Jingjing Zhu1, Xiaohua Liu2,3, Jinling Zhang2, Jun Li2, Linli Chen2, Chen Huang1, Jiong Li4, Yongfu Yu5, Huilin Xu6,7, Guoyou Qin8,9. 1. Department of Biostatistics, School of Public Health, Fudan University, Shanghai, PR China. 2. Shanghai Minhang Center for Disease Control and Prevention, 965 Zhong Yi Road, Shanghai, 201101, PR China. 3. Minhang District Branch of School of Public Health, Fudan University, Shanghai, PR China. 4. Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus University, Aarhus N, 8200, Denmark. 5. Department of Biostatistics, School of Public Health, Fudan University, Shanghai, PR China. yu@fudan.edu.cn. 6. Shanghai Minhang Center for Disease Control and Prevention, 965 Zhong Yi Road, Shanghai, 201101, PR China. iamxuhuilin@163.com. 7. Minhang District Branch of School of Public Health, Fudan University, Shanghai, PR China. iamxuhuilin@163.com. 8. Department of Biostatistics, School of Public Health, Fudan University, Shanghai, PR China. gyqin@fudan.edu.cn. 9. Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai, 200032, PR China. gyqin@fudan.edu.cn.
Abstract
BACKGROUND: Relationship between BMI and all-cause mortality in patients with hypertension remains controversial. This study aimed to evaluate the time-varying association between BMI in patients with hypertension and all-cause mortality. METHODS: This population-based cohort study included 212,394 Chinese adults with hypertension from 2007 to 2015 and was followed up until death, loss-to-follow-up, or December 31, 2018. According to the World Health Organization criteria for Asians, BMI was categorized into five groups: underweight (BMI < 18.5 kg/m2), normal weight (18.5-22.9 kg/m2), overweight (23-24.9 kg/m2), class I obesity (25-29.9 kg/m2) and class II obesity (BMI ≥ 30 kg/m2). Cox model was used to estimate the time-varying association of BMI on the risk of mortality by including the interaction term between BMI and time using restricted cubic spline. RESULTS: Compared with normal weight, underweight and class II obesity were associated with higher mortality (Hazard ratio [HRs] at 1 and 10 years of follow-up: 1.51 [95% CI: 1.39-1.65], and 1.27 (1.15-1.41) for underweight, respectively; 1.08 (0.96-1.21), and 1.16 (1.03-1.30) for class II obesity, respectively). However, overweight and class I obesity were associated with lower mortality, although the protective effects gradually attenuated over time (HRs at 1 and 10 years of follow-up: 0.85 (0.81-0.90), and 0.96 (0.91-1.02) for overweight, respectively; 0.80 (0.76-0.84), and 1.04 (0.99-1.10) for class I obesity, respectively). CONCLUSIONS: We found increased mortality among hypertensive patients with underweight and class II obesity while decreased mortality with overweight and class I obesity was observed during the first 5 years of follow-up. Management efforts for hypertension may target controlling body weight in a reasonable range for patients, and probably more attention should be given to underweight patients.
BACKGROUND: Relationship between BMI and all-cause mortality in patients with hypertension remains controversial. This study aimed to evaluate the time-varying association between BMI in patients with hypertension and all-cause mortality. METHODS: This population-based cohort study included 212,394 Chinese adults with hypertension from 2007 to 2015 and was followed up until death, loss-to-follow-up, or December 31, 2018. According to the World Health Organization criteria for Asians, BMI was categorized into five groups: underweight (BMI < 18.5 kg/m2), normal weight (18.5-22.9 kg/m2), overweight (23-24.9 kg/m2), class I obesity (25-29.9 kg/m2) and class II obesity (BMI ≥ 30 kg/m2). Cox model was used to estimate the time-varying association of BMI on the risk of mortality by including the interaction term between BMI and time using restricted cubic spline. RESULTS: Compared with normal weight, underweight and class II obesity were associated with higher mortality (Hazard ratio [HRs] at 1 and 10 years of follow-up: 1.51 [95% CI: 1.39-1.65], and 1.27 (1.15-1.41) for underweight, respectively; 1.08 (0.96-1.21), and 1.16 (1.03-1.30) for class II obesity, respectively). However, overweight and class I obesity were associated with lower mortality, although the protective effects gradually attenuated over time (HRs at 1 and 10 years of follow-up: 0.85 (0.81-0.90), and 0.96 (0.91-1.02) for overweight, respectively; 0.80 (0.76-0.84), and 1.04 (0.99-1.10) for class I obesity, respectively). CONCLUSIONS: We found increased mortality among hypertensive patients with underweight and class II obesity while decreased mortality with overweight and class I obesity was observed during the first 5 years of follow-up. Management efforts for hypertension may target controlling body weight in a reasonable range for patients, and probably more attention should be given to underweight patients.
Authors: Kenneth F Adams; Arthur Schatzkin; Tamara B Harris; Victor Kipnis; Traci Mouw; Rachel Ballard-Barbash; Albert Hollenbeck; Michael F Leitzmann Journal: N Engl J Med Date: 2006-08-22 Impact factor: 91.245
Authors: Hasan M Shihab; Lucy A Meoni; Audrey Y Chu; Nae-Yuh Wang; Daniel E Ford; Kung-Yee Liang; Joseph J Gallo; Michael J Klag Journal: Circulation Date: 2012-11-14 Impact factor: 29.690