I50; 24 underlying and 98 contributing), and 260 dysrhythmias (ICD10 I46-49; 24 underlying and 236 contributing). Relative to <1.07 METh/d, running or walking 1.8 to 3.6 METh/d produced significantly lower all-cause (29% reduction; 95% confidence interval [CI], 17%-39%; P=0.0001), cardiovascular disease (34% reduction; 95% CI, 20%-46%; P=0.0001), cerebrovascular disease (55% reduction; 95% CI, 27%-73%; P=0.001), dysrhythmia (47% reduction; 95% CI, 27%-62%; P=0.0001), and heart failure mortality (51% reduction; 95% CI, 21%-70%; P=0.003), as did ? 3.6 METh/d with all-cause (22% reduction; 95% CI, 6%-35%; P=0.005), cardiovascular disease (36% reduction; 95% CI, 19%-50%; P=0.0002), cerebrovascular disease (47% reduction; 95% CI, 6%-71%; P=0.03), and dysrhythmia mortality (43% reduction; 95% CI, 16%-62%; P=0.004). Diabetes mellitus and chronic kidney disease mortality also decreased significantly with METh/d. All results remained significant when body mass index adjusted. Merely meeting guideline levels (1.07-1.8 METh/d) did not significantly reduced mortality. The dose-response was significantly nonlinear for all end points except diabetes mellitus, and cerebrovascular and chronic kidney disease. Results did not differ between running and walking. Thus, walking and running produce similar reductions in mortality in hypertensives.
