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Abstract
We aimed to investigate the association of various obesity parameters and phenotypes with hypertension in nationally representative Korean adults. Among adults aged 19 years and older who participated in the Korea National Health and Nutrition Examination Survey in 2008–2010, a total of 16,363 subjects (8,184 men and 8,179 women) were analyzed. Hypertension was defined as blood pressure of 140/90 mm Hg or higher or taking antihypertensive medication. Multiple logistic regression analysis was used to estimate multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Higher obesity parameters [body mass index (BMI) representing general obesity, waist circumference (WC) representing central obesity, and percentage body fat (PBF) representing elevated body fat] were consistently associated with increased odds of prevalent hypertension (OR, 7.54; 95% CI, 5.89–9.65 for BMI ≥30 vs. 18.5–23; OR, 3.97; 95% CI, 3.41–4.63 for WC ≥95 cm in males and ≥90 cm in females vs. <85 cm in males and <80 cm in females; OR, 3.56; 95% CI, 3.05–4.15 for PBF, highest vs. lowest quartile; all p trends<0.0001). These associations were stronger in the younger age group (<40 years), and were observed in both sexes. Furthermore, even in individuals with normal BMI (18.5–23), the odds of prevalent hypertension were consistently increased in those with central obesity (WC≥90 cm in males, WC≥80 cm in females; normal weight central obesity phenotype) (OR, 1.89; 95% CI, 1.63–2.19) and those with high PBF (highest quartile of PBF; normal weight obesity phenotype) (OR, 1.49; 95% CI, 1.25–1.77). These associations were consistent with updated hypertension guidelines in 2017. Obesity may be positively associated with hypertension, regardless of obesity parameters. Even within normal BMI range, high WC and high PBF may be associated with hypertension.
Highlights
The increasing prevalence of obesity worldwide represents a major public health problem
We evaluated whether there is a synergistic interaction between body mass index (BMI) and waist circumference (WC) as well as BMI and percentage body fat (PBF) in relation to prevalent hypertension
The prevalence of hypertension and prehypertension with respect to increasing BMI, WC, and PBF is shown in Fig 1A, 1B and 1C, respectively
Summary
The increasing prevalence of obesity worldwide represents a major public health problem. Obesity increases the risk of metabolic diseases, such as hypertension, diabetes, and dyslipidemia, which lead to increases in cardiovascular morbidity and mortality [3,4]. Hypertension prevalence in obese people with high BMI was reported to be 40.5% in the US [8]. The prevalence of hypertension has been reported to increase progressively with increasing BMI [9]. There is evidence to indicate that weight gain may increase blood pressure (BP) [10], and that weight reduction can prevent or delay obesity-related risk factors for cardiovascular diseases, including hypertension. Visceral obesity appears to be especially important in the activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system, thereby increasing the risk for the development of hypertension and its associated comorbidities. Visceral obesity appears to be especially important in the activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system, thereby increasing the risk for the development of hypertension and its associated comorbidities. [14,15]
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