The association between objectively measured physical activity and home blood pressure: a population-based real-world data analysis

Few studies have examined the association of objectively measured habitual physical activity (PA) and sedentary behavior with out-of-office blood pressure (BP). We investigated the associations of objectively measured PA intensity time, sedentary time, and step count with at-home BP. Using accelerometer-recorded PA indices and self-measured BP in 368 participants (mean age, 53.8 years; 58.7% women), we analyzed 115,575 records of each parameter between May 2019 and April 2024. PA intensities were categorized as light (2.0-2.9 metabolic equivalents [METs]); moderate (3.0-5.9 METs); vigorous (≥6.0 METs), or sedentary (<2.0 METs): the median [interquartile ranges] for these variables was 188 [146-232], 83 [59-114], 1 [0-2], 501 [428-579] minutes, respectively, and for step count, was 6040 [4164-8457]. Means [standard deviations] for systolic and diastolic BP were 116.4 [14.2] and 75.2 [9.3] mmHg, respectively. A mixed-effect model adjusted for possible confounders showed that 1-h longer in vigorous PA was associated with lower systolic and diastolic BP (-1.69 and -1.09 mmHg, respectively). A 1000-step increase in step count was associated with lower systolic and diastolic BP (-0.05 and -0.02 mmHg, respectively). Associations were more pronounced among men and participants aged <60 years. Sedentary time was positively associated with BP in men and participants aged <60 years, but inversely associated with BP in women and participants aged ≥60 years. Our findings suggest that more PA and less sedentary behavior were associated with BP reduction, particularly among men and participants aged <60 years. However, the clinical relevance of this effect remains uncertain because of its modest magnitude.