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J Hum Hypertens. 2014 Sep;28(9):535-42. doi: 10.1038/jhh.2013.145. Epub 2014 Jan 16.

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

Author information

1
Steno Diabetes Centre, Gentofte and Research Centre for Prevention and Health, Glostrup, Denmark.
2
Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
3
1] Center for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Jiantong University School of Medicine, Shanghai, China [2] Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiantong University School of Medicine, Shanghai, China.
4
Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
5
1] Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium [2] Tohoku University Graduate School of Pharmaceutical Science and Medicine, Sendai, Japan.
6
Tohoku University Graduate School of Pharmaceutical Science and Medicine, Sendai, Japan.
7
Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
8
Department of Health Sciences, Shiga University of Medical Sciences, Otsu, Japan.
9
Copenhagen University Hospital, Copenhagen, Denmark.
10
Addenbrook's Hospital, Cambridge University Hospitals, Cambridge, UK.
11
First Department of Cardiology and Hypertension, Jagiellonian University Medical College, Kra-ków, Poland.
12
Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy.
13
Institute of Internal Medicine, Novosibirsk, Russian Federation.
14
The Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay.
15
Faculty of Medicine, Charles University, Pilsen, Czech Republic.
16
Center for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Jiantong University School of Medicine, Shanghai, China.
17
The Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland.
18
1] Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium [2] The Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.

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.

PMID:
24430701
DOI:
10.1038/jhh.2013.145
[Indexed for MEDLINE]

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