Abstract
BACKGROUND: Few prospective studies have evaluated the risk for incident hypertension (HTN) across the normal range of body mass index (BMI). Even fewer studies included body composition and fat distribution measurements in their analyses. In the Aerobics Center Longitudinal Study, we examined HTN risk in women across a wide spectrum of baseline BMI (kg/m(2)) values and also studied waist circumference (WC, cm), percent body fat, fat mass (FM, kg), and fat-free mass (FFM, kg) on incident HTN in subgroup analyses. METHODS: A total of 5,296 healthy normotensive women between 20 and 77 years of age completed a baseline examination during 1971-2004, and were followed for HTN incidence. Incident HTN was identified using mail-back surveys. RESULTS: A total of 592 women reported HTN during a mean 16.7 years of follow-up. Higher BMI, even within the "normal" range, was associated with greater risk of HTN. Compared with women in the lowest fifth of BMI (18.5-20.0 kg/m(2)), the hazard ratios (HRs) (95% confidence interval (CI)) of developing HTN for women with a BMI of 20.1-21.2, 21.3-22.5, 22.6-24.7, and >24.7 were 1.19 (0.89-1.60), 1.33 (0.99-1.78), 1.36 (1.03-1.81), and 2.01 (1.52-2.66), respectively (P(trend) < 0.001). In a subgroup (n = 3,189) with complete data on all the five adiposity measures, significant positive associations with HTN were seen across incremental fifths of BMI, percent body fat, and FM (P(trend) < 0.05 each), but not WC and FFM. CONCLUSIONS: Clinicians should emphasize the importance of weight management for the primary prevention of HTN in women.