Author + information
- Received September 13, 2010
- Revision received December 10, 2010
- Accepted December 14, 2010
- Published online May 3, 2011.
- Enrique G. Artero, PhD⁎,†,⁎ (, )
- Duck-chul Lee, PhD†,
- Jonatan R. Ruiz, PhD§∥,
- Xuemei Sui, MD†,
- Francisco B. Ortega, PhD⁎,§,
- Timothy S. Church, MD, PhD¶,
- Carl J. Lavie, MD#,
- Manuel J. Castillo, MD, PhD⁎ and
- Steven N. Blair, PED†,‡
- ↵⁎Reprint requests and correspondence:
Dr. Enrique G. Artero, 921 Assembly Street, Columbia, South Carolina 29208
Objectives This study sought to assess the impact of muscular strength on mortality in men with hypertension.
Background Muscular strength is inversely associated with mortality in healthy men, but this association has not been examined in men with hypertension.
Methods We followed 1,506 hypertensive men age 40 years and older enrolled in the Aerobics Center Longitudinal Study from 1980 to 2003. Participants received an extensive medical examination at baseline. Muscular strength was quantified by combining 1 repetition maximum (1-RM) measures for leg and bench press and cardiorespiratory fitness assessed by maximum exercise test on a treadmill.
Results During an average follow-up of 18.3 years, 183 deaths occurred. Age-adjusted death rates per 10,000 person-years across incremental thirds of muscular strength were 81.8, 65.5, and 52.0 (p < 0.05 for linear trend). Multivariable Cox regression hazard ratios were 1.0 (reference), 0.81 (95% confidence interval [CI]: 0.57 to 1.14), and 0.59 (95% CI: 0.40 to 0.86) across incremental thirds of muscular strength. After further adjustment for cardiorespiratory fitness, those participants in the upper third of muscular strength still had a lower risk of death (hazard ratio [HR]: 0.66; 95% CI: 0.45 to 0.98). In the muscular strength and CRF combined analysis, men simultaneously in the upper third of muscular strength and high fitness group had the lowest mortality risk among all combination groups (HR: 0.49; 95% CI: 0.30 to 0.82), with men in the lower third of muscular strength and low fitness group as reference.
Conclusions High levels of muscular strength appear to protect hypertensive men against all-cause mortality, and this is in addition to the benefit provided by cardiorespiratory fitness.
This work was supported by National Institutes of Health grants AG06945, HL62508, and R21DK088195 (to Dr. Sui from the National Institute of Diabetes and Digestive and Kidney Diseases), and in part by an unrestricted research grant from the Coca-Cola Company; Spanish Ministries of Education (EX-2008-0641) and Science and Innovation (CEB09-GREIB0005; RYC-2010-05957); the Swedish Heart-Lung Foundation (20090635), and the Swedish Council for Working Life and Social Research (FAS). The authors have reported that they have no relationships to disclose.
- Received September 13, 2010.
- Revision received December 10, 2010.
- Accepted December 14, 2010.
- American College of Cardiology Foundation