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Relation between adiposity and hypertension persists after onset of clinically manifest arterial disease

Dorresteijn, Johannes A.N.a; Spiering, Wilkoa; Van Der Graaf, Yolandab; Visseren, Frank L.J.aon behalf of the SMART Study Group

doi: 10.1097/HJH.0b013e328357f18a

Objectives: To quantify the relation between adiposity and blood pressure (BP) level in patients with symptomatic vascular disease and, thereby, assess whether the obesity paradox can be explained by a causal mechanism involving BP.

Methods: BP and markers of adiposity (i.e. weight, body mass index, waist circumference, waist-to-hip ratio, subcutaneous adipose tissue, and visceral adipose tissue) were recorded in 4556 men and women with symptomatic vascular disease enrolled in the Secondary Manifestations of Arterial Disease Study. Additionally, 185 patients underwent repeated measurements after 3.7 years follow-up.

Results: Each 5 kg/m2 body mass index was associated with +3.8 mmHg (95% confidence interval (CI) 3.0–4.6) SBP difference and +2.3 mmHg (95% CI 1.9–2.8 mmHg) DBP difference in both men and women. Measures of centralized adiposity compared with BMI were equally related with BP. In contrast, subcutaneous adipose tissue was only weakly related with DBP and not related with SBP and pulse pressure. Various methods of adjustment for BP-lowering medication use led to consistent results. Furthermore, 5 kg/m2 body mass index change during follow-up was associated with +8.1/5.1 mmHg BP change.

Conclusion: The relation between general and abdominal adiposity and hypertension persists after onset of symptomatic arterial disease both in men and women. This shows that the obesity paradox cannot be explained by a causal mechanism involving BP and, therefore, supports weight control for reducing BP in secondary prevention of cardiovascular events.

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aDepartment of Vascular Medicine, University Medical Center Utrecht

bJulius Center for Health Sciences and Primary Care, Utrecht, The Netherlands

*Members of the SMART study group are listed in the Acknowledgements section.

Correspondence to Frank L.J. Visseren, MD, PhD, Professor of Vascular Medicine, Department of Vascular Medicine, University Medical Center Utrecht, UMCU P.O. Box F02.126, PO Box 85500, 3508 GA Utrecht, The Netherlands. Tel: +31 (0)88 7555161; fax: +31 (0)30 2523741; e-mail:

Abbreviations: eGFR, estimated glomerular filtration rate; PP, pulse pressure; SAT, subcutaneous adipose tissue; SMART study, Secondary Manifestations of ARTerial disease study; UMCU, University Medical Center Utrecht; VAT, visceral adipose tissue; WHR, waist-to-hip ratio

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Received 3 April, 2012

Revised 6 June, 2012

Accepted 10 July, 2012

This work has not been published and is not being considered for publication elsewhere. It was presented, however, during the 2012 European Meeting on Hypertension and Cardiovascular Prevention in London.

© 2012 Lippincott Williams & Wilkins, Inc.