High Fitness Levels Attenuate the Increased Risk of Hypertension Due to Low Socioeconomic Status in Middle-Aged Men: A Cohort Study

Hypertension (HTN) is the most common modifiable risk factor for cardiovascular disease, the leading cause of mortality globally. Several studies have documented a relationship between low socioeconomic status (SES) and increased risk of HTN.1 Pathways underlying the relationship include the presence of factors that are strongly related to lower SES such as lower levels of education, unhealthy lifestyles such as excessive alcohol consumption, limited access to health care, and higher prevalence of comorbid conditions.1 The health benefits of physical activity (PA) are wellestablished and these include the prevention of vascular diseases such as HTN.2 Cardiorespiratory fitness (CRF), considered to be the gold standard for assessing aerobic exercise capacity, is an indicator of cardiopulmonary function and can be increased though increased PA and exercise training.3 Cardiorespiratory fitness is an established and independent risk marker for vascular outcomes including hypertension.4 There is increasing evidence showing that higher levels of CRF can attenuate the increased risk of adverse outcomes due to other risk factors. For instance, we have previously shown that high CRF levels can attenuate (i) the increased risk of mortality due to SES,5(ii) the increased risk of sudden cardiac death due to low SES,6 (iii) the increased risk of pneumonia due to inflammation,7 and (iv) the increased risk of chronic obstructive pulmonary disease due to lowSES.8Several reports have also observed that the association of obesity with adverse outcomes is reduced on accounting for CRF levels.9