# The Role of Muscle Strength, Physical Activity, Perceived Stress, and Sleep Quality in Patients with Hypertension

## TL;DR

This study explores how muscle strength, physical activity, stress, and sleep affect blood pressure in people with hypertension, finding sex-specific patterns.

## Contribution

The study identifies sex-specific associations between neuromuscular and psychosocial factors and blood pressure variability in hypertensive adults.

## Key findings

- In men, systolic blood pressure correlated positively with age and negatively with lower-limb strength.
- In women, systolic blood pressure was associated with physical activity and perceived stress.
- Sleep quality and perceived stress were independently linked to systolic blood pressure in women.

## Abstract

Background: Hypertension is a multifactorial condition influenced by physiological, behavioral, and psychosocial factors. Muscle strength, physical activity, sleep quality, and perceived stress may contribute to blood pressure variability, although their relative influence remains unclear. This study examined associations between systolic blood pressure (SBP) and demographic, anthropometric, neuromuscular, behavioral, and psychosocial variables in adults with primary hypertension, with secondary analyses for diastolic blood pressure (DBP) and sex differences. Methods: A cross-sectional study was conducted in 391 adults with hypertension (165 men, 226 women). Predictors included age, body mass index, lower-limb muscle strength, physical activity (GPAQ), sleep quality (PSQI), and perceived stress. Associations were analyzed using correlation analyses and sex-stratified multivariable regression models. Results: In men, SBP correlated positively with age and negatively with lower-limb strength. In women, SBP showed associations with physical activity and perceived stress. Regression analyses indicated that sleep quality and perceived stress were independently associated with SBP in women (adjusted R2 = 0.13), whereas hamstring strength was associated with DBP in men with low explanatory capacity (R2 = 0.05). Moderate-to-high collinearity was observed among strength variables. Conclusions: Blood pressure variability was associated with neuromuscular and psychosocial factors with sex-specific patterns; however, the modest explained variance suggests these factors act as complementary rather than primary determinants. Longitudinal studies are needed to clarify causal relationships.