Relation of low body mass to death and stroke in the systolic hypertension in the elderly program. The SHEP Cooperative Research Group.
BACKGROUND
There are scant data on the effect of body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) on cardiovascular events and death in older patients with hypertension.


OBJECTIVE
To determine if low body mass in older patients with hypertension confers an increased risk of death or stroke.


METHODS
Participants were 3975 men and women (mean age, 71 years) enrolled in 17 US centers in the Systolic Hypertension in the Elderly Program trial, a randomized, double-blind, placebo-controlled clinical trial of lowdose antihypertensive therapy, with follow-up for 5 years.


METHODS
Five-year adjusted mortality and stroke rates from Cox proportional hazards analyses.


RESULTS
There was no statistically significant relation of death or stroke with BMI in the placebo group (P = .47), and there was a U- or J-shaped relation in the treatment group. The J-shaped relation of death with BMI in the treated group (P = .03) showed that the lowest probability of death for men was associated with a BMI of 26.0 and for women with a BMI of 29.6; the curve was quite flat for women across a wide range of BMIs. For stroke, men and women did not differ, and the BMI nadir for both sexes combined was 29, with risk increasing steeply at BMIs below 24. Those in active treatment, however, had lower death and stroke rates compared with those taking placebo.


CONCLUSIONS
Among older patients with hypertension, a wide range of BMIs was associated with a similar risk of death and stroke; a low BMI was associated with increased risk. Lean, older patients with hypertension in treatment should be monitored carefully for additional risk factors.
Wassertheil-Smoller
S
S
Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY 10461, USA. smoller@aecom.yu.edu
Fann
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C
Allman
R M
RM
Black
H R
HR
Camel
G H
GH
Davis
B
B
Masaki
K
K
Pressel
S
S
Prineas
R J
RJ
Stamler
J
J
Vogt
T M
TM
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015992:Body Mass Index; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D016016:Proportional Hazards Models; D012306:Risk; D012737:Sex Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D015996:Survival Rate; D013599:Systole; D014481:United States / Q000453:epidemiology
D000959:Antihypertensive Agents