Abstract
BackgroundWe sought to determine the association between appendicular adiposity and hypertension, with the purpose of better understanding the role of body fat distribution on blood pressure (BP).MethodsWe included 7411 adults aged 20 to 59 who were not taking antihypertensives and without cardiovascular disease from the 2011 to 2018 National Health and Nutrition Examination Surveys. Leg & arm adiposity, determined via dual-energy X-ray absorptiometry scans, was defined as percent of total body fat present in legs/arms (leg/total%, arm/total%). Measures were categorized into sex-specific tertiles. We estimated change in BP and odds ratios (ORs) of hypertension (BP ≥ 130/80) and hypertension subtypes using multivariable, survey design-adjusted linear & logistic regression, respectively.ResultsOf the participants, 49% were female, the average (standard deviation) age was 37.4 (0.3) years, and 24% had hypertension. Those in the highest tertile (T3) of leg/total% had 30% decreased adjusted ORs (aOR) of hypertension compared to the lowest tertile (T1; aOR, 0.70; 95% confidence interval [95% CI], 0.55–0.89). This association was not significant for arm/total% (0.89, 0.68–1.17). T3 of leg/total% was associated with 49% lower, 41% lower, and unchanged relative odds of isolated diastolic hypertension (IDH), systolic-diastolic hypertension (SDH), and isolated systolic hypertension (ISH) compared to T1 (IDH: 0.51, 0.37–0.70; SDH: 0.59, 0.43–0.80; ISH: 1.06, 0.70–1.59). For every 10% increase in leg/total%, diastolic BP decreased by an adjusted mean 3.5 mmHg (95% CI, − 4.8 to − 2.2) in males and 1.8 mmHg (95% CI, − 2.8 to − 0.8) in females (P < 0.001 for both).ConclusionsA greater proportional distribution of fat around the legs is inversely, independently associated with hypertension, and more specifically, diastolic hypertension (IDH and SDH).
Highlights
We sought to determine the association between appendicular adiposity and hypertension, with the purpose of better understanding the role of body fat distribution on blood pressure (BP)
In this study, we investigate the association between various appendicular adiposity measures and BP, hypertension, and hypertension subtypes in young- to middle-aged US adults, with the purpose of better understanding the role of body fat distribution and its potential for early identification of hypertension and cardiovascular risk
24% of participants had hypertension. Those in T3 of leg/total% had 30% lower adjusted Odds ratio (OR) of hypertension compared to the lowest tertile (T1; aOR, 0.70; 95% confidence interval [Confidence interval (CI)], 0.55–0.89) (Table 2)
Summary
We sought to determine the association between appendicular adiposity and hypertension, with the purpose of better understanding the role of body fat distribution on blood pressure (BP). While obesity has been associated with hypertension and downstream cardiovascular complications through mechanisms such as activation of the renin-angiotensinaldosterone axis, increased cardiac output, sympathetic activation, insulin resistance, and adipocyte-related hormone release [10, 11], recent literature has provided evidence that distribution of body fat is just as, if not more, important than total body adiposity. On the other hand, has been inversely associated with cardiometabolic factors such as insulin resistance [13,14,15,16,17], metabolic syndrome [18,19,20], and cardiovascular disease & mortality [21,22,23,24,25,26] in several cross-sectional studies, albeit of questionable clinical significance. Subcutaneous fat is less likely to release sympathetic activating or renin-angiotensinaldosterone axis activating substances and is less likely to promote insulin resistance, suggesting a potential physiological mechanism for lower blood pressure (BP) [27,28,29,30]
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