Abstract
BackgroundA determinant of blood pressure is adiposity; however, there are uncertainties surrounding whether general or central adiposity is the more important determinant of blood pressure. Further, inconsistent results exist for the relationships of anthropometric measures with blood pressure and hypertension, and whether these relationships differ substantially by age and sex is unclear. We aimed to elucidate the associations of anthropometric measures of general and central adiposity with blood pressure and hypertension, and determine the effect of age and sex on these relationships.MethodsWe used cross-sectional data from the Centre for Global Health Research health check-up survey conducted during 2006–2007 of the general population in India (n = 7 601; age 18–59 years). We examined the associations of anthropometric measures (body mass index, waist circumference, hip circumference, waist-hip ratio, waist-height ratio) with blood pressure components (systolic pressure, diastolic pressure, pulse pressure, mean arterial pressure, mid-blood pressure) and hypertension within four (18–29 years, 30–39 years, 40–49 years, 50–59 years) age groups, by sex. We adjusted all analyses for education and location, with further adjustments, variously, for either a measure of central (waist circumference) or general (body mass index) adiposity.ResultsOn average, every 5 kg/m2 greater body mass index or 10 cm wider waist circumference was associated with a 5 and 4 mmHg higher systolic blood pressure, respectively. When considered separately, each anthropometric measure was strongly and positively associated with most blood pressure components in all age groups, and for both sexes. However, with few exceptions, when considered jointly (body mass index adjusted for waist circumference), the associations of body mass index with blood pressure components and hypertension were greatly diminished for both sexes, and particularly in the ≥30 years age groups. By contrast, further adjustment of waist circumference for body mass index did not materially alter the associations of waist circumference with blood pressure components and hypertension.ConclusionsOur findings indicate that central adiposity, as assessed with anthropometric measures, may be a more important determinant of blood pressure and hypertension than general adiposity for adults in India.
Highlights
A determinant of blood pressure is adiposity; there are uncertainties surrounding whether general or central adiposity is the more important determinant of blood pressure
Blood pressure increased with age for both sexes, with the exception of diastolic blood pressure (DBP), which increased until the fourth decade and remained relatively constant between the fourth and fifth decade
Hypertension prevalence was higher for men than women, except in the 50–59 years age group where it was comparable
Summary
A determinant of blood pressure is adiposity; there are uncertainties surrounding whether general or central adiposity is the more important determinant of blood pressure. In order to abate the burden of hypertension and related health outcomes, it is important to understand and establish the relationships between major risk factors for elevated blood pressure. Studies examining these relationships are often from high income countries, the results may not be generalizable to low and middle-income countries (LMIC), such as India. Similar to the uncertainties in proposed mechanisms, there are inconsistencies as to whether anthropometric measures of general or central adiposity are more strongly associated with blood pressure and hypertension [11,12,13,14]. Considerable uncertainty exists regarding whether the strength of these associations differs substantially by age and sex
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