Article Impact Level: HIGH Data Quality: STRONG Summary of European Journal of Preventive Cardiology, zwaf441. https://doi.org/10.1093/eurjpc/zwaf441 Dr. Sonia W. M. Cheng et al.
Points
- In a study of adults with high blood pressure, every extra 1,000 daily steps was associated with a 17% lower risk of major adverse cardiovascular events.
- This incremental increase in walking also correlated with a 22% reduction in heart failure risk and a 24% reduction in stroke risk for hypertensive individuals.
- Walking with greater intensity, such as an average of 80 steps per minute during the fastest 30 minutes of the day, was associated with a 30% reduced risk of MACE.
- The magnitude of risk reduction from increased stepping was found to be comparable between people with and without hypertension for most major cardiovascular outcomes.
- These findings support accessible targets for patients, showing that any amount of walking is beneficial and can inform new public health recommendations for people managing high blood pressure.
Summary
This prospective cohort study examined the dose-response association between objectively measured physical activity and cardiovascular outcomes in adults with hypertension. Data were analyzed from 36,192 participants [mean age 64 (SD 7) years] with established hypertension from the UK Biobank accelerometry sub-study. Participants wore a wrist-worn accelerometer for seven consecutive days, and their health outcomes were tracked over a median follow-up period of 7.8 years, resulting in a total of 283,001 person-years of data. The primary outcomes were cardiovascular mortality and the incidence of major adverse cardiovascular events (MACE), including heart failure (HF), myocardial infarction (MI), and stroke.
The study identified non-linear inverse dose-response associations between daily step count, stepping intensity, and MACE risk. Each 1000-step increase in daily steps, up to 10,000 steps/day, was associated with a significant reduction in risk for MACE (HR reduction: 17.1%, 95% CI: 10.2–23.2), HF (HR reduction: 22.4%, 95% CI: 11.0–31.7), and stroke (HR reduction: 24.5%, 95% CI: 5.3–39.0). The association for MI was of a lower magnitude and not statistically significant (HR reduction: 9.3%, 95% CI: -2.8 to 19.6). Furthermore, a higher stepping intensity, measured by peak 30-minute cadence, was also linked to a substantially lower risk of MACE.
The findings suggest that even incremental increases in daily walking, well below the common 10,000-step target, confer significant cardiovascular benefits for individuals with hypertension. These associations were comparable in magnitude to those observed in people without hypertension for MACE, HF, and stroke. While the study is observational and has limitations, such as a single physical activity measurement and a potentially healthier-than-average cohort, its large size and objective measurements support promoting increased daily steps and walking intensity as a core component of cardiovascular risk management in hypertensive patients.
Link to the article: https://academic.oup.com/eurjpc/advance-article/doi/10.1093/eurjpc/zwaf441/8223012
References Cheng, S. W. M., Biswas, R. K., Koemel, N. A., O’Sullivan, J. F., Sabag, A., Ahmadi, M. N., & Stamatakis, E. (2025). Prospective associations of daily step count and stepping intensity with overall and type-specific major adverse cardiovascular events in people with hypertension. European Journal of Preventive Cardiology, zwaf441. https://doi.org/10.1093/eurjpc/zwaf441
