Sedentary Behavior And Risk Of Cardiovascular Disease And All-cause Mortality In Us Adults With Hypertension

BACKGROUND: Hypertension affects more than one billion adults worldwide. Despite advancements in treatment and control, disease burden and mortality risk for hypertensive adults remain high. Contrary to national physical activity guidelines, guidelines intended for hypertension management and prevention do not currently endorse reductions in sedentary behavior (SB). This may be in part due to a paucity of evidence demonstrating that SB confers morbidity and mortality risk in individuals with hypertension. PURPOSE: To examine the association between device-measured SB and risk of cardiovascular mortality and all-cause mortality in US hypertensive adults. METHODS: Data for this analysis come from the 2003-2006 National Health and Nutrition Examination Survey, a nationally representative survey of US adults. SB (expressed as hours/d) and moderate to vigorous physical activity (MVPA) were assessed with an ActiGraph 7164 accelerometer. Hypertension was classified as blood pressure ≥ 140/≥90 mmHg or anti-hypertensive medication use. RESULTS: Median follow-up was 14.5 years. After adjusting for sociodemographics, lifestyle behaviors, cardiovascular disease risk factors, and MVPA, greater time spent in SB was associated with an increased risk of cardiovascular mortality [Quartile 1: REF, Quartile 2: HR = 1.42 (95% CI = 0.84, 2.40), Quartile 3: HR = 1.28 (95% CI: 0.83-1.99), Quartile 4: HR = 2.27 (95% CI: 1.50, 3.43); p-trend<0.001]. Greater SB was also associated with an increased risk of all-cause mortality [Quartile 1: REF: Quartile 2: HR = 1.13 (95% CI: 0.83, 1.52), Quartile 3: HR = 1.33 (95% CI: 1.00, 1.78), Quartile 4: HR = 2.06 (95% CI: 1.60, 2.64); p-trend<0.001]. MVPA moderated the association of SB on cardiovascular mortality and all-cause mortality such that increased time spent in SB was not associated with greater risk of cardiovascular mortality [Quartile 4 vs. Quartile 1: HR = 1.21; 95% CI: 0.52, 0.80; p-trend<0.001] and all-cause mortality [SB Quartile 4 vs. Quartile 1: HR = 1.27; 95% CI: 0.80, 2.02; p-trend<0.001)] among those with high MVPA levels. CONCLUSION: Greater SB is associated with increased risk of cardiovascular mortality and all-cause mortality among US adults with hypertension. These findings suggest reductions in SB should be considered to reduce mortality risk in hypertensive adults.