Association between Physical Activity and Hypertension in Chronic Obstructive Pulmonary Disease

Jun-Hwan Jang; Sun-Dong Ryu; Hye-Shin Kim; Keun-Mi Lee; Seung-Pil Jung

doi:10.15384/kjhp.2016.16.2.77

Korean J Health Promot > Volume 16(2); 2016 > Article

Jang, Ryu, Kim, Lee, and Jung: Association between Physical Activity and Hypertension in Chronic Obstructive Pulmonary Disease

Original Article

Korean Journal of Health Promotion 2016;16(2):77-83.

Published online: January 20, 2016

DOI: https://doi.org/10.15384/kjhp.2016.16.2.77

Association between Physical Activity and Hypertension in Chronic Obstructive Pulmonary Disease

Jun-Hwan Jang, Sun-Dong Ryu, Hye-Shin Kim, Keun-Mi Lee, Seung-Pil Jung

Department of Family Medicine, Yeung-Nam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea

Corresponding author: Seung-Pil Jung, MD, PhD Department of Family Medicine, Yeung-Nam University Medical Center, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea
Tel: +82-53-620-3542, Fax: +82-53-654-2413 E-mail: spjung@yu.ac.kr

Received October 27, 2015 Accepted June 10, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background

Patients with chronic obstructive pulmonary disease (COPD) have increased likelihood of hypertension, which may lead to increased mortality rates. This study investigated the incidence of hypertension in patients with COPD according to the levels of their physical activities.

Methods

This study used data from the fifth Korean National Health and Nutrition Examination Survey, conducted from 2010 to 2012, including 1,243 people aged 40 years or older with COPD who were cross-classified according to their levels of physical activity. The relevance of morbidity associated with high blood pressure was also evaluated through cross and logistic regression analyses.

Results

Among patients with COPD who performed moderate-intensity physical activities, the group without hypertension had 4.3% higher compared to the group with hypertension (P=0.012). Adjusted analysis for patient age, sex, body mass index, smoking, drinking habit, income, diabetes mellitus, hyperlipidemia, and energy intake performed to determine the relationship between physical activity level and hypertension revealed that patients with moderate-intensity physical activity had 53.6% lower (95% confidence interval: 0.288–0.997) incidence of hypertension.

Conclusions

The results of the current study suggest that patients with COPD who perform moderate-intensity physical activity have a lower incidence of hypertension.

Table 1.

General Characteristics of subjects (unweighted n = 1,243)

Variable	Non-hypertension (n = 593)	Hypertension (n = 650)	P
Male sex	74.1 (2.4)	75.4 (2.3)	0.673^a
Current smoking	64.4 (2.6)	72 (2.3)	0.028^a
Heavy drinker	13.8 (2)	11.7 (1.7)	0.40^a
Income	25.7 (2.2)	32.3 (2.2)	0.024^a
Education	57.3 (2.7)	61.6 (2.5)	0.221^a
Marriage status (yes)	88.7 (1.6)	77.5 (2.2)	<0.001^a
DM (yes)	12.2 (1.6)	20.6 (2.1)	0.002^a
Hyperlipidemia (yes)	10 (1.6)	21.4 (2)	<0.001^a
Chronic bronchitis or emphysema (yes)	2.4 (0.7)	2.5 (0.8)	0.916^a
Age, y	59.7±0.5	64.9±0.5	<0.001^b
BMI, kg/m²	23.3±0.1	24.1±0.2	<0.001^b
WC, cm	83.2±0.5	86.1±0.4	<0.001^b
SBP, mmHg	116.9±0.6	136.2±0.9	<0.001^b
DBP, mmHg	73.9±0.5	81.7±0.6	<0.001^b
FVC, L	3.8±0.1	3.5±0.1	<0.001^b
FEV1, L	2.4±0.0	2.3±0.0	<0.001^b
FEV1/FVC	0.635±0.004	0.634±0.003	0.742^b
Energy intake, kcal	2235.4±60.2	1928.5±40.4	<0.001^b

Abbreviations: SE, standard error; DM, diabetes mellitus; BMI, body mass index; WC, waist circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure; FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second. Values are presented as percentage (SE) or mean±SE.

^aCalculated by chi-square test.

^bCalculated by t-test.

Table 2.

Association between physical activity and hypertension in COPD patients

	Physical activity
	Vigorous (yes) (n = 154)	Moderate (yes) (n = 92)	Mild (yes) (n = 488)
Non-hypertension	13 (1.9)	9.2 (1.5)	38.2 (2.7)
Hypertension	11 (1.5)	4.9 (1)	39.5 (2.3)
P^a	0.390	0.012	0.709

Abbreviations: COPD, chronic obstructive pulmonary disease. Values are presented as percentage (SE).

^aCalculated by chi-square test.

Table 3.

Correlations between hypertension and intensity of physical activity in COPD patients^a

	Physical activity
	Vigorous (yes) (n = 154)	Moderate (yes) (n = 92)	Mild (yes) (n = 488)
Model 1^b	0.830^a (0.542–1.270)	0.511^a (0.299–0.871)	1.060^a (0.782–1.435)
Model 2^c	0.962^a (0.607–1.526)	0.528^a (0.298–0.938)	0.992^a (0.724–1.359)
Model 3^d	0.789^a (0.497–1.252)	0.536^a (0.288–0.997)	0.951^a (0.668–1.356)

Abbreviations: COPD, chronic obstructive pulmonary disease; BMI, body mass index; DM, diabetes mellitus. Reference was hypertensive group in COPD patients. Calculated by multiple logistic regression analysis. Model 1: not adjusted. Model 2: adjusted for age, sex, BMI, smoking, and drinking. Model 3: adjusted for age, sex, BMI, smoking, drinking, income, DM, hyperlipidemia, and energy intake.

References

1. Moon HS. Guideline of COPD. Reston: Korean Academy of Tuberculosis and Respiratory Diseases; 2012. [Accessed July 15, 2015].. http://www.lungkorea.org/thesis/guide.php.

2. Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL, Held LS, et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 2006;27(2):397-412.

3. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006;3(11):): e442..

4. Bousquet J, Kiley J, Bateman ED, Viegi G, Cruz AA, Khaltaev N, et al. Prioritised research agenda for prevention and control of chronic respiratory diseases. Eur Respir J 2010;36(5):995-1001.

5. Yoo KH, Kim YS, Sheen SS, Park JH, Hwang YI, Kim SH, et al. Prevalence of chronic obstructive pulmonary disease in Korea: the fourth Korean National Health and Nutrition Examination Survey, 2008. Respirology 2011;16(4):659-65.

6. Maclay JD, McAllister DA, Macnee W. Cardiovascular risk in chronic obstructive pulmonary disease. Respirology 2007;12(5):): 634 –41..

7. Korea Centers for Disease Control and Prevention. The Third Korea National health statistics National Health and Nutrition Examination Survey (KNHANS IV). Seoul: Korea Centers for Disease Control and Prevention; 2011. p. 1-727.

8. World Health Organization. A global brief on Hypertension. Geneva: World Health Organization; 2013. [Accessed August 1, 2015].. http://www.who.int/cardiovascular_diseases/publications/global_brief_hypertension.pdf.

9. Padwal R, Straus SE, McAlister FA. Evidence based management of hypertension. Cardiovascular risk factors and their effects on the decision to treat hypertension: evidence based review. BMJ 2001;322(7292):977-80.

10. Antonelli-Incalzi R, Fuso L, De Rosa M, Forastiere F, Rapiti E, Nardecchia B, et al. Comorbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur Respir J 1997;10(12):2794-800.

11. Jo YS, Choi SM, Lee J, Park YS, Lee SM, Yim JJ, el al. The relationship between chronic obstructive pulmonary disease and comorbidities: a cross-sectional study using data from KNH-ANES 2010–2012. Respir Med 2015;109(1):96-104.

12. Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J 2008;32(4):962-9.

13. Bento VF, Albino FB, Moura KF, Maftum GJ, Santos Mde C, Guarita-Souza LC, et al. Impact of physical activity interventions on blood pressure in Brazilian populations. Arq Bras Cardiol 2015;105(3):301-8.

14. Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc 2001;33(6 Suppl):): S484–92; discussion. S493-4.

15. Padillla J, Wallace JP, Park S. Accumulation of physical activity reduces blood pressure in pre- and hypertension. Med Sci Sports Exerc 2005;37(8):1264-75.

16. IPAQ research committee. Guideline for data processing and analysis of the international physical activity questionnaire (IPAQ) – Short and long forms, Revised Nov 2005. Place unknown: IPAQ research committee;. 2010;[Accessed July 30, 2015].. https://sites.google.com/site/theipaq/scoring-protocol.

17. Finkelstein J, Cha E, Scharf SM. Chronic obstructive pulmonary disease as an independent risk factor for cardiovascular morbidity. Int J Chron Obstruct Pulmon Dis 2009;4:337-49.

18. Huiart L, Ernst P, Suissa S. Cardiovascular morbidity and mortality in COPD. Chest 2005;128(4):2640-6.