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Concurrent hypertension and obesity and the risk of incident heart failure: insights from 2 prospective cohort
Dongjie Du1, Yitian Chen1, Weilan Li1
1Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Insights
Hypertension and obesity together significantly increase heart failure (HF) risk. This risk is highest when both conditions coexist, even in early stages, highlighting the need for integrated management strategies.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Epidemiology
Background:
- Investigates the combined impact of hypertension and obesity on incident heart failure (HF).
- Assesses the clinical obesity definition proposed by The Lancet Diabetes & Endocrinology Commission for feasibility.
Purpose of the Study:
- To examine the association between coexisting hypertension and obesity with incident heart failure (HF).
- To evaluate the feasibility of a novel clinical definition of obesity.
Main Methods:
- Utilized data from the UK Biobank (n=444,754) and Tongzhou Cohort (n=10,459).
- Defined hypertension via diagnosis, blood pressure, or treatment; assessed obesity using BMI, central, combined, and clinical definitions.
- Employed Kaplan-Meier curves and multivariable Cox models to estimate HF risk.
Main Results:
- Coexisting hypertension and obesity consistently showed the highest HF risk across various obesity definitions.
- Prevalence of combined hypertension and obesity ranged from 18.0% to 37.3% across cohorts.
- Elevated blood pressure and pre-obesity increased HF risk even in individuals without diagnosed hypertension or obesity.
Conclusions:
- Combined hypertension and obesity represent a significant risk factor for heart failure.
- The elevated risk associated with these conditions is observable even at preclinical stages.
- The findings support the clinical relevance of assessing both hypertension and obesity for HF risk prediction.
Background:
This study examined the association of hypertension and obesity with incident heart failure (HF) and the feasibility of the clinical obesity definition proposed by The Lancet Diabetes & Endocrinology Commission.
Methods:
Data from the UK Biobank (n = 444,754) and Tongzhou Cohort (n = 10,459) were analyzed. Hypertension was defined as physician-diagnosed hypertension, blood pressure ≥140/90 mm Hg, or antihypertensive treatment. Obesity was assessed as BMI-defined obesity, central obesity, a combined "BMI + central" anthropometric phenotype, and clinical obesity, defined as excess adiposity with obesity-related organ dysfunction and/or functional limitation. Participants were classified into 4 groups: neither hypertension nor obesity, obesity only, hypertension only, and coexisting hypertension and obesity. Kaplan-Meier curves and multivariable Cox models were used to estimate HF risk, and the joint effects of elevated blood pressure and pre-obesity were evaluated.
Results:
The 2 cohorts had similar mean ages: 58.15 ± 6.84 years in the UK Biobank and 59.42 ± 6.29 years in the Tongzhou Cohort. Depending on the obesity definition, the prevalence of coexisting hypertension and obesity ranged from 18.0% to 25.9% in the UK Biobank and 23.1% to 37.3% in the Tongzhou Cohort. Across BMI-defined obesity, central obesity, the combined "BMI + central" phenotype, and, in the UK Biobank, clinical obesity, the coexistence of hypertension and obesity was consistently associated with the highest HF risk. Among individuals without hypertension or obesity, the combination of elevated blood pressure and pre-obesity was associated with increased risk of HF.
Conclusions:
Coexisting hypertension and obesity are associated with the highest HF risk across multiple adiposity definitions, and excess risk is evident even at preclinical stages.
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