European Journal of Cardiovascular Medicine

Handgrip strength (HGS) is a simple, inexpensive, and reproducible measure of voluntary muscle force that has gained attention as a global marker of physical fitness and biological aging. Low HGS has been associated with adverse health outcomes across populations, including increased risk of cardiovascular disease (CVD), poorer respiratory outcomes, and higher all-cause mortality, suggesting that HGS may capture systemic physiological reserve beyond isolated musculoskeletal function [1].

Large prospective studies and meta-analyses have consistently reported inverse associations between HGS and fatal cardiovascular outcomes and overall mortality, indicating that weaker grip strength identifies individuals at elevated long-term cardiometabolic risk [2,3]. These population-scale results have prompted investigators to evaluate whether HGS could augment routine cardiovascular risk stratification and serve as a pragmatic screening tool in primary care [1].

Despite the general inverse relationship between muscle strength and cardiovascular endpoints, the link between HGS and specific hemodynamic measures (for example, blood pressure indices and resting heart rate) is heterogeneous. Longitudinal cohort analyses in older adults have suggested a dose–response inverse relation between higher HGS and lower incidence of hypertension, whereas some cross-sectional studies—particularly in younger or overweight cohorts—report positive or BMI-confounded associations between HGS and blood pressure [4,5]. This inconsistency likely reflects age, body composition, and methodological differences across studies, and it underscores the need for focused investigations in well-characterized, apparently healthy populations.

Mechanistic work indicates plausible links between muscular strength and cardiovascular physiology: greater skeletal-muscle mass and function are associated with improved metabolic profiles, lower systemic inflammation, and better cardiopulmonary performance, all of which could contribute to more favorable hemodynamics [6]. However, the extent to which simple bedside measures of HGS reflect contemporaneous blood pressure and heart-rate metrics in healthy adults remains incompletely defined.

Accordingly, this cross-sectional study evaluated associations between handgrip strength and resting cardiovascular parameters (systolic and diastolic blood pressure, mean arterial pressure, and resting heart rate) in a cohort of apparently healthy adults. The primary objective was to determine whether higher dominant-hand grip strength correlates with a more favorable hemodynamic profile in a non-diseased population.

Study Design and Setting: This observational, cross-sectional study was conducted in a tertiary teaching hospital. Data collection was performed in a controlled laboratory environment to minimize external influences on cardiovascular measurements.

Study Population: Apparently healthy adults aged 18–60 years were invited to participate. Eligibility screening included a brief clinical history and general physical examination.

Inclusion Criteria

• Individuals between 18 and 60 years
• No known history of cardiovascular, metabolic, neuromuscular, or endocrine disorders
• Not taking medications that could influence blood pressure, heart rate, or muscle performance
• Willing to provide informed consent

Exclusion Criteria

• Recent upper-limb injury or conditions limiting handgrip activity
• Smokers or alcohol users in the preceding 48 hours
• Participants with febrile illness, anemia, or uncontrolled hypertension
• Pregnant women

Sample Size Estimation: Published studies assessing correlations between handgrip strength and cardiovascular variables typically report correlation coefficients ranging from 0.25 to 0.40. Assuming an expected correlation of 0.30, with a significance level of 0.05 and 80% statistical power, the minimum required sample was calculated to be 84. To account for incomplete data, a total of 117 participants were enrolled.

Anthropometric Assessment: Height was measured using a stadiometer with participants standing barefoot, and weight was recorded using a calibrated digital scale. Body mass index (BMI) was calculated as weight (kg)/height² (m²).

Measurement of Handgrip Strength: Handgrip strength was evaluated using a digital handheld dynamometer. Participants were seated comfortably with the elbow flexed at 90°, forearm in a neutral position, and wrist slightly extended.

• Three trials were performed for each hand
• A rest interval of at least 60 seconds was provided between attempts
• The highest value from the dominant hand was used for analysis

The device was recalibrated daily to maintain measurement accuracy.

Cardiovascular Parameters: Resting cardiovascular variables were recorded after the participant had been seated quietly for at least 10 minutes. Systolic and diastolic blood pressures were measured using an automated sphygmomanometer with an appropriately sized cuff. Two readings were taken at a two-minute interval, and the average value was included for analysis. Mean arterial pressure (MAP) was calculated using the standard formula. Resting heart rate was obtained simultaneously from the same device.

Data Collection Procedure: All assessments were conducted in the morning hours to avoid diurnal variation. Participants were advised:

• To avoid caffeine and strenuous exercise for at least 12 hours
• To have a light meal at least two hours before testing
• To refrain from wearing constrictive clothing on the arm used for blood pressure measurement

Statistical Analysis: Data were entered into Microsoft Excel and analyzed using SPSS (version 26). Continuous variables were expressed as mean ± standard deviation. Normality was assessed using the Shapiro–Wilk test. The association between handgrip strength and cardiovascular parameters was evaluated using Pearson correlation coefficients. A p-value <0.05 was considered statistically significant.

A total of 117 healthy adults participated in the study. The mean age of the cohort was 32.8 ± 9.4 years, with a nearly balanced sex distribution (53.0% males and 47.0% females). The average body mass index was 23.7 ± 3.4 kg/m², and right-hand dominance was observed in more than 90% of participants, as summarized in Table 1.

Handgrip performance demonstrated a higher force generation in the dominant hand, with a mean value of 32.4 ± 8.6 kg compared with 29.1 ± 7.9 kg in the non-dominant hand. The maximum strength recorded across repeated trials averaged 33.0 ± 8.9 kg. These measurements are presented in Table 2.

Resting cardiovascular parameters for the study population are shown in Table 3. The mean systolic blood pressure was 122.6 ± 11.3 mmHg, while the mean diastolic pressure was 78.9 ± 8.2 mmHg. The corresponding mean arterial pressure was 93.5 ± 8.4 mmHg. Participants demonstrated a mean resting heart rate of 76.4 ± 9.7 beats per minute.

Correlation analysis revealed a statistically significant inverse relationship between handgrip strength and multiple cardiovascular variables (Table 4). Higher grip strength was associated with lower systolic blood pressure (r = –0.26, p = 0.004), diastolic pressure (r = –0.18, p = 0.048), and mean arterial pressure (r = –0.22, p = 0.017). A stronger negative correlation was observed between grip strength and resting heart rate (r = –0.31, p = 0.001), indicating that individuals with greater muscular strength tended to have more favorable hemodynamic profiles.

Table 1. Baseline Characteristics of the Study Participants (n = 117)

Table 2. Handgrip Strength Measurements (n = 117)

Table 3. Cardiovascular Parameters (n = 117)

Table 4. Correlation between Handgrip Strength and Cardiovascular Variables (n = 117)

In this cross-sectional analysis of 117 healthy adults, dominant-hand grip strength was inversely correlated with systolic and diastolic blood pressure, mean arterial pressure, and resting heart rate. These findings align with a growing body of literature that positions handgrip strength (HGS) as a marker of cardiovascular health and risk. Large population studies have demonstrated that lower grip strength predicts higher cardiovascular and all-cause mortality and that HGS can outperform traditional measures such as systolic blood pressure in risk stratification, supporting the clinical relevance of simple dynamometry in population health assessment [7].

Epidemiological studies examining the link between HGS and blood pressure or incident hypertension provide context for our observed inverse associations. Analyses using relative measures of grip strength have reported that lower strength (adjusted for body size) is associated with higher prevalence and incidence of hypertension across adult populations, suggesting that muscular fitness relative to body mass may be especially important for vascular health [8,9]. Our results—showing modest but statistically significant negative correlations between absolute HGS and blood-pressure indices—are compatible with these cohort and cross-sectional data and suggest that even in apparently healthy adults, greater muscular strength is associated with more favorable resting hemodynamics.

Intervention studies and meta-analyses lend biological plausibility to observational associations by demonstrating that targeted isometric handgrip training can lower resting systolic blood pressure in adults, particularly in hypertensive or prehypertensive individuals [10,11]. The blood-pressure lowering effect reported in randomized trials and systematic reviews—though variable in magnitude—implies that increases in localized muscular strength or repeated isometric contractions may produce systemic vascular adaptations (improved endothelial function, reduced peripheral resistance) and autonomic modulation that reduce blood pressure. These mechanisms could partly explain the cross-sectional association we observed between higher HGS and lower blood pressure and heart rate [10,11].

Beyond blood pressure, HGS has been associated with broader cardiovascular outcomes. Recent cohort studies have linked lower grip strength to higher incidence of stroke, heart failure, and other cardiovascular events, reinforcing the view that HGS reflects systemic physiological reserve and cumulative cardiometabolic risk [12,13]. Our finding of an inverse correlation with resting heart rate may reflect improved autonomic balance in individuals with greater muscular fitness; lower resting heart rate is frequently observed in fitter individuals and is associated with lower cardiovascular risk. While our cross-sectional design cannot determine temporality, the concordance between our data and longitudinal outcome studies supports the potential utility of HGS in early risk identification [12,13].

Mechanistically, several pathways could link greater skeletal-muscle strength to better hemodynamic profiles. Higher muscle mass and function are associated with improved insulin sensitivity, lower systemic inflammation, and enhanced endothelial function—factors that together favor lower peripheral vascular resistance and improved cardiac autonomic regulation. Recent narrative and methodological reviews emphasize HGS as a reproducible, low-cost “vital sign” that captures multisystem health, including cardiometabolic and autonomic domains [14]. These reviews also highlight the importance of how HGS is expressed (absolute vs relative to body size), which can influence its association with blood pressure; our study used absolute dominant-hand strength and observed consistent inverse relations, but future analyses using relative indices could further clarify size-related confounding.

Study strengths include standardized measurement of grip strength and resting hemodynamics and focus on an apparently healthy adult sample, reducing confounding by overt disease. However, limitations warrant careful interpretation. The cross-sectional design precludes causal inference; residual confounding by unmeasured factors (physical activity, diet, visceral adiposity, sympathetic tone) is possible despite screening for known comorbidities. Sample size (n = 117) provided sufficient power to detect moderate correlations but limits subgroup analyses by age, sex, or body-composition strata. Finally, our cohort’s demographic and geographic characteristics may constrain generalizability to other populations with differing age distributions or cardiometabolic profiles.

The present study demonstrates that greater handgrip strength is associated with more favorable cardiovascular profiles in healthy adults. Individuals with higher muscular strength exhibited lower systolic, diastolic, and mean arterial pressures, along with reduced resting heart rates. These findings suggest that handgrip strength, a simple and non-invasive measure of peripheral muscle performance, may serve as an indirect indicator of cardiovascular health in the general population. Incorporating routine assessment of grip strength into health evaluations may help identify individuals at risk of developing adverse cardiovascular trends, even in the absence of overt disease. Further longitudinal research is warranted to determine whether strengthening interventions translate into measurable improvements in cardiovascular parameters over time.

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