cardiovascular diseases are the leading cause of death worldwide1 , and about two - thirds of the cerebrovascular disease burden 
 and half of the ischemic heart disease burden can be attributed to non - optimal blood 
 pressure2 . hypertension burden and blood pressure staging
are usually reported on the basis of both 
 systolic blood pressure ( sbp ) and diastolic blood pressure ( dbp)3 according to the joint national committee vi ( jnc - vi ) and 
 international society of hypertension ( who - ish ) guidelines4 , 5
. however , different 
 prevalences of systolic and diastolic hypertension have been reported6 , 7 .
additionally , 2 
 recent studies have reported that sbp has a different impact than dbp on blood pressure 
 staging6 , 8 . to our knowledge , the impact of sbp and dbp on blood pressure 
 staging has only been reported in the us6 , 8 , 9 .
the impact of sbp and dbp on blood pressure staging , as well as the community burden of 
 elevated sbp and dbp may vary across study populations and countries or between age groups 
 and sexes within a population .
the beneficial effects of blood - pressure - lowering treatments on the risks of major 
 cardiovascular events are well established10,11,12,13,14,15 ; however , the influence of health and 
 fitness - related variables remains unclear .
sbp is a more frequent cardiovascular risk factor than dbp , and has a greater impact on 
 blood pressure staging , although this influence can vary with age , sex , and county16 .
the present study aimed to separately 
 compare sbp and dbp with health and fitness - related variables among asian obese and normal 
 weight middle - aged women in a community .
the findings of this study will offer further 
 evidence of the authenticity of the texts to human race and will provide valuable 
 information on health in asian middle - aged women .
the present study included 1,201 middle - aged women ( age range , 3059  years ) , who had not 
 been previously diagnosed with abnormal glucose metabolism or other health problems and who 
 did not exercise regularly .
the participants were classified into an obese group ( n=686 ) and 
 a normal weight group ( n=515 ) , and all participants had body fat percentage greater than 30 . 

the study protocols were approved by the human care and use committee for the society of 
 sport research institute of dongguk university and gyeong - ju city community health center in 
 the republic of korea .
all participants visited the gyeong - ju city community health center for evaluation of 
 glucose metabolism or other health problems , and body composition and health and 
 fitness - related variables were assessed .
the body composition measurements included height , weight , standard weight , percent fat , 
 fat weight , core fat , body mass index ( bmi ) , and basal metabolic rate ( bmr ) .
the health and 
 fitness - related variables included cardiorespiratory endurance ( maximal oxygen uptake 
 [ vo2max ] ) , muscular strength ( grip strength ) , muscular endurance ( sit - ups ) , power ( sargent 
 jump ) , agility ( body reaction ) , flexibility ( sit and reach ) , heart rate , and blood pressure 
 ( systolic and diastolic ) .
blood pressure was measured using a mercury sphygmomanometer under standardized conditions , 
 and the average of 3 readings was used in the analysis .
height , weight , standard weight , 
 percent fat , fat weight , core fat , bmi , and bmr were measured using an 8-polar bioelectrical 
 impedance instrument ( inbody 720 , biospace , seoul , korea ) .
the bmi values ( kg / m ) 
 of the participants were calculated on the basis of their height and weight . for the vo2max test ,
a computerized metabolic cart ( quinton , nj ) was used with the modified 
 bruce s protocol17 in all participants . 
 and measured stopping of rer1.10 or identity of vo2max and no longer difficult to perform 
 themselves . for the grip - strength test ( muscular strength ) , a grip strength - testing device 
 ( tkk 5401 grip d , takei , tokyo , japan ) that had an inbuilt potentiometer control system was 
 used .
the control lever of the device was adjusted such that the second knuckles of the 
 fingers were at the bottom of the grip bar .
the participants flexed maximally over 3 trials , 
 and the average strength ( kg ) was recorded . for the sit - up test ( muscular endurance ) , the 
 participants were instructed to lie on a sit - up board ( nh 3000n , o2run , korea ) , bend their 
 knees to 90 , and raise their upper body and bend forward by using only their abdominal 
 muscles .
the number of sit - ups completed in 30  s was recorded . for the sargent jump test 
 ( power ) , chalk powder was applied to the ends of the participants fingertips .
the 
 participants were instructed to stand beside a wall , with both feet on the ground , reach up 
 as high as possible with one hand , and mark the wall with the fingertips ( m1 ) .
the 
 participants were then instructed to jump as high as possible from a static position and 
 mark the wall with the fingertips ( m2 ) . the distance ( cm ) from m1 to m2 was assessed .
the 
 highest distance among 2 trials was recorded . for the body - reaction test ( agility ) , the 
 participants were instructed to stand on a reaction measuring instrument with a lamp ( nh 
 3000i , o2run , korea ) and move the foot when the lamp was turned on . the average time 
 ( 1/1,000  s ) among 5 trials was recorded . for the sit - and - reach test ( flexibility ) , the 
 participants were instructed to sit on a flexibility - measuring instrument ( kj092 , japan ) , 
 position their heels approximately 5  cm apart , place their heels on the edge of the 
 instrument , extend their knees , bend their backs forward , and naturally move the measuring 
 instrument forward .
the independent t - test was performed 
 to examine differences in blood pressure , body composition , and fitness - related variables 
 between the 2 study groups .
additionally , pearson s correlation analysis was performed to 
 examine the relationships between blood pressure and other variables .
the significance level 
 was set at p<0.05 , and all analyses were performed using spss version 21.0 ( spss , 
 chicago , il , usa ) .
the characteristics of the participants in the obese and normal weight groups are presented 
 in table 1table 1.characteristics of the subjectsvariablesowg ( n=686)m  sdnwg ( n=515)m  sdage ( years)44.7  8.542.6  7.7height ( cm)159.8  54.4161.9  56.4weight ( kg)63.0  8.654.6  6.1body mass index ( kg / m)25.3  2.921.4  2.1body fat ( % ) 35.2  3.925.3  3.5owg : obese weight group , nwg : normal weight group .
comparisons of body composition and health and fitness - related variables 
 between the groups are presented in table 
 2table 2.comparison of body composition , blood pressure and physical fitness levels 
 between obese and normal middle - aged womenvariablesowgm  sdnwgm  sdweight ( kg)63.0  8.654.6  6.2standard weight ( kg)50.8  46.252.6  47.9body fat ( % ) 35.2  3.925.3  3.5fat weight ( kg)22.3  5.113.9  2.9core fat ( waist / hip)0.9  0.10.9  0.4body mass index ( kg / m)25.3  2.921.4  2.1basal metabolic rate ( kcal)1,245.3  114.31,248.6  88.3sbp ( mmhg)119.1  14.4113.9  12.2dbp ( mmhg)71.5  9.568.2  9.2heart rate ( bpm)76.4  8.477.1  8.8vo2max25.9  5.328.8  6.2grip strength ( kg)23.4  4.324.2  4.2sit - up ( time)10.1  4.911.9  4.5sargent jump ( cm)19.6  5.322.8  4.5body reactions ( 1/1000 s)338.0  121.0302.2  97.5sit and reach ( cm)14.3  7.316.6  7.4owg : obese weight group , nwg : normal weight group . * p<0.05 , * * p<0.01 , 
 * * * p<0.001 .
significant interaction effects ( independent t - test ) were observed for weight 
 ( t=18.759 , p<0.001 ) , body fat ( t=44.909 , p<0.001 ) , fat weight ( t=33.496 , p<0.001 ) , 
 core fat ( t=16.230 , p<0.001 ) , bmi ( t=25.143 , p<0.001 ) , sbp ( t=6.713 , p<0.001 ) , dbp 
 ( t=6.015 , p<0.001 ) , vo2max ( t=8.806 , p<0.001 ) , muscular strength ( t=3.364 , p=0.001 ) , 
 muscular endurance ( t=6.652 , p<0.001 ) , power ( t=11.049 , p<0.001 ) , agility ( t=5.509 , 
 p<0.001 ) , and flexibility ( t=5.445 , p<0.001 ) were observed between the obese and 
 normal weight groups .
however , significant interaction effects were not observed for 
 standard weight , bmr , and heart rate between the obese and normal weight groups ( all 
 p>0.05 ) .
owg : obese weight group , nwg : normal weight group owg : obese weight group , nwg : normal weight group .
* p<0.05 , * * p<0.01 , 
 * * * p<0.001 the correlations of blood pressure with body composition and health and fitness - related 
 variables are presented in table 
 3table 3.correlation between blood pressure , health and fitness related variablevariablesblood pressureowgnwgsdpdbpsdpdbprrrrweight0.249***0.245***0.236***0.149**standard weight0.078*0.089*0.0340.019body fat0.297***0.266***0.180***0.114*fat weight0.310***0.289***0.248***0.158***core fat0.282***0.209***0.301***0.209***body mass index0.323***0.314***0.274***0.206***basal metabolic rate0.216***0.169***0.171***0.096*heart rate0.201***0.285***0.0070.017vo2max0.0370.0010.125*0.102*grip strength0.0370.0780.0290.051sit - up0.124**0.077*0.0050.015sargent jump0.123**0.088*0.0440.022body reactions0.081 * 0.0650.0000.024sit and reach0.0260.0290.107 * 0.073*p<0.05 , * * p<0.01 , * * * p<0.001 .
blood pressure showed significant positive correlations with 
 weight , body fat , fat weight , core fat , bmi , and bmr in the obese and normal weight groups 
 ( all p<0.05 ) .
* p<0.05 , * * p<0.01 , * * * p<0.001 in the obese group , sbp showed significant correlations with muscular endurance ( r=0.124 , 
 p=0.001 ) , power ( r=0.123 , p=0.001 ) , and agility ( r=0.081 , p=0.033 ) , while dbp showed 
 significant correlations with muscular endurance ( r=0.077 , p=0.043 ) and power ( r=0.088 , 
 p=0.021 ) . in the normal weight group ,
sbp showed significant correlations with vo2max 
 ( r=0.125 , p=0.004 ) and flexibility ( r=0.107 , p=0.015 ) , while dbp showed significant 
 correlations with vo2max ( r=0.102 , p=0.020 ) .
obesity increases the insulin resistance in the body and results in metabolism 
 abnormalities that cause dyslipidemia and arteriosclerosis , and it serves as one of the 
 major factors that can elevate the risk of developing cardiovascular disorders and 
 mortality19 .
in particular , abdominal 
 obesity and weight gain are causative factors for high blood pressure and primary risk 
 factors for various adult diseases20 , and 
 have been reported to result from lack of exercise , stress , improper diet , etc.21 .
lloyd et al.22 performed a comparative 
 analysis among 6,125 individuals under the age of 60  years by controlling age and sex in 
 order to identify the hazard ratios of blood pressure and cardiovascular disorders based on 
 the findings in the normal blood pressure group .
the authors found that both phase 1 and 
 phase 2 high blood pressure groups showed increases in the degree of hazards for 
 cardiovascular disorders by 1.8 times and 3.1 times , respectively , when compared to the 
 results in the normal blood pressure group .
it has been reported that high blood pressure is 
 a significant factor for cardiovascular disorders , coronary arterial heart disease , and 
 congestive cardiac insufficiency and that obesity can cause diabetes , hyperlipidemia , and 
 various cardiovascular disorders20 , 21 .
williams reported that cardiovascular endurance is the most important 
 predictable factor for determining the symptoms of cardiovascular disorders and has a high 
 negative correlation with chronic diseases and mortality23 , 24 . in general , with higher 
 blood pressure and a higher prevalence rate of high blood pressure , cardiovascular disorders 
 are more likely to develop25 . 
 additionally , nakura reported that blood pressure is associated with age and obesity and has 
 a positive correlation with bmi , and that the occurrence rate of high blood pressure is 
 closely related with the extent of obesity26 .
the present study found that blood pressure has a positive correlation with body weight , 
 standard weight , body fat , fat mass , abdominal fat , bmi , and bmr in obese and normal weight 
 individuals , and these findings are consistent with those of previous studies , reaffirming a 
 close relationship between blood pressure and obesity .
in addition , studies are being performed to identify the presence of relationships between 
 obesity - related factors and cardiovascular endurance , and it has been reported that 
 cardiovascular endurance affects a variety of obesity - related insulin resistance syndrome 
 indexes27 .
wong et al.28 reported that superior 
 cardiovascular endurance reduces body fat , intra - abdominal fat , and subcutaneous belly fat . 

additionally , ross and katzmarzyk29 
 reported that the amount of subcutaneous fat and the waistline were significantly lower in 
 individuals with high cardiovascular endurance that in those with low cardiovascular 
 endurance .
aerobic exercises , walking , running , and body activities during leisure time have been 
 reported to be effective for reducing the risk factors of high blood pressure and for 
 lowering blood pressure30 .
stewart et al . 
 reported that male and female high blood pressure patients showed a significant decrease in 
 dbp after aerobic exercises and resistive exercises performed for 6 months31 .
the present study showed a negative correlation between vo2max and blood pressure 
 among participants in the normal weight group , which supports a relation between vo2max and 
 blood pressure that can be explained as an index of cardiovascular endurance in line with 
 the relation between obesity and blood pressure reported previously .
that is , a positive 
 correlation between blood pressure and obesity demonstrated in previous studies and a 
 negative correlation between vo2max and obesity are considered to be able to explain the 
 negative correlation between vo2max and blood pressure noted in the present study .
performed an epidemiological survey and reported that blood pressure was lower 
 in individuals with high physical strength than in those with low physical strength , 
 indicating that exercise can improve cardiovascular activity and the cerebrovascular flow 
 rate , and can expand the blood vessel owing to elastic factors in the arterial vessel 
 wall32 .
performed an 
 analysis following long - term resistive exercise among 320 male and female adults and 
 reported that gradual resistive exercise reduced both sbp and dbp by 3 mmhg33 .
the present study found a negative correlation between activities , such as sit - up and 
 sargent jump , and blood pressure among participants in the obese group , which supports a 
 correlation between physical strength and blood pressure identified in previous studies .
as indicated by these results , deterioration in physical strength affects blood pressure , 
 and an increase in blood pressure is one of the major factors that can increase the 
 prevalence of obesity . with a higher extent of obesity , it is more likely that a patient 
 will be exposed to risks involving various adult diseases . in conclusion ,
the relationships between sbp and heart rate , muscle endurance , power , and 
 agility are stronger than the relationships between dbp and these variables .
additionally , 
 the values of health and fitness - related variables might be lower in obese individuals than 
 in normal individuals .
moreover , blood pressure might show a strong relationship with health 
 and fitness - related variables in obese patients .
 [ purpose ] the present study aimed to separately compare systolic blood pressure and 
 diastolic blood pressure with health and fitness - related variables among asian obese and 
 normal weight middle - aged women . 
 [ subjects and methods ] the study included 1,201 women 
 aged 3059  years . 
 the participants were classified into obese and normal weight groups . 
 
 the blood pressure and health and fitness - related variables of all participants were 
 assessed . 
 [ results ] significant interaction effects were observed for most blood pressure 
 and health and fitness - related variables between the groups . 
 however , significant 
 interaction effects were not observed for standard weight , basal metabolic rate , and heart 
 rate . blood pressure showed significant positive correlations with weight , body fat , fat 
 weight , core fat , body mass index , and basal metabolic rate in both groups . 
 systolic blood 
 pressure was significantly correlated with muscular endurance , power , and agility in the 
 obese group and with vo2max and flexibility in the normal weight group . 
 diastolic blood 
 pressure was significantly correlated with muscular endurance and power in the obese group 
 and with vo2max in the normal weight group . 
 [ conclusion ] the relationships between 
 systolic blood pressure and heart rate , muscle endurance , power , and agility are stronger 
 than the relationships between diastolic blood pressure and these variables . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION
Conflict of Interest