Controlled Hypertension Linked to Residual Risks of Adverse Outcomes

Sarfaroj Khan 


January 11, 2021


  • Controlled hypertension (systolic blood pressure [BP] <140 mmHg and diastolic BP <90 mmHg) was associated with an increased risk of major adverse cardiac and cerebrovascular events (MACCEs) vs normotension.

  • Moderate or moderate-to-vigorous physical activity was associated with a lower risk of MACCEs and mortality in individuals with controlled hypertension and even in those with normotension or uncontrolled hypertension.

Why this matters

  • Physicians may encourage physical activity for the general population, even for patients with controlled hypertension, not being reassured by their achieved target BP values.

Study design

  • This large-scale observational study included participants (age, 40-69 years) from the UK Biobank cohort (UKB, n=220,026) and the Korean National Health Insurance Service cohort (KNHIS, n=3,593,202).

  • 161,405 (73%)/18,844 (9%)/39,777 (18%) and 3,122,890 (87%)/383,828 (11%)/86,484 (2%) individuals were included in the normotension/controlled hypertension /uncontrolled hypertension groups from the UKB and KNHIS cohorts, respectively.

  • Main outcomes: MACCEs in UKB (myocardial infarction [MI], cardiac death and ischaemic stroke) and KNHIS (MI, revascularisation and acute ischaemic stroke); all-cause mortality.

  • Funding: Korea Healthcare Technology Research & Development Project and others.

Key results

  • Compared with the normotensive group, the controlled hypertension group had a significantly greater risk of:

    • MACCEs (UKB: adjusted HR [aHR], 1.73; 95% CI, 1.55-1.92; KNHIS: aHR, 1.46; 95% CI, 1.43-1.49); and

    • all-cause mortality (UKB: aHR, 1.28; 95% CI, 1.18-1.3; KNHIS: aHR, 1.29; 95% CI, 1.26-1.32).

  • In the controlled hypertension group, moderate or moderate-to-vigorous physical activity was associated with a better prognosis, and no physical activity was associated with a high risk of adverse outcomes.

  • In the UKB cohort:

    • MACCEs:

      • no moderate physical activity (aHR, 1.82; 95% CI, 1.43-2.30);

      • 1-3 days/week (aHR, 1.45; 95% CI, 1.19-1.78); and

      • 4-7 days/week (aHR, 1.46; 95% CI, 1.20-1.76).

    • all-cause mortality:

      • no moderate physical activity (aHR, 1.26; 95% CI, 1.07-1.50);

      • 1-3 days/week (aHR, 0.88; 95% CI, 0.76-1.02); and

      • 4-7 days/week (aHR, 0.93; 95% CI, 0.81-1.06).

  • In the KNHIS cohort:

    • MACCEs:

      • no moderate-to-vigorous physical activity (aHR, 1.48; 95% CI, 1.43-1.52);

      • 1-3 days/week (aHR, 1.31; 95% CI, 1.27-1.35); and

      • 4-7 days/week (aHR, 1.28; 95% CI, 1.22-1.35).

    • all-cause mortality:

      • no moderate physical activity (aHR, 1.36; 95% CI, 1.31-1.41);

      • 1-3 days/week (aHR, 1.04; 95% CI, 0.99-1.08); and

      • 4-7 days/week (aHR, 1.08; 95% CI, 1.02-1.16).


  • Observational design.


Park S, Han K, Lee S, Kim Y, Lee Y, Kang MW, Park S, Kim YC, Han SS, Lee H, Lee JP, Joo KW, Lim CS, Kim YS, Kim DK. Cardiovascular or mortality risk of controlled hypertension and importance of physical activity. Heart. 2021 Jan 5 [Epub ahead of print]. doi: 10.1136/heartjnl-2020-318193. PMID: 33402363.  View abstract

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: