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Association between weight variability, weight change and clinical outcomes in hypertension
Richard Kazibwe1, Matthew J Singleton2, Muhammad Imtiaz Ahmad3
1Department of Medicine, Section on Hospital Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Insights
Weight fluctuations and changes increase cardiovascular risks in hypertensive individuals. Maintaining stable weight is crucial for better health outcomes in this population.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Obesity and Metabolism
Background:
- The impact of body weight variability (BWV) and body weight change (BWC) on cardiovascular outcomes in hypertensive individuals without diabetes mellitus (DM) is not well-established.
- High-risk populations with hypertension require careful management to mitigate cardiovascular events.
Purpose of the Study:
- To investigate the association between BWV and BWC and the risk of major adverse cardiovascular events and all-cause mortality in the Systolic Blood Pressure Intervention Trial (SPRINT).
Main Methods:
- A post-hoc analysis of the SPRINT trial data was conducted.
- Multivariate Cox regression models were used to assess the risk associated with BWV (defined as intra-individual average successive variability) and BWC (defined as baseline minus final weight).
- The primary outcome included myocardial infarction, other acute coronary syndromes, stroke, acute decompensated heart failure, or cardiovascular death.
Main Results:
- Increased BWV was significantly associated with a higher risk of the primary composite outcome, all-cause mortality, heart failure, myocardial infarction, and stroke.
- Increased BWC was also significantly associated with a higher risk of the primary composite outcome, all-cause mortality, myocardial infarction, and heart failure.
- No significant association was found between BWV or BWC and cardiovascular death, or between BWC and stroke.
Conclusions:
- Both body weight variability and body weight change are linked to increased risks of major cardiovascular events and all-cause mortality in high-risk hypertensive patients.
- These findings underscore the clinical significance of maintaining weight stability and achieving sustained weight loss in managing hypertension.
Objective:
The effect of body weight variability (BWV) and body weight change (BWC) in high-risk individuals with hypertension, but without diabetes mellitus (DM) remains unclear. We examined the effect of BWV and BWC on the primary outcome [the composite of myocardial infarction (MI), other acute coronary syndromes, stroke, acute decompensated heart failure (HF), or cardiovascular (CV) death] and all-cause mortality in the Systolic Blood Pressure Intervention Trial (SPRINT).
Methods:
In this post-hoc analysis, we used multivariate Cox regression models to examine the risk associated with BWV and BWC for the primary outcome in SPRINT. BWV was defined as the intra-individual average successive variability (ASV). BWC was defined as baseline weight minus final weight.
Results:
A total of 8714 SPRINT participants (mean age 67.8 ± 9.4 years, 35.1 % women, 58.9 % Whites) with available data on body weight were included. The median follow-up was about 3.9 years (IQR, 3.3-4.4). In multivariable-adjusted Cox models, each 1 unit standard deviation (SD) of BWV was significantly associated with a higher risk for the primary outcome, all-cause mortality, HF, MI, and stroke [HR(95 % CI)]: 1.13 (1.07-1.19; p < 0.0001), 1.22 (1.14-1.30; p < 0.0001), 1.16 (1.07-1.26; p < 0.001), 1.10 (1.00-1.20; p = 0.047), and 1.15 (1.05-1.27; p = 0.005), respectively. Similarly, each 1 unit SD of BWC was significantly associated with a higher risk of the primary outcome, all-cause mortality, MI, and HF: 1.11(1.02-1.21; p = 0.017), 1.44 (1.26-1.65; p < 0.0001), 1.16 (1.01-1.32; p = 0.041) and 1.19 (1.02-1.40; p = 0.031) respectively. However, there was no significant association with CV death (for both BWV and BWC) or stroke (BWC).
Conclusion:
In high-risk hypertension, BWV and BWC were both associated with higher risk of the primary outcome and all-cause mortality. These results further stress the clinical importance of sustained weight loss and minimizing fluctuations in weight in hypertension.
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