Article | Published:

Adiposity, physical activity, and risk of hypertension: prospective data from the population-based HUNT Study, Norway


Adiposity and inactivity have been associated with increased risk of hypertension. However, reports on the joint effect of these two risk factors in relation to hypertension are scarce and their interaction poorly understood. We prospectively examined both independent and joint effects of measured body mass index (BMI) and self-reported physical activity on the risk of hypertension. We conducted a longitudinal study of 11,238 men and 15,301 women who participated in the Nord-Trøndelag Health Study (HUNT) in Norway. Poisson regression was used to estimate adjusted risk ratios (RRs) of hypertension (≥140/90 mmHg) according to BMI and physical activity. BMI was positively associated with risk of hypertension in both sexes (Ptrends < 0.001), whereas the independent effect of physical activity was less clear. Obese men who reported no physical activity had a RR of 1.50 (95% confidence interval (CI): 1.27–1.77) compared to normal weight men with a high activity level, whereas obese men who reported high activity levels had a RR of 1.16 (95% CI: 0.79–1.70). Correspondingly, obese and inactive women had a RR of 1.55 (95% CI: 1.35–1.77), whereas obese and highly active women had RRs of 1.41 (95% CI: 1.18–1.69). Our data suggest that high levels of physical activity could to some extent attenuate the unfavorable effect of adiposity on hypertension, particularly in men.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13.

  2. 2.

    Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365:217–23.

  3. 3.

    Czernichow S, Mennen L, Bertrais S, Preziosi P, Hercberg S, Oppert JM. Relationships between changes in weight and changes in cardiovascular risk factors in middle-aged French subjects: effect of dieting. Int J Obes. 2002;26:1138–43.

  4. 4.

    Drøyvold WB, Midthjell K, Nilsen TI, Holmen J. Change in body mass index and its impact on blood pressure: a prospective population study. Int J Obes. 2005;29:650–5.

  5. 5.

    Hu G, Barengo NC, Tuomilehto J, Lakka TA, Nissinen A, Jousilahti P. Relationship of physical activity and body mass index to the risk of hypertension: a prospective study in Finland. Hypertension. 2004;43:25–30.

  6. 6.

    Rankinen T, Church TS, Rice T, Bouchard C, Blair SN. Cardiorespiratory fitness, BMI, and risk of hypertension: the HYPGENE study. Med Sci Sports Exerc. 2007;39:1687–92.

  7. 7.

    Barlow CE, LaMonte MJ, FitzGerald SJ, Kampert JB, Perrin JL, Blair SN. Cardiorespiratory fitness is an independent predictor of hypertension incidence among initially normotensive healthy women. Am J Epidemiol. 2006;163:142–50.

  8. 8.

    Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA. American College of Sports Medicine position stand. Exercise and hypertension. Med Sci Sports Exerc. 2004;36:533–53.

  9. 9.

    Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002;136:493–503.

  10. 10.

    Aadahl M, Kjaer M, Jorgensen T. Associations between overall physical activity level and cardiovascular risk factors in an adult population. Eur J Epidemiol. 2007;22:369–78.

  11. 11.

    Kronenberg F, Pereira MA, Schmitz MK, Arnett DK, Evenson KR, Crapo RO, et al. Influence of leisure time physical activity and television watching on atherosclerosis risk factors in the NHLBI Family Heart Study. Atherosclerosis. 2000;153:433–43.

  12. 12.

    Paffenbarger RS, Wing AL, Hyde RT, Jung DL. Physical activity and incidence of hypertension in college alumni. Am J Epidemiol. 1983;117:245–57.

  13. 13.

    Lee CD, Blair SN, Jackson AS. Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. Am J Clin Nutr. 1999;69:373–80.

  14. 14.

    Vatten LJ, Nilsen TI, Romundstad PR, Droyvold WB, Holmen J. Adiposity and physical activity as predictors of cardiovascular mortality. Eur J Cardiovasc Prev Rehabil. 2006;13:909–15.

  15. 15.

    Hjerkind KV, Stenehjem JS, Nilsen TI. Adiposity, physical activity and risk of diabetes mellitus: prospective data from the population-based HUNT study, Norway. BMJ Open. 2017;7:e013142.

  16. 16.

    Nilsen TI, Romundstad PR, Vatten LJ. Recreational physical activity and risk of prostate cancer: A prospective population-based study in Norway (the HUNT study). Int J Cancer. 2006;119:2943–7.

  17. 17.

    Augestad LB, Schei B, Forsmo S, Langhammer A, Flanders WD. Healthy postmenopausal womenphysical activity and forearm bone mineral density: the Nord-Trondelag health survey. J Women Aging. 2006;18:21–40.

  18. 18.

    Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159:702–6.

  19. 19.

    Newson RB. Attributable and unattributable risks and fractions and other scenario comparisons. Stata J. 2013;13:672–98.

  20. 20.

    Mitchell MN. Interpreting and visualizing regression models using stata. TX, USA: Stata Press; 2012.

  21. 21.

    Hu G, Tian H. A comparison of dietary and non-dietary factors of hypertension and normal blood pressure in a Chinese population. J Hum Hypertens. 2001;15:487–93.

  22. 22.

    Sonne-Holm S, Sørensen TI, Jensen G, Schnohr P. Independent effects of weight change and attained body weight on prevalence of arterial hypertension in obese and non-obese men. BMJ. 1989;299:767–70.

  23. 23.

    Jones DW. Body weight and blood pressure. Effects of weight reduction on hypertension. Am J Hypertens. 1996;9:50–54s.

  24. 24.

    Masuo K, Mikami H, Ogihara T, Tuck ML. Weight gain-induced blood pressure elevation. Hypertension. 2000;35:1135–40.

  25. 25.

    Wilsgaard T, Schirmer H, Arnesen E. Impact of body weight on blood pressure with a focus on sex differences: The Tromso Study, 1986–95. Arch Intern Med. 2000;160:2847–53.

  26. 26.

    Haapanen N, Miilunpalo S, Vuori I, Oja P, Pasanen M. Association of leisure time physical activity with the risk of coronary heart disease, hypertension and diabetes in middle-aged men and women. Int J Epidemiol. 1997;26:739–47.

  27. 27.

    Pereira MA, Folsom AR, McGovern PG, Carpenter M, Arnett DK, Liao D, et al. Physical activity and incident hypertension in black and white adults: The Atherosclerosis Risk in Communities Study. Prev Med. 1999;28:304–12.

  28. 28.

    Reaven PD, Barrett-Connor E, Edelstein S. Relation between leisure-time physical activity and blood pressure in older women. Circulation. 1991;83:559–65.

  29. 29.

    Carnethon MR, Gidding SS, Nehgme R, Sidney S, Jacobs DR, Liu K. Cardiorespiratory fitness in young adulthood and the development of cardiovascular disease risk factors. JAMA. 2003;290:3092–3100.

  30. 30.

    Powers SK, Howley ET, editors. Exercise physiology: theory and application to fitness and performance. 5th ed. New York, NY: McGraw-Hill; 2004.

  31. 31.

    Hall JE. Mechanisms of abnormal renal sodium handling in obesity hypertension. Am J Hypertens. 1997;10:49S–55S.

  32. 32.

    Ketelhut R, Losem CJ, Messerli FH. Is a decrease in arterial pressure during long-term aerobic exercise caused by a fall in cardiac pump function? Am Heart J. 1994;127:567–71.

  33. 33.

    Bond V, Franks BD, Tearney RJ, Wood B, Melendez MA, Johnson L, et al. Exercise blood pressure response and skeletal muscle vasodilator capacity in normotensives with positive and negative family history of hypertension. J Hypertens. 1994;12:285–90.

  34. 34.

    Arakawa K. Anti-hypertensive mechanism of exercise. J Hypertens. 1993;11:223–9.

  35. 35.

    Higashi Y, Sasaki S, Nakagawa K, Matsuura H, Chayama K, Oshima T. Effect of obesity on endothelium-dependent, nitric oxide-mediated vasodilation in normotensive individuals and patients with essential hypertension. Am J Hypertens. 2001;14:1038–45.

  36. 36.

    Kurtze N, Rangul V, Hustvedt BE, Flanders WD. Reliability and validity of self-reported physical activity in the Nord-Trondelag Health Study: HUNT1. Scand J Public Health. 2008;36:52–61.

  37. 37.

    Chuang SY, Chou P, Hsu PF, Cheng HM, Tsai ST, Lin IF, et al. Presence and progression of abdominal obesity are predictors of future high blood pressure and hypertension. Am J Hypertens. 2006;19:788–95.

  38. 38.

    Os I, Oparil S, Gerdts E, Hoieggen A. Essential hypertension in women. Blood Press. 2004;13:272–8.

  39. 39.

    Krokstad S, Langhammer A, Hveem K, Holmen TL, Midthjell K, Stene TR, et al. Cohort profile: the HUNT study, Norway. Int J Epidemiol. 2013;42:968–77.

Download references


The Nord-Trøndelag Health Study (The HUNT Study) is a collaboration between HUNT Research Centre (Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU)), Nord-Trøndelag County Council, Central Norway Regional Health Authority, and The Norwegian Institute of Public Health.

Author information

Conflict of interest

The authors declare that they have no conflict of interest.

Correspondence to Jo S. Stenehjem.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark