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OS 04-09 CARDIORESPIRATORY FITNESS AND RISK FOR DEVELOPING HEART FAILURE IN HYPERTENSIVES.

OBJECTIVE: Hypertension is one of the most common risk factors for congestive heart failure (CHF). Evidence suggests that increased fitness may attenuate the risk for CHF in the general population. However, the association between fitness and CHF incidence in hypertensive patients has not been assessed.

DESIGN AND METHOD: A total of 8,725 hypertensive men (mean age 60 ± 10) from Washington DC and Palo Alto Veterans Affairs Medical Centers underwent routine exercise tolerance testing. Peak workload was estimated in metabolic equivalents (METs). We established five fitness categories based on age-stratified quartiles of peak metabolic equivalents (MET) achieved: Least-fit (4.3 ± 1.18 METs; n = 1,643); Low-Fit (5.8 ± 1.10 METs; n = 1,926); Moderately-Fit (7.2 ± 1.2 METs; n = 1,771); Fit (8.4 ± 1.2 METs; n = 1,931) and Highly-Fit (11.2 ± 2.2 METs; n = 1,455). Cox proportional hazard models were applied after adjusting for age, BMI, race, family history of CV disease, CV/antihypertensive medications, and risk factors. P-values < 0.05 using two sided tests were considered statistically significant.

RESULTS: During a mean follow-up period of 10.7 ± 6.5 (median 10.4), there were 654 incidences of CHF (7.5%) or 6.7 events per 1000 person-years of follow-up. The association between new onset CHF risk and fitness was inverse and graded. For every 1-MET increase in exercise capacity, the risk was lowered by 16% (HR = 0.84; CI: 0.81-0. 87; p < 0.001). When compared to the individuals in the Least-Fit category, the risk for developing CHF was progressively lower, ranging from 32% (HR = 0.68; CI: 0.55-0.84; p < 0.001) for the next fitness category (Low-Fit) to 70% those in the highest fitness category (HR = 0.30; CI: 0.23-0.41; p < 0.001).

CONCLUSIONS: Increased cardiorespiratory fitness is associated with lower risk for developing CHF in hypertensive patients.

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