title: The relationship of body mass and fat distribution with incident hypertension: observations from the Dallas Heart Study.
abstract: BACKGROUND
  Obesity has been linked to the development of hypertension, but whether total adiposity or site-specific fat accumulation underpins this relationship is unclear.
  
  
  OBJECTIVE
  This study sought to determine the relationship between adipose tissue distribution and incident hypertension.
  
  
  METHODS
  Normotensive participants enrolled in the Dallas Heart Study were followed for a median of 7 years for the development of hypertension (systolic blood pressure [SBP] ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or initiation of blood pressure medications). Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) was quantified by magnetic resonance imaging and proton-spectroscopic imaging, and lower body fat (LBF) was imaged by dual-energy x-ray absorptiometry. Multivariable relative risk regression was performed to test the association between individual fat depots and incident hypertension, adjusting for age, sex, race/ethnicity, diabetes, smoking, SBP, and body mass index (BMI).
  
  
  RESULTS
  Among 903 participants (median age, 40 years; 57% women; 60% nonwhite; median BMI 27.5 kg/m(2)), 230 (25%) developed incident hypertension. In multivariable analyses, higher BMI was significantly associated with incident hypertension (relative risk: 1.24; 95% confidence interval: 1.12 to 1.36, per 1-SD increase). However, when VAT, SAT, and LBF were added to the model, only VAT remained independently associated with incident hypertension (relative risk: 1.22; 95% confidence interval: 1.06 to 1.39, per 1-SD increase).
  
  
  CONCLUSIONS
  Increased visceral adiposity, but not total or subcutaneous adiposity, was robustly associated with incident hypertension. Additional studies will be needed to elucidate the mechanisms behind this association.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Alvin
authors.initials: A
authors.lastname: Chandra
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Neeland
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Jarett D
authors.initials: JD
authors.lastname: Berry
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Colby R
authors.initials: CR
authors.lastname: Ayers
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Anand
authors.initials: A
authors.lastname: Rohatgi
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Sandeep R
authors.initials: SR
authors.lastname: Das
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Amit
authors.initials: A
authors.lastname: Khera
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Darren K
authors.initials: DK
authors.lastname: McGuire
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: aslan.turer@utsouthwestern.edu.
authors.forename: Aslan T
authors.initials: AT
authors.lastname: Turer
mesh_terms: D000328:Adult; D017677:Age Distribution; D050218:Body Fat Distribution / Q000706:statistics & numerical data*; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology*; D012044:Regression Analysis; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D013781:Texas
keywords: body fat distribution; hypertension; obesity; visceral fat