title: Relation between adiposity and hypertension persists after onset of clinically manifest arterial disease.
abstract: OBJECTIVE
  To quantify the relation between adiposity and blood pressure (BP) level in patients with symptomatic vascular disease and, thereby, assess whether the obesity paradox can be explained by a causal mechanism involving BP.
  
  
  METHODS
  BP and markers of adiposity (i.e. weight, body mass index, waist circumference, waist-to-hip ratio, subcutaneous adipose tissue, and visceral adipose tissue) were recorded in 4556 men and women with symptomatic vascular disease enrolled in the Secondary Manifestations of Arterial Disease Study. Additionally, 185 patients underwent repeated measurements after 3.7 years follow-up.
  
  
  RESULTS
  Each 5 kg/m(2) body mass index was associated with +3.8 mmHg (95% confidence interval (CI) 3.0-4.6) SBP difference and +2.3 mmHg (95% CI 1.9-2.8 mmHg) DBP difference in both men and women. Measures of centralized adiposity compared with BMI were equally related with BP. In contrast, subcutaneous adipose tissue was only weakly related with DBP and not related with SBP and pulse pressure. Various methods of adjustment for BP-lowering medication use led to consistent results. Furthermore, 5 kg/m(2) body mass index change during follow-up was associated with +8.1/5.1 mmHg BP change.
  
  
  CONCLUSIONS
  The relation between general and abdominal adiposity and hypertension persists after onset of symptomatic arterial disease both in men and women. This shows that the obesity paradox cannot be explained by a causal mechanism involving BP and, therefore, supports weight control for reducing BP in secondary prevention of cardiovascular events.
authors.affiliation: Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Johannes A N
authors.initials: JA
authors.lastname: Dorresteijn
authors.forename: Wilko
authors.initials: W
authors.lastname: Spiering
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Van Der Graaf
authors.forename: Frank L J
authors.initials: FL
authors.lastname: Visseren
mesh_terms: D050154:Adiposity / Q000502:physiology*; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000503:physiopathology*; D014652:Vascular Diseases / Q000209:etiology / Q000503:physiopathology*; D055105:Waist Circumference / Q000502:physiology; D049629:Waist-Hip Ratio