Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Physical activity lower blood pressure and mortality in hypertensive patients with diabetes: data from National Health and Nutrition Examination Survey (NHANES) 1999–2018

Journal of Human Hypertension volume 38, pages 694–702 (2024)Cite this article

Subjects

Abstract

In prior research related to physical activity, researchers have often centered their focus on only a limited number of activities, with little regard for mortality-related outcomes and insufficient focus on outcomes among diabetes patients with hypertension. The National Health and Nutrition Examination Survey was evaluated from 1999-2018 to identify individual with both diabetes and hypertension. These individuals were classified as being physically active or inactive. Comparisons among groups were performed with appropriate statistical tests. In total, this study evaluated data from 6,163 patients with a mean age of 63.18 ± 12.80 years. A total of 50.30% of the participants were male, with 39.86% being non-Hispanic white, 57.17% with a normal body mass index, and 89.20% were insured. Physical activity was significantly negatively correlated with systolic blood pressure in the overall population (p = 0.01) and when specifically focusing on individuals undergoing antihypertensive drug treatment (p = 0.0035). This negative relationship remained intact even following adjustment for age, sex, and ethnicity (p = 0.03). Physical activity was positively correlated with diastolic blood pressure in the overall population of participants (p = 0.002) and when specifically evaluating participants undergoing antihypertensive drug treatment (p = 0.02). All-cause and hypertensive mortality risk levels were significantly higher among individuals classified as being physically inactive (p < 0.0001), and this relationship remained true even with adjustment for age, sex, and ethnicity (p < 0.0001). In conclusion, physical activity is capable of lowering systolic blood pressure and decreasing the incidence of mortality among diabetes patients with hypertension.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Study flowchart showing the process of participant selection.
Fig. 2: Summary figure of the primary findings.

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author, Lijiang Tang, upon reasonable request.

References

  1. Tinajero MG, Malik VS. An Update on the Epidemiology of Type 2 Diabetes: A Global Perspective. Endocrinol Metab Clin North Am. 2021;50:337–55.

    Article  Google Scholar 

  2. Prasertsri P, Phoemsapthawee J, Kuamsub S, Poolpol K, Boonla O. Effects of Long-Term Regular Continuous and Intermittent Walking on Oxidative Stress, Metabolic Profile, Heart Rate Variability, and Blood Pressure in Older Adults with Hypertension. J Environ Public Health. 2022;2022:5942947.

    Article  Google Scholar 

  3. Akhtar S. Diabetes-induced peripheral neuropathy: Is prescribing physical exercise the answer? Biomol Biomed. 2024;24:436–9.

  4. Tatsumi Y, Ohkubo T. Hypertension with diabetes mellitus: significance from an epidemiological perspective for Japanese. Hypertens Res. 2017;40:795–806.

    Article  Google Scholar 

  5. Balducci S, Sacchetti M, Haxhi J, Orlando G, D’Errico V, Fallucca S, et al. Physical exercise as therapy for type 2 diabetes mellitus. Diabetes Metab Res Rev. 2014;30:13–23.

    Article  Google Scholar 

  6. Newsome ANM, Reed R, Sansone J, Batrakoulis A, McAvoy C W, Parrott M. 2024 ACSM Worldwide Fitness Trends: Future Directions of the Health and Fitness Industry. ACSM’s Health & Fitness Journal. 2024;28:14–26.

    Article  Google Scholar 

  7. Alpsoy. Exercise and Hypertension. Adv Exp Med Biol. 2020;1228:153–67.

    Article  Google Scholar 

  8. Saco-Ledo G, Valenzuela PL, Ruiz-Hurtado G, Ruilope LM, Lucia A. Exercise Reduces Ambulatory Blood Pressure in Patients With Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc. 2020;9:e018487.

    Article  Google Scholar 

  9. Sampath Kumar A, Maiya AG, Shastry BA, Vaishali K, Ravishankar N, Hazari A, et al. Exercise and insulin resistance in type 2 diabetes mellitus: A systematic review and meta-analysis. Ann Phys Rehabil Med. 2019;62:98–103.

    Article  Google Scholar 

  10. Jiang JQ, Xia XH, Wang H, Zhang ZH. Meta-analysis on influence of different exercise intervention modes to blood glucose related indexes of pre-diabetes. Zhongguo Ying Yong Sheng Li Xue Za Zhi. 2017;33:189–92.

  11. Batrakoulis A, Jamurtas A, Fatouros I. Exercise and Type II Diabetes Mellitus: A Brief Guide for Exercise Professionals. Strength Conditioning J. 2022;44:64–72.

  12. Marttila J, Laitakari J, Nupponen R, Miilunpalo S, Paronen O. The versatile nature of physical activity-on the psychological, behavioural and contextual characteristics of health-related physical activity. Patient Educ Couns. 1998;33:S29–38.

    Article  Google Scholar 

  13. Börjesson M, Onerup A, Lundqvist S, Dahlöf B. Physical activity and exercise lower blood pressure in individuals with hypertension: narrative review of 27 RCTs. Br J Sports Med. 2016;50:356–61.

    Article  Google Scholar 

  14. Draznin B, Aroda VR, Bakris G, Benson G, Brown FM, Freeman R, et al. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45:S17–s38. 2.

    Article  Google Scholar 

  15. Bakker EA, Sui X, Brellenthin AG, Lee DC. Physical activity and fitness for the prevention of hypertension. Curr Opin Cardiol. 2018;33:394–401.

    Article  Google Scholar 

  16. You Y, Teng W, Wang J, Ma G, Ma A, Wang J, et al. Hypertension and physical activity in middle-aged and older adults in China. Sci Rep. 2018;8:16098.

    Article  Google Scholar 

  17. Nagata JM, Vittinghoff E, Pettee Gabriel K, Garber AK, Moran AE, Sidney S, et al. Physical Activity and Hypertension From Young Adulthood to Middle Age. Am J Prev Med. 2021;60:757–65.

    Article  Google Scholar 

  18. Liu X, Zhang D, Liu Y, Sun X, Han C, Wang B, et al. Dose-Response Association Between Physical Activity and Incident Hypertension: A Systematic Review and Meta-Analysis of Cohort Studies. Hypertension. 2017;69:813–20.

    Article  Google Scholar 

  19. Al-Mhanna SB, Rocha-Rodriguesc S, Mohamed M, Batrakoulis A, Aldhahi MI, Afolabi HA, et al. Effects of combined aerobic exercise and diet on cardiometabolic health in patients with obesity and type 2 diabetes: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil. 2023;15:165.

    Article  Google Scholar 

  20. Batrakoulis A, Jamurtas AZ, Metsios GS, Perivoliotis K, Liguori G, Feito Y, et al. Comparative Efficacy of 5 Exercise Types on Cardiometabolic Health in Overweight and Obese Adults: A Systematic Review and Network Meta-Analysis of 81 Randomized Controlled Trials. Circ Cardiovasc Qual Outcomes. 2022;15:e008243.

    Article  Google Scholar 

  21. Batrakoulis A, Jamurtas AZ, Fatouros IG. High-Intensity Interval Training in Metabolic Diseases Physiological Adaptations. ACSMs Health Fitness J. 2021;25:54–59.

  22. Stamatakis E, Gale J, Bauman A, Ekelund U, Hamer M, Ding D. Sitting Time, Physical Activity, and Risk of Mortality in Adults. J Am Coll Cardiol. 2019;73:2062–72.

    Article  Google Scholar 

  23. Sallis JF, Floyd MF, Rodríguez DA, Saelens BE. Role of built environments in physical activity, obesity, and cardiovascular disease. Circulation. 2012;125:729–37.

    Article  Google Scholar 

  24. Lee CD, Folsom AR, Blair SN. Physical activity and stroke risk: a meta-analysis. Stroke. 2003;34:2475–81.

    Article  Google Scholar 

  25. Lavie CJ, Ozemek C, Kachur S. Promoting physical activity in primary and secondary prevention. Eur Heart J. 2019;40:3556–8.

    Article  Google Scholar 

  26. Sattelmair J, Pertman J, Ding EL, Kohl HW 3rd, Haskell W, Lee IM. Dose response between physical activity and risk of coronary heart disease: a meta-analysis. Circulation. 2011;124:789–95.

    Article  Google Scholar 

  27. Kraus WE, Powell KE, Haskell WL, Janz KF, Campbell WW, Jakicic JM, et al. Physical Activity, All-Cause and Cardiovascular Mortality, and Cardiovascular Disease. Med Sci Sports Exerc. 2019;51:1270–81.

    Article  Google Scholar 

  28. Mok A, Khaw KT, Luben R, Wareham N, Brage S. Physical activity trajectories and mortality: population based cohort study. BMJ. 2019;365:l2323.

    Article  Google Scholar 

  29. Stamatakis E, Ahmadi MN, Gill JMR, Thøgersen-Ntoumani C, Gibala MJ, Doherty A, et al. Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality. Nat Med. 2022;28:2521–9.

    Article  Google Scholar 

Download references

Funding

This study was supported by the Scientific and Technological Projects for Medicine and Health of Zhejiang Province (Grant No.2022481190) and Traditional Chinese Scientific and Technological Projects for Medicine and Health of Zhejiang Province (Grant No.2024ZL223).

Author information

Author notes

  1. These authors contributed equally: Xin Zhong, Xiaowei Liu, Zhi Zhang.

Authors and Affiliations

  1. The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, PR China

    Xin Zhong

  2. Department of Cardiology, Zhejiang Hospital, Hangzhou, 310013, Zhejiang, PR China

    Xiaowei Liu & Lijiang Tang

  3. Department of Cardiology, First People’s Hospital of Linping District, Hangzhou, 311100, Zhejiang, PR China

    Zhi Zhang

Authors
  1. Xin Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiaowei Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhi Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lijiang Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceived and designed the experiments: Lijiang Tang and Xiaowei Liu. Performed the experiments: Zhi Zhang and Xin Zhong. Analyzed and interpreted the data: Xiaowei Liu and Zhi Zhang. Contributed reagents, materials, analysis tools or data: Lijiang Tang and Xiaowei Liu. Wrote the paper: Xin Zhong, Xiaowei Liu and Zhi Zhang

Corresponding author

Correspondence to Lijiang Tang.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval

Our data comes from the NHANES database, which is a public database and has been approved by the ethics committee of NHANES, and all the participants have signed written informed consent, so our study does not need to be approved by ethics committee.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhong, X., Liu, X., Zhang, Z. et al. Physical activity lower blood pressure and mortality in hypertensive patients with diabetes: data from National Health and Nutrition Examination Survey (NHANES) 1999–2018. J Hum Hypertens 38, 694–702 (2024). https://doi.org/10.1038/s41371-024-00941-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41371-024-00941-2

Search

Advanced search

Quick links