Ambulatory blood pressure monitoring for risk stratification in obese and non-obese subjects from 10 populations

T W Hansen, L Thijs, Y Li, J Boggia, Y Liu, K Asayama, M Kikuya, K Björklund-Bodegård, T Ohkubo, Jacob Jeppesen, C Torp-Pedersen, E Dolan, T Kuznetsova, K Stolarz-Skrzypek, V Tikhonoff, S Malyutina, E Casiglia, Y Nikitin, L Lind, E SandoyaK Kawecka-Jaszcz, J Filipovský, Y Imai, J Wang, E O'Brien, J A Staessen

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    Abstract

    Overweight clusters with high blood pressure (BP), but the independent contribution of both risk factors remains insufficiently documented. In a prospective population study involving 8467 participants (mean age 54.6 years; 47.0% women) randomly recruited from 10 populations, we studied the contribution of body mass index (BMI) to risk over and beyond BP, taking advantage of the superiority of ambulatory over conventional BP. Over 10.6 years (median), 1271 participants (15.0%) died and 1092 (12.9%), 637 (7.5%) and 443 (5.2%) experienced a fatal or nonfatal cardiovascular, cardiac or cerebrovascular event. Adjusted for sex and age, low BMI (<20.7 kg m(-2)) predicted death (hazard ratio (HR) vs average risk, 1.52; P<0.0001) and high BMI (> or = 30.9 kg m(-2)) predicted the cardiovascular end point (HR, 1.27; P=0.006). With adjustments including 24-h systolic BP, these HRs were 1.50 (P<0.001) and 0.98 (P=0.91), respectively. Across quartiles of the BMI distribution, 24-h and nighttime systolic BP predicted every end point (1.13 < or = standardized HR < or = 1.67; 0.046 < or = P<0.0001). The interaction between systolic BP and BMI was nonsignificant (P > or = .22). Excluding smokers removed the contribution of BMI categories to the prediction of mortality. In conclusion, BMI only adds to BP in risk stratification for mortality but not for cardiovascular outcomes. Smoking probably explains the association between increased mortality and low BMI.

    Original languageEnglish
    JournalJournal of Human Hypertension
    Volume28
    Issue number9
    Pages (from-to)535-542
    Number of pages8
    ISSN0950-9240
    DOIs
    Publication statusPublished - Sep 2014

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