"Body Mass Index
and Risk of Incident Hypertension Over the Life Course: The
Johns Hopkins Precursors Study"
What is the association of body mass index (BMI) in young adulthood,
into middle age, and through late life with risk of developing
The association of BMI over the lifetime of white men and the
development of hypertension was evaluated in 1,132 participants
in The Johns Hopkins Precursors Study, a prospective cohort
study. Estimated cumulative incidence of hypertension was assessed
by BMI category of normal to obese and as a time-dependent continuous
variable with BMI at ages 25, 45, and 65 years.
Over a median follow-up period of 46 years, 508 men developed
hypertension. Obesity (BMI =30 kg/m2) in young adulthood was
strongly associated with incident hypertension (hazard ratio
[HR], 4.17; 95% confidence interval [CI], 2.34-7.42). Overweight
(BMI 25 to <30 kg/m2) also signaled increased risk (HR, 1.58;
95% CI, 1.28-1.96). Men of normal weight at age 25 years who
became overweight or obese at age 45 years were at increased
risk compared with men of normal weight at both times (HR, 1.57;
95% CI, 1.20-2.07), but not men who were overweight or obese
at age 25 years who returned to normal weight at age 45 years
(HR, 0.91; 95% CI, 0.43-1.92). After adjustment for time-dependent
number of cigarettes smoked, cups of coffee, alcohol intake,
physical activity, parental premature hypertension, and baseline
BMI, the rate of change in BMI over the life course increased
the risk of incident hypertension in a dose-response fashion,
with the highest risk among men with the greatest increase in
BMI (HR, 2.52; 95% CI, 1.82-3.49).
The findings underscore the importance of higher weight and
weight gain in increasing the risk of hypertension from young
adulthood through middle age and into late life.
To place this in perspective, for a 5-foot 9-inch-tall man at
age 25 years, a 10-lb weight gain over the life course translates
to an 18% increased risk of hypertension. When this study was
designed, the relationship between blood pressure, insulin resistance,
and visceral obesity was not known. More recent observational
studies may help define the relationship between the lifelong
development of visceral obesity, hypertension, and other variables
of the metabolic syndrome.