Association between leisure-time physical activity trajectories and stroke risk in patients with hypertension in Jiangsu Province of China

Background Leisure-time physical activity (LTPA) is associated with a reduced risk of stroke among patients with hypertension. However, most studies have relied on a single LTPA assessment and have not adequately captured its sustainable of changes. Objective To identify the long term trajectories of LTPA among patients with hypertension in Jiangsu Province and to examine their association with stroke risk. Methods Data were extracted from the Jiangsu Provincial Early Screening and Comprehensive Intervention Program for High-Risk Populations of Cardiovascular Diseases. Participants with hypertension who enrolled in 2016 and had at least two annual follow-up data between 2017 and 2019 were included. LTPA levels were calculated based on the type, frequency, and duration of physical activity reported in questionnaires. Incident stroke data were obtained from the provincial cardiovascular disease registry system and death registration system of the Jiangsu Centers for Disease Prevention and Control. Group-based trajectory modeling (GBTM) was used to identify long term LTPA trajectories from 2016 to 2019. Multivariable Cox proportional hazards regression models were used to calculate hazard ratios ( HR s) and 95% confidence intervals ( CI s) for the association between LTPA trajectories and the incidence of stroke and its subtypes. Results The study included 10,760 participants with hypertension. GBTM identified two LTPA trajectories: a stable-low group (87.8%) and a high-decreasing group (12.2%). Over a median follow-up of 5.68 years, 1102 incident stroke cases occurred, including 979 ischemic strokes and 114 hemorrhagic strokes. Compared with the stable-low group, the high-decreasing group was associated with a lower risk of stroke ( HR =0.76; 95% CI , 0.60–0.97) and ischemic stroke ( HR =0.74; 95% CI , 0.57–0.96), but not hemorrhagic stroke ( HR =0.77; 95% CI , 0.35–1.70). Stratified analyses revealed that no significant interactions between LTPA trajectories and gender, age, smoking status, alcohol consumption, body mass index (BMI), history of diabetes, or duration of hypertension (all P for interaction >0.05). Conclusion Most patients with hypertension in Jiangsu Province maintain persistently low LTPA levels. Compared with this group, a high-level declining LTPA trajectory is associated with a lower risk of incident stroke, particularly ischemic stroke.