BackgroundRegular exercise has been associated in prospective studies with reduced incidence of cardiovascular disease (CVD) and death.ObjectiveTo assess in a cohort study whether there is a similar protective effect of regular exercise among hypertensive individuals.DesignPopulation-based prospective cohort study. Spare time physical activity was assessed by structured interview.SettingMalmö, Sweden.ParticipantsHealthy men (n= 642) born in 1914. A baseline examination took place in 1969–1970.Main outcome measuresAll-cause and cardiovascular mortality rates during 25 years of follow-up in relation to blood pressure and other risk factors for atherosclerosis.ResultsOne-hundred (16%) men reported vigorous spare time physical activity. In this group, 31 had hypertension (blood pressure ≥ 160/95 mmHg or treatment for hypertension), 47 were smokers and 39 had hyperlipidaemia. Among the 173 men with hypertension, vigorous physical activity was associated with markedly reduced rates of all-cause (17.3 versus 40.0 deaths per 1000 person-years) and cardiovascular mortality (6.3 versus 21.0 deaths per 1000 person-years). The risk reductions associated with exercise remained statistically significant after adjustment for smoking, systolic blood pressure and antihypertensive therapy. The relative risk was 0.43 (confidence interval 0.22–0.82) for total mortality and 0.33 (confidence interval 0.11–0.94) for CVD mortality.ConclusionPeople who regularly perform physical activity constitute a heterogeneous group with regard to their exposure to known cardiovascular risk factors. Our results support the view that regular physical activity is associated with a reduced incidence of cardiovascular disease and death and suggest that this protective effect may be enhanced among hypertensive individuals.