Cureus. 2026 Sep 11;18(9):e116112. doi: 10.7759/cureus.116112. eCollection 2026 Sep.
ABSTRACT
Background Hypertension continues to be a principal modifiable risk factor for cardiovascular disease and premature mortality in the United States. Current clinical guidelines recommend regular aerobic physical activity for the prevention and management of hypertension; however, contemporary population-level estimates from recent nationally representative data remain useful for evaluating whether established associations persist. This study evaluated the association between leisure-time aerobic physical activity and blood pressure-defined hypertension among U.S. adults. Methods We conducted a cross-sectional analysis of adults aged ≥18 years using data from the National Health and Nutrition Examination Survey (NHANES) 2021-2023. Participants with complete physical activity data and valid blood pressure measurements were included. Aerobic physical activity was categorized according to adherence to the Physical Activity Guidelines for Americans (≥150 minutes/week of moderate-intensity equivalent activity). Hypertension was defined as a mean systolic blood pressure ≥130 mmHg or a mean diastolic blood pressure ≥80 mmHg, based on up to three standardized oscillometric measurements. Antihypertensive medication use was not assessed and was not incorporated into this case definition. Survey-weighted multivariable logistic regression was performed to evaluate the association between meeting aerobic physical activity recommendations and hypertension after adjustment for age, sex, race/ethnicity, smoking status, alcohol consumption, household income, and educational attainment. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Results The analytic sample included 6,123 participants, representing approximately 245 million U.S. adults. Overall, 3,254 participants (54.7% weighted) met recommended aerobic physical activity guidelines, and 2,465 participants (37.5% weighted) met criteria for hypertension. Hypertension prevalence was lower among adults meeting activity recommendations than among those who did not (1,210 participants, 34.4% weighted vs. 1,255 participants, 41.2% weighted). In unadjusted analyses, meeting aerobic activity guidelines was associated with lower odds of hypertension (OR, 0.75; 95% CI, 0.67-0.84). This association remained statistically significant after multivariable adjustment (adjusted OR, 0.79; 95% CI, 0.62-0.99; p=0.044). Age demonstrated the strongest association with hypertension, with adults aged ≥60 years having significantly greater odds of hypertension than those aged 18-39 years (adjusted OR, 2.35; 95% CI, 1.44-3.82). No significant effect modification was found across the subgroups examined. Conclusions In this nationally representative sample of U.S. adults, leisure-time aerobic physical activity meeting recommended levels was independently associated with lower adjusted odds of blood pressure-defined hypertension after adjustment for demographic, socioeconomic, and behavioral factors. Although the cross-sectional design precludes causal inference, physical activity was self-reported, and antihypertensive medication use was not incorporated into the hypertension case definition, these data support current guideline recommendations advocating regular aerobic physical activity as an important component of cardiovascular health.
PMID:42861390 | PMC:PMC13654592 | DOI:10.7759/cureus.116112