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Body Weight, Weight Change, and Risk for Hypertension in Women

Zhiping Huang, MD, PhD; Walter C. Willett, MD, DrPH; JoAnn E. Manson, MD, DrPH; Bernard Rosner, PhD; Meir J. Stampfer, MD, DrPH; Frank E. Speizer, MD; and Graham A. Colditz, MBBS, DrPH
[+] Article and Author Information

From Harvard Medical School, Brigham and Women's Hospital, and Harvard School of Public Health, Boston, Massachusetts. Acknowledgments: The authors thank the participants in the Nurses' Health Study for their continuing dedication and commitment. They also thank Leiming Li, Mark Shneyder, and Karen Corsano for unfailing assistance. Grant Support: By research grants CA 40356 and DK 46200 from the National Institutes of Health and by grants from Amgen, Inc. Requests for Reprints: Zhiping Huang, MD, PhD, Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115. Current Author Addresses: Drs. Huang and Willett: Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;128(2):81-88. doi:10.7326/0003-4819-128-2-199801150-00001
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Background: Obesity increases the risk for hypertension, but the effects of modest long-term weight changes have not been precisely quantified.

Objective: To investigate body mass index (BMI) and weight change in relation to risk for hypertension.

Design: Cohort study.

Setting: General community.

Participants: Cohort of 82 473 U.S. female nurses 30 to 55 years of age followed every 2 years since 1976. The follow-up rate was 95%.

Measurements: Primary risk factors examined were 1) BMI at age 18 years and midlife and 2) long-term and medium-term weight changes. The outcome was incident cases of hypertension.

Results: By 1992, 16 395 incident cases of hypertension had been diagnosed. After adjustment for multiple covariates, BMI at 18 years of age and midlife were positively associated with occurrence of hypertension (P for trend < 0.001). Long-term weight loss after 18 years of age was related to a significantly lower risk for hypertension, and weight gain dramatically increased the risk for hypertension (compared with weight change ≤ 2 kg, multivariate relative risks were 0.85 for a loss of 5.0 to 9.9 kg, 0.74 for a loss ≥ 10 kg, 1.74 for a gain of 5.0 to 9.9 kg, and 5.21 for a gain ≥ 25.0 kg). Among women in the top tertile of baseline BMI at age 18 years, weight loss had a greater apparent benefit. The association between weight change and risk for hypertension was stronger in younger (<45 years of age) than older women (≥ 55 years of age). Medium-term weight changes after 1976 showed similar relations to risk for hypertension.

Conclusions: Excess weight and even modest adult weight gain substantially increase risk for hypertension. Weight loss reduces the risk for hypertension.

Figures

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Figure 1.
Multivariate relative risk for hypertension according to weight change after age 18 years within strata of body mass index (BMI) at age 18 years.2

Adjusted for age, BMI (measured in kg/m ) at age 18 years, height, family history of myocardial infarction, parity, oral contraceptive use, menopausal status, postmenopausal use of hormones, and smoking status.

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Figure 2.
Multivariate relative risk for hypertension according to weight change after age 18 years within strata of age.

Adjusted for age, body mass index at age 18 years, height, family history of myocardial infarction, parity, oral contraceptive use, menopausal status, postmenopausal use of hormones, and smoking status.

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