Background: There is a strong dose-response relationship between regular physical activity (PA) and stroke risk. However, this relationship is attenuated in the presence of cardiovascular risk. This study aimed to compare the dose-response relationship between PA and stroke between normo- and hypertensive individuals. Methods: A cohort study including 139,930 individuals was performed (median follow up: 6.75 years). Participants were stratified at baseline as hypertensive or normotensive and were categorised into quartiles of lowest (Q1) to highest (Q4) moderate-to-vigorous (MV), self-reported PA. Primary outcome was stroke. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals. The main analyses were stratified on baseline blood pressure and adjusted for confounders. Additionally, hypertensives were stratified into medicated or not medicated. Results: Compared to Q1, adjusted HRs were 0.87 (0.69-1.10, P=0.23) for Q2, 0.75 (0.59-0.95, P=0.02) for Q3, and 0.94 (0.74-1.20, P=0.64) for Q4 in the total population. In the stratified analyses, HRs for individuals with normotension were 0.79 (0.50-1.25, P=0.32), 0.75 (0.48-1.18, P=0.22), 0.97 (0.62-1.51, P=0.90) for MVPA Q2 to Q4, respectively. In hypertensive individuals, HRs compared to Q1 were 0.89 (0.68-1.17, P=0.41), 0.74 (0.56-0.98, P=0.03), 0.92 (0.69-1.23, P=0.56) for Q2-Q4, respectively. There was no significant interaction between PA and hypertensive status. A smaller benefit of MVPA in medicated hypertensives compared to non-medicated was observed, however the dose-response association was similar. Conclusion: MVPA reduces stroke risk in the total population (Q3), which is not affected by the presence of hypertension. Use of anti-hypertensive medication may interfere with the impact of MVPA on stroke risk.

The authors have declared no competing interest.

This is not a clinical trial

EAB has received funding from the European Union?s Horizon 2020 research and innovation programme under the Marie Sk?odowska-Curie grant agreement No [101064851]. The Lifelines Biobank initiative received funding from the Dutch Ministry of Health, Welfare and Sport, the Dutch Ministry of Economic Affairs, the University Medical Center Groningen [UMCG], University Groningen and the Northern Provinces of the Netherlands. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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The Lifelines Cohort study was conducted according to the principles of the Declaration of Helsinki and approved by the University Medical Centre Groningen Medical Ethical Committee.

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