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Relative weight and major ischaemic heart disease events in hypertensive men
1Department of Clinical Epidemiology and General Practice, Royal Free Hospital School of Medicine, London.
Insights
Leaner hypertensive men are not at higher risk for major ischemic heart disease (IHD) events than overweight or obese hypertensive men. Weight reduction remains appropriate for managing blood pressure and reducing IHD risk.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Previous research suggested lean hypertensive men face higher ischemic heart disease (IHD) event risks than obese hypertensive men.
- This hypothesis warrants further investigation due to its implications for hypertension management and cardiovascular health.
Purpose of the Study:
- To investigate the relationship between body mass index (BMI) and major ischemic heart disease (IHD) events in hypertensive and normotensive men.
- To re-evaluate the risk stratification of lean versus obese hypertensive individuals for IHD.
Main Methods:
- Analysis of data from the British Regional Heart Study, following 7735 middle-aged men for an average of 7.5 years.
- Hypertension defined by specific systolic/diastolic blood pressure thresholds or treatment.
- Standardized analysis of major IHD events, adjusted for age and smoking, across varying BMI levels.
Main Results:
- For both hypertensive and normotensive men, major IHD event rates increased with higher BMI.
- A 5 kg/m2 increase in BMI was associated with significantly higher odds of IHD events in both groups (Odds Ratios 1.30-1.43).
- A meta-analysis of eleven studies, including the British Regional Heart Study, indicated lean hypertensive men do not have a higher risk of IHD events compared to overweight/obese hypertensive men.
Conclusions:
- The study found no evidence to support the claim that lean hypertensive men are at greater risk of major IHD events than their overweight/obese counterparts.
- Findings suggest that weight reduction strategies for blood pressure management remain appropriate and beneficial for reducing cardiovascular risk.
Abstract:
Some studies have suggested that lean hypertensive men may be at greater risk of major ischaemic heart disease (IHD) events than obese hypertensive men. The issue was examined on data from the British Regional Heart Study for 7735 middle-aged men followed up for an average of 7.5 years; during this time 443 men experienced a major IHD event. Hypertension was defined as systolic blood pressure of 160 mm Hg or above, diastolic blood pressure of 95 mm Hg or above, or receiving treatment for hypertension. For both hypertensive and normotensive men the rate of major IHD events, standardised for age and cigarette smoking, rose with increasing body mass index (BMI). The relative odds associated with a 5 kg/m2 difference in BMI (ie, a 15 kg difference in weight in men of average height [1.73 m]) were 1.30 (p = 0.02) and 1.43 (p = 0.0004) for hypertensive and normotensive men, respectively. A review of eleven prospective studies, including the British Regional Heart Study, presented in standard form for comparative purposes, suggests that lean hypertensive men are not at higher risk of major IHD events than overweight/obese hypertensive men. There seems to be no justification for the suggestion that a policy of weight reduction to lower blood pressure might be inappropriate.