Body Mass Index and Risk of Incident Hypertension Over the Life Course

TLDR

The link between obesity and hypertension across the life course is poorly defined, despite rising prevalence of both conditions in the United States. Using a prospective cohort of 1,132 white men, the study examined how BMI measured in young adulthood, middle age, and late life predicts incident hypertension. Over 46 years, 508 men developed hypertension, with obesity at age 25 associated with a 4.17‑fold higher risk, overweight with a 1.58‑fold risk, and greater BMI gain across adulthood doubling the risk, underscoring that higher weight and weight gain elevate hypertension risk throughout adulthood.

Abstract

Background— The obesity-hypertension link over the life course has not been well characterized, although the prevalence of obesity and hypertension is increasing in the United States. Methods and Results— We studied the association of body mass index (BMI) in young adulthood, into middle age, and through late life with risk of developing hypertension in 1132 white men of The Johns Hopkins Precursors Study, a prospective cohort study. Over a median follow-up period of 46 years, 508 men developed hypertension. Obesity (BMI ≥30 kg/m 2 ) in young adulthood was strongly associated with incident hypertension (hazard ratio, 4.17; 95% confidence interval, 2.34–7.42). Overweight (BMI 25 to <30 kg/m 2 ) also signaled increased risk (hazard ratio, 1.58; 95% confidence interval, 1.28–1.96). Men of normal weight at age 25 years who became overweight or obese at age 45 years were at increased risk compared with men of normal weight at both times (hazard ratio, 1.57; 95% confidence interval, 1.20–2.07), but not men who were overweight or obese at age 25 years who returned to normal weight at age 45 years (hazard ratio, 0.91; 95% confidence interval, 0.43–1.92). After adjustment for time-dependent number of cigarettes smoked, cups of coffee taken, alcohol intake, physical activity, parental premature hypertension, and baseline BMI, the rate of change in BMI over the life course increased the risk of incident hypertension in a dose-response fashion, with the highest risk among men with the greatest increase in BMI (hazard ratio, 2.52; 95% confidence interval, 1.82–3.49). Conclusions— Our findings underscore the importance of higher weight and weight gain in increasing the risk of hypertension from young adulthood through middle age and into late life.