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Independent and joint associations of estimated cardiorespiratory fitness and its dynamic changes and obesity with the risk of hypertension: A prospective cohort


Our aim was to examine the independent and joint associations of estimated cardiorespiratory fitness (CRF) and its changes and obesity with risk of hypertension in a rural Chinese population. A prospective cohort including 9848 adults without hypertension at baseline was enrolled. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated by logistic regression models. Restricted cubic splines were used to model the dose–response relationship. During 6 years follow-up, 2,019 individuals developed hypertension. A negative association between estimated CRF and hypertension incidence was observed, with the risk being 0.87 (0.84–0.90) per MET increment. For estimated CRF change, the risks of hypertension were 1.50 (1.27–1.77) and 0.75 (0.59–0.97) for decreasers and increasers, respectively, compared to maintainers. Joint analyses showed individuals in the overweight/obesity-fourth quartile of estimated CRF had a 2.08 times higher risk of hypertension than those in the normal weight-first quartile (Pinteraction < 0.05). Those overweight/obesity-decreasers had the highest risk (OR: 2.19, 95%CI: 1.71–2.81; Pinteraction < 0.05) compared to the normal-maintainers. Similar results for abdominal obesity were also observed. Estimated CRF and its dynamic changes showed a negative association with hypertension incidence in the rural Chinese population.

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Fig. 1: Dose–response association of CRF and CRF change with risk of hypertension.
Fig. 2: Risk of hypertension incidence in relation to CRF and CRF change in subgroups of obesity at baseline.
Fig. 3: Stratified analyses of CRF and CRF change with risk of hypertension for per SD increase.

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Data availability

Data available on request from the authors. Data available on request from the corresponding author.

Code availability

The code used for the study are available from the corresponding author by request.


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The investigators are grateful to the dedicated participants and all research staff of the study.


This study was supported by the National Natural Science Foundation of China (grant nos. 82073646, 81973152, 82103940, and 82273707), Guangdong Basic and Applied Basic Research Foundation (grant nos. 2021A1515012503, and 2022A1515010503), and Shenzhen Science and Technology Program (grant nos. JCYJ20210324093612032 and JCYJ20220818095818040).

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YZ and DH substantially contributed to the design and drafting of the study and the analysis and interpretation of the data. YZ wrote the manuscript. XF, YK, YW, PQ, FH, MZ, and DH, revised it critically for important intellectual content. All authors were involved in the collection of data and approval of the final version of the manuscript.

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Correspondence to Dongsheng Hu.

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Zhao, Y., Fu, X., Ke, Y. et al. Independent and joint associations of estimated cardiorespiratory fitness and its dynamic changes and obesity with the risk of hypertension: A prospective cohort. J Hum Hypertens 38, 413–419 (2024).

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