About half of all adults with obesity have controlled or uncontrolled hypertension and a significantly higher mortality rate compared with normotensive counterparts, researchers reported in Obesity.
“Health care providers should aim to optimize the level of hypertension control and advocate weight loss through lifestyle and pharmacological interventions to achieve better outcomes for people with obesity,” Nicholas Chew, MBChB, MMed, MRCP, from the department of cardiology at the National University of Singapore, told Healio.
Researchers assessed 49,099 participants from the National Health and Nutrition Examination Survey between 1999 and 2018. Participants with obesity were categorized into groups based on presence of hypertension: no hypertension, controlled hypertension or uncontrolled hypertension.
The study outcomes were cardiovascular mortality and all-cause mortality.
Overall, 35.6% of participants had obesity. Of these, 53.1% had no hypertension, 24.7% had controlled hypertension and 22.2% had uncontrolled hypertension. Participants with uncontrolled hypertension had significantly higher all-cause mortality (17.1%), followed by those with controlled hypertension (14.8%) and no hypertension (4%).
P = .001) and those with controlled hypertension (HR = 1.21; 95% CI, 1.10-1.34; P < .001) had the highest risk for mortality compared with those without hypertension, the researchers reported.
Independent predictors of hypertension for participants with obesity were older age (RR = 1.03; 95% CI, 1.03-1.03; P < .001), male sex (RR = 1.04; 95% CI, 1.02-1.05; P < .001), BMI (RR = 1.02; 95% CI, 1.01-1.02; P < .001) and presence of diabetes (RR = 1.22; 95% CI, 1.18-1.26; P < .001).
In addition, white (RR = 1.08; 95% CI, 1.05-1.11; P < .001), Black (RR = 1.25; 95% CI, 1.20-1.31; P < .001) or other Hispanic participants (RR = 1.09; 95% CI, 1.04-1.14; P < .001) had higher risks for hypertension compared with Mexican American participants. Women, participants with diabetes and those older than 65 years had a more pronounced excess mortality trend.
According to Chew, the level of blood pressure control should be the main focus as obesity-related hypertension ensues. The findings of this study regarding mortality risk based on BMI category highlight the complex pathophysiological effects of obesity-related hypertension on CV morbidity and mortality, he said.
“The emerging interest in SGLT2 inhibitors and GLP-1 receptor agonists and their effects on blood pressure control and weight loss appears promising,” Chew said. “Studies examining the beneficial metabolic effects of these pharmacotherapies within the obesity-related hypertensive cohort will be an important next step.”
Nicholas Chew, MBChB, MMed, MRCP, can be reached at email@example.com