Combined associations of physical activity and sedentary behavior with all-cause and cardiovascular mortality in hypertensive adults: A cohort study using NHANES data (2007–2018)

With rising sedentary behavior (SB) and reduced physical activity (PA) levels, hypertensive adults face an escalated risk of mortality. The individual impacts of PA and SB on mortality are well-documented, yet their combined effects on survival outcomes in this population remain underexplored. This study investigates the combined associations of PA and SB with all-cause and cardiovascular mortality risks in hypertensive U.S. adults. This cohort study utilized data from the National Health and Nutrition Examination Survey (2007-2018) with mortality follow-up through December 31, 2019. PA and SB were assessed using the Global Physical Activity Questionnaire. Mortality status and cause of death were ascertained by linkage to the National Death Index. Kaplan-Meier curves and the Cox proportional hazard model were used to evaluate the associations between separate and joint prognostic effects of PA and SB with mortality outcomes among hypertensive adults. Hypertensive individuals who engaged in short-term sitting (≤6 hours/day) and active physical activity (PA ≥ 600 metabolic equivalent [MET]-minute/week) exhibited the lowest all-cause mortality risk (hazard ratio = 0.42, 95% CI: 0.36-0.48, P < .001). Similarly, those with short-term sitting (≤6 hours/day) and insufficiently active PA (0 < PA < 600 MET-minute/week) showed the lowest cardiovascular mortality risk (hazard ratio = 0.36, 95% CI: 0.24-0.53, P < .001). Conversely, hypertensive adults with long-term sitting (>6 hours/day) and no physical activity (PA = 0 MET-minute/week) faced the highest risks of all-cause and cardiovascular mortality. Kaplan-Meier survival analysis further confirmed that hypertensive patients with short-term sitting and active PA had significantly higher overall survival probabilities compared to other groups. Our study highlights that the combination of active PA and short-term SB was strongly associated with reduced mortality risk of hypertensive adults. Our findings might help to refine the lifestyle intervention recommendations for this population.