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: 2.85). 05/2007; 20(4):370-7. DOI: 10.1016/j.amjhyper.2006.10.011
Source: PubMed


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.

Full-text preview

Available from:
  • Source
    • "Participants with hypertensive disease had higher anthropometric (BMI and WHR) parameters, consistent with the strong association between higher BMI and increased risk of hypertension [48]. The association has consistently been associated with central obesity (an indicator of higher waist-to-hip ratio) and abnormal lipid profiles which are key risk factors in development of hypertension [49]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. Hypertensive disease is increasing in developing countries due to nutritional transition and westernization. Hypertensive disease among Kenya military may be lower because of health-focused recruitment, physical activities, routine checkups, and health awareness and management, but the disease has been increasing. Purpose. The purpose of this study was to determine physiological, behavioral, and dietary characteristics associated with hypertension among Kenyan military. Methods. A cross-sectional study involving 340 participants was conducted at Armed Forces Memorial Hospital. Participants' history, risk factors assessment, and dietary patterns were obtained by structured questionnaire, while physiological and anthropometric parameters were measured. Results. Hypertensive participants were likely to have higher age, physiological, and anthropometric measurements, and they participated in peace missions. Daily alcohol and smoking, frequent red meat, and inadequate fruits and vegetables were associated with hypertension. Conclusions. The findings mimic the main risk factors and characteristics for hypertensive disease in developed countries whose lifestyle adoption is happening fast in low and middle-income countries. Whether or not prediction rules and/or risk scores may identify at-risk individuals for preventive strategy for targeted behavioral interventions among this population require investigation.
    Full-text · Article · May 2013
  • Source
    • "This cross-sectional study showed a strong association between overweight and obesity, and cardiometabolic risk factors such as high blood pressure, high cholesterol, and arthritis. Several large cohort studies also found a direct positive association between high BMI and hypertension [6,39], and increased BMI and osteoarthritis [23]. A systematic review and meta-analysis of prospective cohort studies on comorbidity related to obesity and overweight demonstrated a significant association between overweight and obesity with incident diabetes, CVD, asthma, gallbladder disease, osteoarthritis, and various types of cancer [40]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Overweight has increased in many countries over the past 20 years and excessive body weight is an established risk factor for adverse health outcomes and chronic diseases. This study aimed to determine comorbidity associated with overweight and obesity in a nationally representative sample of German adults. Methods In the German National Health Interview and Examination Survey 1998 standardized measures of body weight, height and waist circumference (WC) were obtained for 7,124 men and women 18 to 79 years of age. Information on pre-existing health conditions, health-related behaviors, and sociodemographic characteristics was collected using physician-administered computer-assisted interviews and self-administered questionnaires. World Health Organization (WHO) cut-off criteria were applied to define overweight (BMI 25.0-29.9 kg/m2) and obesity (BMI ≥30.0 kg/m2) and abdominal obesity (men: WC ≥102 cm; women: WC ≥88 cm). Results The crude prevalence of persons with cardiometabolic risk factors, diabetes mellitus, cardiovascular disease (CVD), gall bladder disease, and osteoarthritis showed a significant stepwise increase from the lowest to the highest BMI category in both sexes. In multiple logistic regression models adjusting for age, social status, and smoking, significant associations with overweight and obesity persisted for cardiometabolic risk factors and osteoarthritis. For example, obese persons had a three- to fourfold higher chance of having any cardiometabolic risk factor compared to normal weight persons (odds ratio (OR) = 4.07, 95% CI: 3.16-5.25 for men; OR = 3.40 (2.60-4.46) for women). Only in women, overweight and obesity as well as abdominal obesity, independent of BMI category, were significantly and consistently associated with diabetes (overweight: OR = 1.85 (1.03-3.30); obesity: OR = 2.94 (1.63-5.31); abdominal obesity: OR = 1.44 (1.08-1.92) and gall bladder disease (overweight: OR = 1.65 (1.22-2.25); obesity: OR = 3.06 (2.26-4.14); abdominal obesity: OR = 1.73 (1.25-2.39)). Conclusion Current estimates of disease burden underline the public health importance and clinical relevance related to overweight and obesity and needs to take into account comorbidity aspects.
    Full-text · Article · Aug 2012 · BMC Public Health
  • Source
    • "There is an increasing body of data showing gender-dependent effects of commonly accepted confounders (such as age, lifestyle factors or genetic susceptibility) contributing to the determination of an individual's BP [8-12]. For instance, obesity has been shown to be predominant risk factor for women [11], whereas smoking enhances the development of hypertension in men [12]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: More than one third of adult population in Estonia has problems with elevated blood pressure (BP). The Hypertension in Estonia (HYPEST) study represents the country's first hypertension-targeted sample collection aiming to examine the epidemiological and genetic determinants for hypertension (HTN) and related cardiovascular diseases (CVD) in Estonian population. The HYPEST subjects (n = 1,966) were recruited across Estonia between 2004-2007 including clinically diagnosed HTN cases and population-based controls. The present report is focused on the clinical and epidemiological profile of HYPEST cases, and gender-specific effects on the pathophysiology of hypertension. Current analysis was performed on 1,007 clinically diagnosed HTN patients (617 women and 390 men) aged 18-85 years. The hypertensives were recruited to the study by BP specialists at the North Estonia Medical Center, Centre of Cardiology, Tallinn or at the Cardiology Clinic, Tartu University Hospital, Estonia. Longitudinal BP data was extracted retrospectively from clinical records. Current and retrospective data of patient's medical history, medication intake and lifestyle habits were derived from self-administrated questionnaire and each variable was examined separately for men and women. Eleven biochemical parameters were measured from fasting serum samples of 756 patients. The distribution of recruited men and women was 39% and 61% respectively. Majority of Estonian HTN patients (85%) were overweight (BMI ≥ 25 kg/m2) and a total of 79% of patients had additional complications with cardiovascular system. In men, the hypertension started almost 5 years earlier than in women (40.5 ± 14.5 vs 46.1 ± 12.7 years), which led to earlier age of first myocardial infarction (MI) and overall higher incidence rate of MI among male patients (men 21.2%, women 8.9%, P < 0.0001). Heart arrhythmia, thyroid diseases, renal tubulo-intestinal diseases and hyperlipidemia were more prevalent in hypertensive women compared to men (P < 0.0001). An earlier age of HTN onset was significantly associated with smoking (P = 0.00007), obesity (BMI ≥ 30 kg/m2; P = 0.0003), increased stress (P = 0.0003) and alcohol consumption (P = 0.004). Understanding the clinical profile of HTN patients contributes to CVD management. Estonian hypertension patients exhibited different disease and risk profiles of male and female patients. This well-characterized sample set provides a good resource for studying hypertension and other cardiovascular phenotypes.
    Full-text · Article · Aug 2011 · BMC Cardiovascular Disorders
Show more