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Obesity is associated with an increased risk of morbidity and mortality from cardiometabolic diseases, but not all obese individuals are at increased risk. This phenotype of obesity is referred to as “metabolically healthy obesity (MHO).” MHO describes a cohort of the obese population with relatively low risk of cardiovascular and metabolic diseases. Although MHO has favorable metabolic profiles such as insulin sensitivity, low inflammatory markers, and low body fat, there remains a substantial unexplained variance. Obesity is associated with increased prevalence of hypertension, but some obese individuals exhibit normal blood pressure. Several studies have shown the relationship between obesity and clustering of metabolic abnormalities and increased risk of incident hypertension, but there are few studies on the risk of incident hypertension among MHO. Although these studies suggested that MHO was at increased risk of incident hypertension, but this relationship has not been extensively studied, and confounding variables are not adequately accounted for in the analyses. Therefore, the association between MHO and the risk of incident hypertension still remains limited and controversial. Lifestyle factors may play a large role in why a subset of the obese individuals do not present the obesity-related cardio-metabolic outcomes. Several studies have shown that levels of physical activity and cardiopulmonary fitness increase in MHO when compared to the metabolically unhealthy obese individuals. Although previous studies have attempted to adjust for physical activity using self-report questionnaires to clarify the association between obesity phenotypes and incident hypertension, there was no direct assessment of cardiopulmonary fitness. It is well known that cardiopulmonary fitness can attenuate the increased risk of incident hypertension even after adjusted for adiposity and metabolic risk factors, but the role of cardiopulmonary fitness on the association between MHO and risk of incident hypertension has not been fully explored. In this presentation, available scientific evidence regarding the favorable influence of cardiopulmonary fitness on the incidence of hypertension in individuals with MHO will be introduced.

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