The effect of body mass index and its interaction with family history on hypertension: a case–control study

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Abstract

Background

BMI is an indicator commonly used in the world to measure the weight and height of the body, it reflects the comprehensive outcome of acquired lifestyle; FH is a sign reflecting the main role of genetic factors. This study aimed to evaluate the effect of BMI and interaction with FH on hypertension risk in Shanghai adult population.

Methods

According to l:l matched pairs design, 342 cases and 342 controls were selected and investigated in this study, this study was performed in Shanghai, China. Participants received face-to-face questionnaire survey, anthropometric tests and laboratory examinations. Relevant indicators that reflect obesity including BMI and waist to hip ratio (WHR) were calculated. Multivariate logistic regression analysis was applied to explore the association between factors and hypertension risk. Interactive effect was evaluated by synergy index (SI), relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and the percentage of the interaction between the pure factors (PAP).

Results

Among 684 study participants aged 28–87 years old, the differences of mean age and height between case group and control group are no significant ( p > 0.05), but the differences of mean of weight, WC, HC, BMI and WHR are significant ( p < 0.001). The OR of FH on hypertension is 4.986 (95%CI: 2.832~ 8.877); the OR of BMI on hypertension is respectively: low weight is 1.528 (95%CI: 0.551~ 4.239), overweight is 3.333 (95%CI: 1.678~ 6.617) and obesity is 7.312 (95%CI: 3.556~ 15.035). The OR of interaction between FH and BMI to hypertension is 12.993 (95%CI: 7.426~22.734). SI is 1.90 (95% CI: 1.48~3.78), RERI is 5.67 (95% CI: 1.66~11.88), AP is 43.87% (95% CI: 12.84~91.88%), and PAP is 47.55% (95%CI: 13.91~99.58%). FH and BMI have positive interaction on hypertension. 43.87% of hypertension exposed to both FH and BMI was attributable to the interaction of them.

Conclusions

FH and BMI are significant higher risks of hypertension; with the increase of BMI, the risk of hypertension will increase more. FH and BMI have positive interaction with hypertension, the interaction is greater than the sum of two independent actions.

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Most cited references 28

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Obesity-associated hypertension: new insights into mechanisms.

Kamal Rahmouni, Marcelo L G Correia, William Haynes … (2005)

Obesity is strongly associated with hypertension and cardiovascular disease. Several central and peripheral abnormalities that can explain the development or maintenance of high arterial pressure in obesity have been identified. These include activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system. Obesity is also associated with endothelial dysfunction and renal functional abnormalities that may play a role in the development of hypertension. The continuing discovery of mechanisms regulating appetite and metabolism is likely to lead to new therapies for obesity-induced hypertension. Better understanding of leptin signaling in the hypothalamus and the mechanisms of leptin resistance should facilitate therapeutic approaches to reverse the phenomenon of selective leptin resistance. Other hunger and satiety signals such as ghrelin and peptide YY are potentially attractive therapeutic strategies for treatment of obesity and its complications. These recent discoveries should lead to novel strategies for treatment of obesity and hypertension.

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Obesity-related hypertension: epidemiology, pathophysiology, and clinical management.

Theodore Kotchen (2010)

The prevalence of obesity, including childhood obesity, is increasing worldwide. Weight gain is associated with increases in arterial pressure, and it has been estimated that 60-70% of hypertension in adults is attributable to adiposity. Centrally located body fat, associated with insulin resistance and dyslipidemia, is a more potent determinant of blood pressure elevation than peripheral body fat. Obesity-related hypertension may be a distinct hypertensive phenotype with distinct genetic determinants. Mechanisms of obesity-related hypertension include insulin resistance, sodium retention, increased sympathetic nervous system activity, activation of renin-angiotensin-aldosterone, and altered vascular function. In overweight individuals, weight loss results in a reduction of blood pressure, however, this effect may be attenuated in the long term. An increasing number of community-based programs (including school programs and worksite programs) are being developed for the prevention and treatment of obesity. Assessment and treatment of the obese hypertensive patient should address overall cardiovascular disease (CVD) risk. There are no compelling clinical trial data to indicate that any one class of antihypertensive agents is superior to others, and in general the principles of pharmacotherapy for obese hypertensive patients are not different from nonobese patients. Future research directions might include: (i) development of effective, culturally sensitive strategies for the prevention and treatment of obesity; (ii) clinical trials to identify the most effective drug therapies for reducing CVD in obese, hypertensive patients; (iii) continued search for the genetic determinants of the obese, hypertensive phenotype.

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The new BMI criteria for asians by the regional office for the western pacific region of WHO are suitable for screening of overweight to prevent metabolic syndrome in elder Japanese workers.

Akiko Nogi, K. Kitajima, Y Yamane … (2003)

Obesity occurs less frequently in Japanese than in various other ethnic populations. A person with abnormal glucose tolerance is often found to have one or more of the other cardiovascular disease risk factors, such as obesity, hypertension and hyperlipidemia. This clustering has been labeled as metabolic syndrome (WHO, 1998). It was suggested that Japanese, categorized as having normal weight (BMI of less than 25.0), as defined by the WHO (2000), have an increasing tendency toward metabolic syndrome. Our objective was to analyze metabolic syndrome in "Overweight" with BMI of 23.0-24.9 in Japanese workers, and to assess the suitability for Asians of the Regional Office for the Western Pacific Region of WHO criteria pertaining to obesity (WPRO criteria, 2000). We conducted a cross-sectional study in the workplace setting and investigated the relationship between BMI classification based on WPRO criteria and metabolic syndrome by gender and age group (18-44 yr vs. 45-60 yr). Three hundred seventy-nine men and 432 women Japanese workers participated in this study. BMI were categorized as 20% "Overweight" (23.0-24.9 BMI), 20% "Obese I" (25.0-29.9 BMI) and 2% "Obese II" (over 30.0 BMI), based on WPRO criteria. Graded increases in BMI were positively associated with body fat percentage, waist circumference, hip circumference and waist/hip ratio in both genders and age groups. A progressively increasing BMI category in the elder group aged 45-60 yr in both genders was positively related with parameters constituting metabolic syndrome. Graded increases in BMI classes in elder workers based on WPRO criteria were positively associated with prevalence of metabolic syndrome, and "Overweight" elder women had significantly higher prevalence of metabolic syndrome. The present investigation, based on the increasing risks of "Overweight" with a BMI of 23.0-24.9, suggests that WPRO criteria are suitable for Japanese workers aged over 45 yr.

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Author and article information

Contributors

An-le Li:

ORCID: http://orcid.org/0000-0003-3200-4770

anle_li@aliyun.com

Qian Peng: pengqian@jiading.gov.cn

Yue-qin Shao: yueqshao@sohu.com

Xiang Fang: xiangfang159@126.com

Yi-ying Zhang: zyyzyyjd@163.com

Journal

Journal ID (nlm-ta): Clin Hypertens

Journal ID (iso-abbrev): Clin Hypertens

Title: Clinical Hypertension

Publisher: BioMed Central (London )

ISSN (Electronic): 2056-5909

Publication date (Electronic): 21 February 2019

Publication date PMC-release: 21 February 2019

Publication date Collection: 2019

Volume: 25

Electronic Location Identifier: 6

Affiliations

Jiading district center for disease control and prevention, Shanghai, China

Author information

An-le Li http://orcid.org/0000-0003-3200-4770

Article

Publisher ID: 111

DOI: 10.1186/s40885-019-0111-2

PMC ID: 6383274

PubMed ID: 30828463

SO-VID: ae2fd1fe-b91e-4b5e-a096-1d141de1db29

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 6 December 2018

Date accepted : 6 February 2019

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Keywords: hypertension,case-control study,body mass index,family history,interaction

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Keywords: hypertension, case-control study, body mass index, family history, interaction

The effect of body mass index and its interaction with family history on hypertension: a case–control study

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Karger: Nutrition and Dietetics

Most cited references 28

Obesity-associated hypertension: new insights into mechanisms.

Obesity-related hypertension: epidemiology, pathophysiology, and clinical management.

The new BMI criteria for asians by the regional office for the western pacific region of WHO are suitable for screening of overweight to prevent metabolic syndrome in elder Japanese workers.

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