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Body composition, energy expenditure and physical activity

Longitudinal association between physical activity and blood pressure, risk of hypertension among Chinese adults: China Health and Nutrition Survey 1991–2015



To examine the effects of physical activity (PA) in adults with or without prehypertension at baseline on systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension risk by gender.


A total of 5986 men and 6525 women (≥18 years old) without hypertension-related disease at baseline who attended surveys from China Health and Nutrition Survey (1991–2015) at least twice were selected. In terms of the nested data structure, three-level random intercept growth model and three-level logistic regression were used to estimate the relationship between the PA and SBP/DBP or hypertension risk.


The incidence of hypertension increased from 10.86% in 1991 to 20.34% in 2015, and the median of PA dropped from 408 MET·h/week in 1991 to 104 MET·h/week in 2015. After adjusting confounders, PA in the third and fourth quartiles decreased SBP (by 0.98 and 0.96 mm Hg, p < 0.05) and DBP (by 0.30 and 0.38 mm Hg, p < 0.05), and it reduced the odds of hypertension by 12 and 15% (p < 0.05), compared with PA in the lowest quartile. For normotensive women in the third quartile of PA and prehypertensive women in the fourth quartile of PA, the risk of hypertension was reduced 15 and 22%, compared with women in the lowest quartile of PA.


Physical activity should be improved to the relatively high level to be effective in controlling blood pressure. Normotensive women had an association between physical activity and SBP, DBP, and the risk of hypertension.

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Fig. 1: The incidence of hypertension by the quartiles of physical activity in each survey round.
Fig. 2: The mean of SBP and DBP by the quartiles of physical activity in each survey round.
Fig. 3: Odds ratios for incident hypertension by quartiles of physical activity based on three-level logistic regression model.


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This research uses data from the CHNS. We thank all the participants in our study and the staff responsible for conducting CHNS. The authors also are grateful to the team at the National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, and the Carolina Population Center, University of North Carolina at Chapel Hill.


The present study is funded by the National Key Research and Development Program of China (No. 2019YFC1605100) and supported by grants from the National Natural Science Foundation of China (No. 81573155). The “China Nutritional Transition Cohort Study” project received funding from Ministry of Finance of the People’s Republic of China (No. 13103110700015005). The present study is also sponsored by Carolina Population Center (P2CHD050924, T32 HD007168), the University of North Carolina at Chapel Hill, the NIH (R01-HD30880, DK056350, R24 HD050924, and R01-HD38700), and the National Institutes of Health Fogarty International Center (D43TW009077, D43 TW007709) for financial support for CHNS data collection and analysis files from 1989 to 2015 and future surveys.

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All authors contributed significantly to this article. QZ analyzed the data and wrote the first version of the paper; HW, ZW, CS, WD, YO, XJ, and BZ performed the surveys; HW, CS, WD, YO, XJ, ZW, and GD interpreted the results and revised the paper; and BZ and GD critically reviewed the paper for important intellectual content. All authors approved the final paper.

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Correspondence to Bing Zhang.

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Zou, Q., Wang, H., Su, C. et al. Longitudinal association between physical activity and blood pressure, risk of hypertension among Chinese adults: China Health and Nutrition Survey 1991–2015. Eur J Clin Nutr 75, 274–282 (2021).

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