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Original research
Cardiovascular or mortality risk of controlled hypertension and importance of physical activity
  1. Sehoon Park1,2,
  2. Kyungdo Han3,
  3. Soojin Lee4,
  4. Yaerim Kim5,
  5. Yeonhee Lee4,
  6. Min Woo Kang4,
  7. Sanghyun Park6,
  8. Yong Chul Kim4,
  9. Seung Seok Han4,
  10. Hajeong Lee4,
  11. Jung Pyo Lee7,8,9,
  12. Kwon Wook Joo4,8,9,
  13. Chun Soo Lim7,8,9,
  14. Yon Su Kim1,4,8,9,
  15. Dong Ki Kim4,8,9
  1. 1Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  2. 2Department of Internal Medicine, Armed Forces Capital Hospital, Gyeonggi-do, Korea (the Republic of)
  3. 3Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea (the Republic of)
  4. 4Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
  5. 5Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea (the Republic of)
  6. 6Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Korea (the Republic of)
  7. 7Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of)
  8. 8Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  9. 9Kidney Research Institute, Seoul National University, Seoul, Korea (the Republic of)
  1. Correspondence to Professor Dong Ki Kim, Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea (the Republic of); dkkim73{at}


Objective To investigate the risk of major adverse cardiac and cerebrovascular events (MACCEs) and all-cause death of patients with controlled hypertension and suggest the benefits of physical activity in their prognosis.

Methods People aged 40–69 years from the prospective UK Biobank cohort (UKB, n=220 026) and the retrospective Korean National Health Insurance Service cohort (KNHIS, n=3 593 202) were included in this observational cohort study, excluding those with previous cerebrocardiovascular diseases or hypertension without treatment. The study groups were stratified into normotension, controlled hypertension (patients with hypertension with systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg) and uncontrolled hypertension groups. The outcomes were MACCEs and all-cause mortality, analysed by Cox regression analysis.

Results We included 161 405/18 844/39 777 and 3 122 890/383 828/86 484 individuals with normotension/controlled hypertension/uncontrolled hypertension state from the UKB and KNHIS cohorts, respectively. The controlled hypertension group showed significantly higher risk of MACCEs (UKB: adjusted HR 1.73 (95% CI 1.55 to 1.92); KNHIS: 1.46 (95% CI 1.43 to 1.49)) and all-cause mortality (UKB: adjusted HR 1.28 (95% CI 1.18 to 1.39); KNHIS: 1.29 (95% CI 1.26 to 1.32)) than individuals with normotension. The controlled hypertension group not involved in any moderate or moderate-to-vigorous physical activity showed high risk of adverse outcomes, which was comparable with or even higher than the risk of patients with uncontrolled hypertension who were engaged in physical activity.

Conclusions Controlled hypertension is associated with residual risks of adverse outcomes. Clinicians may encourage physical activity for patients with controlled hypertension, not being reassured by their achieved target blood pressure values.

  • hypertension
  • coronary artery disease
  • epidemiology

Statistics from


  • SP and KH contributed equally.

  • Contributors The corresponding author attests that all listed authors meet the authorship criteria and that no others meeting the criteria have been omitted. SeP, KH, SaP, HL, KWJ and DKK contributed to the conception and design of the study. SL, YK, YL, MWK, YCK, SSH, JPL, KWJ, CSL, YSK and DKK provided statistical advice and interpreted the data. SeP, KH and SaP performed the main statistical analysis, assisted by SL. HL, JPL, KWJ, CSL, YSK and DKK provided advice regarding data interpretation. YCK, SSH, HL, JPL, KWJ, CSL and YSK provided material support during the study. SeP, KH and DKK had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors participated in drafting the manuscript. All authors reviewed the manuscript and approved the final version to be published.

  • Funding This work was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI17C0530). The funder played no role in the performance of the study, and the study was performed independently by the authors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was performed in accordance with the Declaration of Helsinki. The investigation for the UK Biobank cohort was approved by the institutional review boards of Seoul National University Hospital (E-1910-044-1067) and by the UK Biobank organisation (application no. 53799). The investigation for the Korean National Health Insurance Service (NHIS) cohort was approved by the institutional review boards (E-2001-038-1092) and by the NHIS (NHIS-2018-1-247). The requirement for informed consent was waived as the study investigated anonymous databases.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data that support the findings of this study are available from the UK Biobank (application no. 53799) and the NHIS of the Republic of Korea (NHIS-2018-1-247). The study data will be made available by organisations upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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