Advocate for Hypertension Control and Weight Loss to Patients with Obesity, Suggest Authors of New Study

Nearly 50% of US patients with obesity have hypertension (HTN), of whom half have uncontrolled HTN, according to findings from a 2-decade population-based study presented at the American College of Cardiology’s (ACC) 72nd Annual Scientific Session Together with the World Congress of Cardiology, being held March 4-6, 2023, in New Orleans.

“With rising prevalence of hypertension and obesity, the effect of hypertension in obesity remains an important global issue,” wrote researchers from Singapore in the study abstract. “We examined the prognosis of the US general population with obesity based on hypertension control.”

The research team analyzed participants from the National Health and Nutrition Examination Survey (NHANES) between 1999-2018. Patients with obesity were stratified into 3 groups based on HTN diagnosis: no HTN, controlled HTN, and uncontrolled HTN. The study outcome was all-cause mortality and investigators used multivariable Cox regression to examine the association of HTN and all-cause mortality, which was adjusted for age, sex, ethnicity, diabetes, and previous myocardial infarction.

In total, 16 386 patients with obesity were studied, of whom 53.1% had no HTN, 24.7% had controlled HTN, and 22.2% had uncontrolled HTN, according to the abstract. Compared to non-obese participants, there was a significantly higher proportion of patients in the obesity group with controlled and uncontrolled HTN. Patients with obesity-related HTN tended to be older, have higher body mass index, and have diabetes according to investigators.

All-cause mortality rates were significantly higher in the uncontrolled HTN group (17.1%) followed by the controlled HTN (14.8%) and no HTN (4.0%) groups. After adjustment, participants with uncontrolled HTN had the highest risk of all-cause mortality (hazard ratio [HR] 1.34, 95% CI 1.13-1.59, P=.001), followed by those with controlled HTN (HR 1.21, 95% CI 1.10-1.34, P<.001), compared to those without HTN. Researchers observed this trend across all weight groups, with risk of all-cause mortality most pronounced in participants with obesity.

For all 3 HTN groups, the effect sizes in mortality were more pronounced in women, those with diabetes, and older adults.

“The stepwise incremental risk of mortality in controlled and uncontrolled hypertension, compared to the normotension, is present in the general population. Healthcare providers should aim to optimize hypertensive control and advocate weight loss for better prognosis,” concluded investigators.

Jieyu Lim will present the study, "A two-decade population-based study on the effect of hypertension in the general population with obesity in the United States," on Saturday, March 4, 2023 at 1 am CT.