A prospective study of body mass index and the risk of developing hypertension in men

Harvard University, Cambridge, Massachusetts, United States
American Journal of Hypertension (Impact Factor: 3.4). 05/2007; 20(4):370-7. DOI: 10.1016/j.amjhyper.2006.10.011
Source: PubMed

ABSTRACT Although obesity is known to increase the risk of hypertension, few studies have prospectively evaluated body mass index (BMI) across the range of normal weight and overweight as a primary risk factor.
In this prospective cohort, we evaluated the association between BMI and risk of incident hypertension. We studied 13,563 initially healthy, nonhypertensive men who participated in the Physicians' Health Study. We calculated BMI from self-reported weight and height and defined hypertension as self-reported systolic blood pressure (BP) > or = 140 mm Hg, diastolic BP > or = 90 mm Hg, or new antihypertensive medication use.
After a median 14.5 years, 4920 participants developed hypertension. Higher baseline BMI, even within the "normal" range, was consistently associated with increased risk of hypertension. Compared to participants in the lowest BMI quintile (<22.4 kg/m(2)), the relative risks (95% confidence interval) of developing hypertension for men with a BMI of 22.4 to 23.6, 23.7 to 24.7, 24.8 to 26.4, and >26.4 kg/m(2) were 1.20 (1.09-1.32), 1.31 (1.19-1.44), 1.56 (1.42-1.72), and 1.85 (1.69-2.03), respectively (P for trend, <.0001). Further adjustment for diabetes, high cholesterol, and baseline BP did not substantially alter these results. We found similar associations using other BMI categories and after excluding men with smoking history, those who developed hypertension in the first 2 years, and those with diabetes, obesity, or high cholesterol at baseline.
In this large cohort, we found a strong gradient between higher BMI and increased risk of hypertension, even among men within the "normal" and mildly "overweight" BMI range. Approaches to reduce the risk of developing hypertension may include prevention of overweight and obesity.

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    01/2013; 03(03). DOI:10.4172/2167-1095.1000147
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    ABSTRACT: Objective: To describe the incidence of hypertension in a cohort of Australian Aboriginal and Torres Strait Islanders. Method: A follow-up study conducted among 1831 indigenous population aged 15 years and over without hypertension at baseline from 19 communities in North Queensland during 1997–2008. Main measurements included baseline and follow-up weight, waist circumference, blood pressure, fasting glucose, lipids (triglycerides and cholesterol), gamma-glutamyl transferase, urinary albumin creatinine ratio, self-reported tobacco smoking, alcohol intake and physical activity. Results: Hundred cases of hypertension developed over 2633.4 person-years giving a crude incidence of hypertension of 22.6 (16.2–31.4) per 1000 person-years in females and 60.0 (47.1–76.6) per 1000 person-years for males. Age standardized overall incidence was 51.9 per 1000 person-years. Aboriginal participants were twice as likely as Torres Strait Islanders to develop hypertension, which increased with age. Obesity (BMI >30) strongly predicted incident hypertension independently of age or sex (adjusted hazard ratio 2.9, 95% confidence interval 1.9–4.8). Albuminuria and elevated gamma-glutamyl transferase increased the risk of hypertension (adjusted hazard ratio 1.4–1.7) in this population. Conclusion: Incidence of hypertension in indigenous Australian adults is nearly double than that of the general Australian population. High background prevalence of obesity, diabetes and albuminuria contributes to this excess. As well as early detection and management of high blood pressure, albuminuria and diabetes in primary care settings, attention should be equally focused on community-level prevention and management of obesity.
    Journal of Hypertension 12/2014; 33(4). DOI:10.1097/HJH.0000000000000462 · 4.22 Impact Factor
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    ABSTRACT: Obesity is one of the most common disorders encountered in clinical practice and has major public health implications. It is also one of the most difficult and frustrating disorders to manage successfully. The prevalence of overweight and obesity in Saudi Arabia is high and increasing over recent years. Management of obesity should be based on the best available scientific evidence. At present, there are no national clinical practice guidelines of use by dietitians and other health practitioners for the management of obesity. Since dietetics is a relatively new profession in Saudi Arabia there is little published data available in this area. This thesis aimed to describe the current dietetic practices of obesity in Saudi Arabia and to develop a draft set of national clinical practice guidelines for obesity management. The present thesis includes three main projects. Based on the outcomes of these projects, a draft of evidence-based practice guidelines for the nutritional management of obesity in Saudi Arabia was prepared.The first project (Chapter 3) involved dietitians to investigate the context and better understand the range of current practices in obesity management in Saudi Arabia, demand for and level of service, and barriers to obesity management. Analysis of the study showed that Saudi Arabian dietetic practice for the management of obesity does incorporate most practice recommendations, but some specific elements are rarely used. The most common assessment approaches were assessment of BMI, exercise habits and weight history while the most common strategies for obesity management were dietary total fat reduction and increased incidental daily activity. The major barriers for establishment of a weight management clinic were inadequate resources and administration and referral issues. None of the participants used local obesity guidelines but 61% of participants relied on international guidelines.The second project included two studies focused on the validity of the most important practical tools used for the classification of obesity (Chapter 4) and the assessment of energy requirements (Chapter 5) since research has been lacking in this area in the Saudi population. The first study examined the use of different BMI cut-off points for obesity classification. Results indicated that the diagnostic usefulness of BMI alone in defining obesity is limited in the Saudi adult population, for both men and women. It seems likely that limiting management of obesity only to those individuals with a BMI ≥ 30, as defined by the WHO, may mean that many Saudis at risk of serious co-morbidities could be missing necessary interventions. The second study assessed the accuracy of prediction equations and a popular hand-held calorimeter (BodyGem) for assessment of resting energy expenditure (REE). Based on the findings of this study it was concluded that the Harris-Benedict, Schofield and WHO equations tend to predict REE more accurately than the BodyGem device. However, their accuracy was not clinically acceptable on an individual level. Therefore, the value of the use of both BodyGem devices and predictive equations is still uncertain for Saudi population and more research is needed in this area.The third project (Chapter 6) focused on the development of draft clinical practice guidelines, based on a review of existing international guidelines, supplemented with systematic literature reviews, and refined through the use of consultation workshops and Delphi technique consultations with Saudi experts and practitioners. Findings from the systematic mini reviews provided low to medium level evidence for the use of some novel dietary interventions such as the high intake of calcium, PUFA or fiber to assist with weight loss or maintenance. There was also similar evidence for the use of a low glycemic index diet. Higher eating frequency, not exceeding 6 meals per day, may also help in weight reduction. Regular breakfast intake also appears to be associated with lower body weight. Consultations workshops and Delphi consultations indicated that there are cultural differences between Saudi Arabian population and other Western populations. Therefore, specific consensus statements were developed to cover practice areas such as behavioral modifications, dietary counselling strategies, physical activity and obesity management in Ramadan. In summary, this thesis has provided clinical practice guidelines for obesity management in Saudi Arabia. The application of these guidelines will improve nutritional management of obesity and enable dietitians and other health professionals to use approaches based on the best available evidence.


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