Author(s): FORNARA, E.1,2, HERNÁNDEZ, M.H.2, HERNÁEZ, A.1,2, Institution: UNIVERSITY RAMON LLULL, Country: SPAIN, Abstract-ID: 750

INTRODUCTION:
European guidelines recommend at least 150 minutes per week of moderate or 75 minutes per week of vigorous physical activity (approximately 100 METs-min/day); however, it remains unclear whether achieving this level is sufficient to influence age-related blood pressure trajectories and hypertension-related outcomes in older adults at high cardiovascular risk. Therefore, we aimed to investigate the association between moderate-to-vigorous leisure-time physical activity (MVLTPA) and longitudinal changes in systolic (SBP) and diastolic blood pressure (DBP), as well as the risk of incident high blood pressure and initiation of antihypertensive medication, among adults aged 60-80 years.
METHODS:
In 5,254 participants from the PREDIMED study, SBP and DBP trajectories between ages 60 and 80 were estimated according to MVLTPA levels, categorized as insufficient (<100 METs-min/day) or sufficient (>=100 METs-min/day). Longitudinal changes were modelled using mixed-effects regression with smoothed cubic splines. Associations of MVLTPA categories and per-25 METs-min/day increments with incident elevated blood pressure (SBP >=140 mmHg or DBP >=90 mmHg) and initiation of antihypertensive medication were assessed using multivariable Cox proportional hazards models, overall and stratified by sex.
RESULTS:
Higher MVLTPA was associated with more favourable SBP and DBP trajectories over follow-up. Inter-group differences increased with advancing age, with lower SBP among more active participants from approximately age 70 onwards (overall: -0.67 to -1.20 mmHg; men: -0.56 to -0.89 mmHg; women: -1.06 to -1.72 mmHg). Similar age-dependent patterns were observed for DBP, with modest but consistent reductions at older ages (overall: -0.22 to -0.91 mmHg). Participants achieving >=100 METs-min/day had a significantly lower risk of initiating antihypertensive medication compared with insufficiently active participants (hazard ratio [HR] 0.81, 95% CI 0.69-0.96; approximately 19% lower risk). Associations were directionally consistent across sexes and stronger among women (HR 0.73, 95% CI 0.57-0.93). Spline analyses supported a linear dose-response association between MVLTPA and antihypertensive drug initiation (p-value = 0.013) across most of the activity range, with evidence of a plateau at higher MVLTPA levels (approximately >300 METs-min/day). The inverse association appeared slightly more pronounced among women, with each additional 25 METs-min/day associated with a 3% lower risk of treatment initiation (HR 0.97, 95% CI 0.94-0.99).
CONCLUSION:
Among older adults at high cardiovascular risk, higher MVLTPA was associated with more favourable age-related blood pressure trajectories and a lower risk of antihypertensive drug initiation. Benefits became more evident at older ages and were slightly more pronounced among women, supporting the relevance of sustained MVLTPA in later life.