H ypertension represents a major public health problem, affecting more than 1 billion persons worldwide, a number that is expected to increase to ≈1.5 billion during the next decade. 1 The prevalence of hypertension rises with increasing age; in fact, the majority of elderly individuals have high blood pressure (BP).2 On the basis of Framingham data, the probability of an individual with normal BP at 55 years of age to become hypertensive during the next 2 decades is ≈90%, 3 with 7.6 million premature deaths (≈13.5% of the total global mortality) attributed to high BP. 4 Given that advances in medical therapy and living conditions have prolonged life expectancy, the number of older individuals is expected to double over the next 2 decades, with 1 of 5 individuals being ≥65 years by 2030.5 Thus, the prevalence of hypertension is expected to continue to be a major public health problem worldwide.Although cardiorespiratory fitness (CRF) is influenced by many factors, regular physical activity develops CRF.6,7 Low-tomoderate intensity exercise training has been shown to improve CRF significantly in middle-aged and older hypertensive veterans.8 Increased physical activity leading to improved CRF status is now a part of standard lifestyle recommendations for hypertensive individuals by itself or as an adjunct to pharmaceutical therapy to manage hypertension and lower mortality risk.
9Increased CRF is associated with a lower rate of progression to hypertension 10 and a lower mortality risk in relatively healthy individuals and those with comorbidities, including hypertension.11-15 Significant reductions is mortality risk are noted in middle-aged individuals when peak exercise capacity exceeds ≈5 to 7 metabolic equivalents (METs).11-15 However, it is not known whether this fitness threshold applies to the elderly. The proportion of individuals achieving the minimum amount of recommended physical activity decreases with age and is estimated to be as low as 15.9% in adults ≥65 years of age.16 Furthermore, chronic health conditions known to be associated with aging might limit the ability of older individuals to exercise or to achieve an exercise capacity necessary for health benefits. Moreover, medical costs increase substantially with aging, which coupled with life prolongation, dramatically increase healthcare costs during subsequent decades.9 Because regular physical activity is associated with better health Abstract-Aging, even in otherwise healthy subjects, is associated with declines in muscle mass, strength, and aerobic capacity. Older individuals respond favorably to exercise, suggesting that physical inactivity plays an important role in age-related functional decline. Conversely, physical activity and improved exercise capacity are associated with lower mortality risk in hypertensive individuals. However, the effect of exercise capacity in older hypertensive individuals has not been investigated extensively. A total of 2153 men with hypertension, aged ≥70 years (mean, 75±4) from the Washington, DC, and Palo Alto...