Blood pressure, body mass index and risk of cardiovascular disease in Chinese men and women.
BACKGROUND
It is still uncertain whether increased blood pressure (BP) has a stronger effect on the risk of cardiovascular disease (CVD) in lean persons than in obese persons. We tested it using a data set collected from a large cohort of Chinese adults.


METHODS
Systolic and diastolic BP, body mass index (BMI) and other variables were measured in 169,871 Chinese men and women > or = 40 years of age in 1991 using standard protocols. Follow-up evaluation was conducted in 1999-2000, with a response rate of 93.4%. Data were analyzed with Cox proportional hazards models.


RESULTS
After adjusted for age, sex, cigarette smoking, alcohol consumption, high school education, physical inactivity, geographic region, and urbanization, we found that the effects of systolic or diastolic BP on risk of CVD generally increased with the increasing BMI levels (underweight, normal, overweight, and obese). For example, hazard ratios (HRs) and 95% confidence interval (CI) per 1- standard deviation (SD) increase in systolic BP within corresponding BMI levels were 1.27(1.21-1.33), 1.45(1.41-1.48), 1.52 (1.45-1.59) and 1.63 (1.51-1.76), respectively. Statistically significant interactions (P < 0.0001) were observed between systolic BP, diastolic BP and BMI in relation to CVD. In baseline hypertensive participants we found both obese men and women had higher risk of CVD than normal-weight persons. The multivariate-adjusted HRs(95%CI) were 1.23(1.03-1.47) and 1.20(1.02-1.40), respectively.


CONCLUSIONS
Our study suggests that the magnitude of the association between BP and CVD generally increase with increasing BMI. Hypertension should not be regarded as a less serious risk factor in obese than in lean or normal-weight persons in Chinese adults.
Wang
Hongwei
H
Department of Evidence Based Medicine, Cardiovascular Institute and FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cao
Jie
J
Li
Jianxin
J
Chen
Jichun
J
Wu
Xigui
X
Duan
Xiufang
X
Huang
Jianfeng
J
Gu
Dongfeng
D
D000328:Adult; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D012307:Risk Factors
J Epidemiol Community Health. 1995 Jun;49(3):265-70
7629461
Obesity (Silver Spring). 2008 Jun;16(6):1448-53
18388899
Circulation. 2008 Oct 14;118(16):1637-42
18824645
Circulation. 1988 Feb;77(2):501A-514A
3338138
Hypertens Res. 2004 Oct;27(10):703-9
15785004
Lancet. 2002 Dec 14;360(9349):1903-13
12493255
JAMA. 2003 May 21;289(19):2560-72
12748199
Circulation. 1985 Jul;72(1):53-60
4006136
N Engl J Med. 2009 Jan 8;360(2):150-9
19129528
Lancet. 1989 May 6;1(8645):1005-8
2565476
Cardiol Rev. 2001 Jul-Aug;9(4):202-7
11405900
Hypertension. 1987 Jul;10(1):22-8
3596766
Circulation. 1994 Feb;89(2):703-11
8313558
Am J Hypertens. 2008 Mar;21(3):265-72
18188156
Heart. 2003 Sep;89(9):1104-9
12923045
Am J Epidemiol. 1995 Jun 15;141(12):1117-27
7771450
N Engl J Med. 2005 Sep 15;353(11):1124-34
16162883
Hypertension. 1991 Apr;17(4):553-64
2013482
Am J Epidemiol. 2002 Aug 1;156(3):239-45
12142258
Int J Cardiol. 1995 Nov 10;52(1):39-44
8707434
N Engl J Med. 1995 Sep 14;333(11):677-85
7637744
Arterioscler Thromb Vasc Biol. 2004 Aug;24(8):1498-502
15178569
Hypertension. 2003 Jul;42(1):69-75
12756223
JAMA. 1986 Dec 5;256(21):2972-5
3773213
Cardiology. 1988;75(6):448-57
3228826
Ann Epidemiol. 2000 Oct;10(7):424-31
11018345
Lancet. 2002 Nov 2;360(9343):1347-60
12423980
J Hypertens. 2006 Mar;24(3):423-30
16467640
Am Heart J. 1990 Nov;120(5):1195-201
2239671
Am J Epidemiol. 1985 Sep;122(3):434-42
4025293
Circulation. 1982 Jul;66(1):55-60
7083520