Association Between Physical Activity, Sleep, and Hypertension Among U.S. Middle-Aged and Older Adults: Insights From NHANES

Background. Hypertension is a major cause of cardiovascular disease and mortality in the US among middle-age and older adults. Physical activity and sleep are key modifiable factors, yet their age-specific association to hypertension remain unclear. Methods. We conducted a cross-sectional analysis of 9133 adults aged 40-80 years using data from National Health and Nutrition Examination Survey (NHANES) 2013-2018. Logistic regression models estimated odds ratios and 95% confidence intervals for associations between physical activity, sleep duration, and hypertension, adjusting for sociodemographic and health covariates. Analyses were stratified by age. Results. Overall, 61.2% of participants had hypertension, with prevalence higher among older adults (76.9%) than middle-aged adults (54.2%). In the overall sample, not meeting physical activity guidelines was associated with higher odds of hypertension (OR = 1.51, 95% CI: 1.18-1.92). Among middle-aged adults, both insufficient physical activity (OR = 1.63, 95% CI: 1.20-2.22) and long sleep duration (>9 hours/night) (OR = 1.45, 95% CI: 1.04-2.03) were linked to higher odds of hypertension. No significant associations were observed among older adults. Conclusion. Middle-age is critical for lifestyle-based hypertension prevention. Promoting physical activity and monitoring sleep during this period may reduce the likelihood of hypertension and improve cardiovascular health.