Association between abdominal obesity and increased risk for the development of hypertension regardless of physical activity: A nationwide population‐based study

Abstract

The presence of abdominal obesity and lack of physical activity are both risk factors for the development of hypertension. The aim of this study was to analyze the risk of developing hypertension according to baseline waist circumference (WC). In total, 16 312 476 non‐hypertensive participants who were covered by the National Health Insurance Service (NHIS) from 2009 to 2012 in Korea were included in the study. The participants were divided into six groups according to the level of baseline WC with a 5‐cm interval starting from 80 cm in men and 75 cm in women. The risk for the future development of hypertension was assessed in 2015 using the claims data on the diagnosis of hypertension and prescription of anti‐hypertensive medications. Approximately 7.8% of the participants developed hypertension over a median follow‐up of 5.48 years. The proportion of participants who developed hypertension significantly increased from 4.2% in the WC level 1% to 17.5% in the WC level 6. After adjusting for confounding factors, level 6 of the baseline WC had a higher hazard ratio (HR) for the development of hypertension among the 6 levels of baseline with level 3 as the reference (1736; 95% confidence interval [95% CI]: 1.72‐1.753). The participants with abdominal obesity had a significantly higher HR than those without abdominal obesity regardless of whether they engage in high‐ or moderate‐intensity physical intensity (1.741; 95% CI: 1.718‐1.764). WC had a linear association with the development of hypertension based on this large nationwide population‐based cohort study, which was not influenced by physical activity.

General obesity, abdominal adiposity, and the risk of incident hypertension—From anthropometry to modern imaging techniques

“…In conclusion, the study of Rhee et al is the largest prospective observational study conducted so far to demonstrate a strong linear relationship between abdominal obesity and risk of new‐onset hypertension in a national‐wide population of >16 million Korean adults. This observation confirms and expands the results of recent dose‐response meta‐analyses, calling for properly designed randomized trials aiming to ascertain the role of several weight loss interventions in the prevention and overall management of hypertension.…”

“…In this issue of The Journal of Clinical Hypertension , Rhee et al explored the association of abdominal obesity with the risk of developing hypertension in a national‐wide, population‐based cohort study of 16 312 476 normotensive Koreans, who received a health screening evaluation covered by the National Health Insurance Service (NHIS) of Korea during 2009‐2012. Screening examinations included routine anthropometric measurements (ie, body weight, height, waist circumference) and standardized office BP monitoring.…”

“…Adjudication of hypertension status, which was the prespecified outcome of this analysis, was performed in 2015 on the basis of claim records of the NHIS with ICD‐10 codes I10‐I15 and claims for antihypertensive drug use throughout the observational period. Over a median follow‐up of 5.48 years, the overall incidence of hypertension was as high as 7.8% . When participants were stratified into 6 sub‐groups according to the baseline level of waist circumference, the incidence of hypertension increased linearly from 4.2% in category 1 (waist circumference <80 cm for men and <75 cm for women) to 17.5% in category 6 (waist circumference >100 cm for men and >95 cm for women).…”

“…When participants were stratified into 6 sub‐groups according to the baseline level of waist circumference, the incidence of hypertension increased linearly from 4.2% in category 1 (waist circumference <80 cm for men and <75 cm for women) to 17.5% in category 6 (waist circumference >100 cm for men and >95 cm for women). Using the waist circumference category 3 as reference standard, those participants stratified in category 6 had 73.6% higher risk of incident hypertension [hazard ratio (HR): 1.736; 95% CI: 1.720‐1.753] . This association remained significant even after adjustment for age, gender, smoking status, alcohol consumption, income level, and history of diabetes and dyslipidemia.…”

“…This association remained significant even after adjustment for age, gender, smoking status, alcohol consumption, income level, and history of diabetes and dyslipidemia. In sub‐group analysis, participants with abdominal obesity at baseline had significantly higher risk for developing hypertension than those without abdominal obesity regardless of self‐reported intensity of physical activity (HR: 1.741; 95% CI: 1.718‐1.764) …”