Independent and Joint Associations of Obesity and Hypertension on Incident Heart Failure: A Pooled Cohort Analysis

To assess the independent and combined associations of obesity and hypertension on incident heart failure (HF).

We studied participants of 3 epidemiologic cohorts: Atherosclerosis Risk in Communities (baseline visit 4, 1996-1998, to follow-up, 2017), Multi-Ethnic Study of Atherosclerosis (baseline examination 1, 2000-2002, to follow-up, 2015), and Jackson Heart Study (baseline visit 1, 2000-2004, to follow-up, 2014). Participants were stratified into 4 groups: neither obesity nor hypertension (reference), only obesity, only hypertension, or both. Hypertension was defined as systolic blood pressure of 140 mm Hg or higher, diastolic blood pressure of 90 mm Hg or higher, or use of antihypertensive medications at baseline. Obesity was defined as body mass index of 30 kg/m² or higher. Cox proportional hazards models adjusted for prespecified covariates were used to assess the association of the 4 groups with incident HF.

Overall, 18,351 participants were included in the analyses. Participants with only obesity (adjusted hazard ratio [aHR], 1.60; 95% CI, 1.36 to 1.88) and only hypertension (aHR, 2.10; 95% CI, 1.87 to 2.37) demonstrated a higher risk of incident HF, whereas the highest risk of incident HF was in participants with both comorbidities (aHR, 2.97; 95% CI, 2.63 to 3.36) compared with participants with neither. Furthermore, participants with both obesity and hypertension had a higher risk of incident HF (aHR, 1.86; 95% CI, 1.60 to 2.16) compared with only obesity.

Obesity and hypertension are associated with incident HF, and individuals with both have the highest risk of HF. Hypertension increases the risk of incident HF in participants with obesity. These data highlight the impact of obesity and hypertension and how together they have a higher risk of HF.