Dynamic interplay of body mass index and hypertension: a 10-year longitudinal study revealing cumulative risk

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Abstract Background Hypertension is a major risk factor for cardiovascular diseases. While body mass index (BMI) is known to be associated with hypertension, the impact of BMI changes over time on new-onset hypertension remains unclear. Purpose To investigate the relationship between baseline BMI, BMI changes over time, and the risk of new-onset hypertension in a 10-year cohort study. Methods We analysed health check-up data from an Hospital Health Management Center from 2008 to 2017. Of 3,412 individuals with available data for both 2008 and 2017, we excluded individuals with hypertension at baseline. The primary outcome was new-onset hypertension over 10 years. Baseline BMI and BMI changes over the 10-year period were the main exposures for the primary outcome in logistic regression analysis adjusting for potential confounders, such as age, gender, smoking habits, drinking alcohol, baseline systolic and diastolic blood pressure, chronic kidney disease, hemoglobin A1c, and serum uric acid. Results Of the 3,412 individuals, 698 hypertensive individuals at baseline were excluded. The final cohort comprised 2,714 participants (69% male, mean age 52.2±10.2 years). During the 10-year follow-up, 433 participants developed hypertension. The hypertension group, compared to the non-hypertension group, had a higher proportion of males (74% vs. 68%, p=0.17), were older (56.3±10.4 vs. 51.5±10.0 years, p<0.001), had higher baseline BMI (23.7±3.4 vs. 22.3±2.8 kg/m2, p<0.001), and showed greater BMI increase over 10 years (0.4±1.5 vs. 0.1±1.5 kg/m2, p<0.001). Multivariable analysis revealed that independent associations with new-onset hypertension were aging (OR per year, 1.049; 95% CI 1.035-1.062; p<0.001), higher baseline BMI (OR per 1 kg/m2, 1.141; 95% CI, 1.096-1.188; p<0.001), and 10-year BMI increase (OR per 1kg/m2, 1.259; 95%CI, 1.162-1.364; p<0.001), in addition to baseline systolic and diastolic blood pressure. Interestingly, alcohol consumption showed a protective effect (OR, 0.781; 95% CI 0.612-0.997; p=0.047) in this study. Gender, smoking habits, presence of CKD, baseline HbA1c, and serum uric acid levels were not significantly associated with new-onset hypertension. The 2x2 Figure demonstrated that cumulative incidence of new-onset hypertension ranged from 7% in those with baseline BMI <18.5 kg/m2 and BMI decrease of 0-3 kg/m2, to 60% in those with baseline BMI ≥30 kg/m2 and BMI increase >3 kg/m2. Conclusion Our 10-year cohort study demonstrates that both baseline BMI and BMI increases over time are significantly associated with new-onset hypertension. These findings highlight the crucial role of weight management in hypertension prevention and underscore the importance of maintaining a healthy BMI. Future interventional studies are needed to determine if preventing weight gain or promoting weight loss can effectively reduce the incidence of hypertension.Body mass index and Hypertension

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