The Impact Of Overweight And Obesity On Incident Hypertension In Chinese Adults: A Prospective Study

Background and objective:Hypertension has become the leading cause for global diseases burden since 2010. During recent decades, the prevalence and incidence of hypertension are increasing dramatically. Meanwhile, overweight and obesity have been serious public health problems in China. It has been well examined that overweight and obesity are independent predictors for hypertension in developed countries. However, limited cohort studies were conducted in China. The present study was aimed to evaluate the impact of overweight and obesity on incident hypertension in Chinese adults.Subjects and methods:This prospective study included 13,739 Chinese adults aged 35-74 years at baseline from China Multicenter Collaborative Study of Cardiovascular Epidemiology and the International Collaborative Study of Cardiovascular Disease in Asia. Baseline examination was conducted in 1998 and 2000-2001, respectively, and the follow-up examination was conducted during 2007-2008. According to body mass index (BMI), participants were divided into four groups:underweight (<18.5 kg/m2), normal weight (18.5-23.9 kg/m2), overweight (24.0-27.9 kg/m2), and obesity (≥28.0 kg/m2) groups. Age-standardized cumulative incidence of hypertension was calculated for each group, respectively. With normal weight as the reference group, the relative risks (RRs) and 95% confidence intervals (CIs) for incident hypertension of underweight, overweight and obesity groups were estimated using generalized linear regression model with log link and binomial error distribution. The population attributable risk proportion (PAR%) was calculated using the equation of [P×(RR-1)]/[P×(RR-1)+1]×100%, where P indicates the proportion of overweight and obesity and RR indicates the adjusted relative risk of developing hypertension.Results:During 8.1 years of follow-up,4,271 incident hypertension cases (2,012 in men and 2,259 in women) were identified. Age-standardized cumulative incidence of hypertension for the underweight, normal weight, overweight and obesity groups was 21.6%,30.6%, 42.4%, and 50.8%, respectively. Compared with the normal weight, multivariate-adjusted RR (95%CI) of incident hypertension for underweight, overweight, and obesity groups was 0.84 (0.74-0.94),1.19 (1.14-1.25), and 1.29 (1.21-1.37), respectively. Besides, compared with non-overweight subjects both at baseline and at follow-up, the RR (95%CI) was 1.31 (1.23-1.40),1.09 (0.99-1.20) and 1.36 (1.29-1.43) for subjects who were non-overweight at baseline but overweight/obesity at follow-up, overweight/obesity at baseline but non-overweight at follow-up, and overweight/obesity both at baseline and at follow-up, respectively. This result suggested that changes in BMI also impact on incidence of hypertension. The PAR% for developing hypertension attributable to overweight and obesity was 8.3% in all participants,7.4% in men and 8.8% in women, respectively.Conclusion:Participants with overweight or obesity are at an increased risk of developing hypertension, thus prevention and control of overweight/obesity is highly needed to reduce hypertension incidence in Chinese adults.