Higher BMI is significantly associated with increased hypertension prevalence in U.S. adults.

Physical activity has a limited effect on reducing hypertension prevalence across BMI categories.

Maintaining a healthy BMI is more strongly associated with reduced hypertension than physical activity in joint models.

Weight management and physical activity are both important, though BMI confers greater public health benefits for hypertension.

This study examines the joint associations of physical activity (PA) and body mass index (BMI) on the prevalence of hypertension in a nationally representative sample of 1.9 million U.S. adults.

Data were pooled from five U.S. Behavioural Risk Factor Surveillance System surveys from 2011 to 2019. Cross-sectional associations between self-reported PA and BMI status (independent variables) and hypertension (dependent variable) were analysed using Poisson log-linear regression with a robust-error variance, reported by adjusted prevalence ratios (APRs).

Data was available for 1,909,597 individuals (≥18 years). Compared to normal weight, highly active individuals (reference category), there was an association with decreased PA, increased BMI and prevalence of hypertension. Adjusted prevalence ratios (APRs) ranged from APR= 1.05, 95 % CI= 1.05–1.05 (Non-Active, Normal Weight) to APR= 1.83, 95 % CI= 1.82–1.83 (Non-Active, Obesity Class III).

A high body mass and low levels of PA were associated with a substantially increased prevalence of hypertension. Being highly active was associated with minor differences in the prevalence of hypertension for individuals who were living with obesity; however, this association was not observed among those who were living with normal weight or overweight. Due to likely bias in this cross-sectional study, findings regarding PA should be replicated in longitudinal studies with objective measures. These findings nonetheless highlight the public health relevance of maintaining a healthy body weight in relation to hypertension prevalence and the importance of PA for weight loss and management.

Adjusted Prevalence Ratio

Behavioral Risk Factor Surveillance System

Cardiovascular Disease

Moderate-to-Vigorous Physical Activity

Physical activity

Body mass index

Hypertension

Public health

Epidemiology

© 2025 The Author(s). Published by Elsevier Inc.