RELATIONSHIP BETWEEN METABOLICALLY HEALTHY OBESITY AND THE DEVELOPMENT OF HYPERTENSION: A NATIONWIDE POPULATION-BASED STUDY

Abstract

Objective: Metabolically healthy obesity (MHO), which does not have a general definition, has been recognized as a transient phenotype with few cardiometabolic diseases. This study aimed to assess the relationship between the development of hypertension and metabolically healthy abdominal obesity (MHAO) and metabolically healthy general obesity (MHGO) phenotype. Design and method: This was a retrospective cohort study of 4764 adults who were enrolled from the China Health and Nutrition Survey (CHNS) study from 2009 to 2015. Obesity was classified as abdominal obesity based on waist circumference and as general obesity based on body mass index. Logistic regression was used to analyze the relationship between metabolic health combined with obesity and prehypertension and hypertension. Results: There were 412 (37.9%) participants with prehypertension and 446 (41.0%) participants with hypertension with the MHAO phenotype. Subjects with the MHAO phenotype had significantly higher risks of prehypertension [risk ratio (RR) = 1.89 (1.51–2.36), P < 0.001] and hypertension [RR = 2.58 (2.02–3.30), P < 0.001] than subjects with the metabolically healthy nonabdominal obesity (MHNAO) phenotype. A similar trend existed with regard to the subjects with the MHGO phenotype, particularly in young individuals aged under 64 years. Men with the MHAO phenotype seemed to have higher risks of prehypertension [men: 2.42 (1.52–3.86) vs. women: 1.76 (1.36–2.29)] and hypertension [men: 3.80 (2.38–6.06) vs. women: 2.22 (1.64–3.00)] than women when compared with those with the MHNAO phenotype. Conclusions: The MHO phenotype, regardless of the presence of general or abdominal obesity, showed a worse effect on the development of prehypertension and hypertension, particularly in young adults. Abdominal adiposity with healthy metabolic status is more strongly associated with incident hypertension in men than in women, guiding decision-making for sex-specific and risk-stratified obesity treatment.