Abstract
BACKGROUND: To address the limited evidence in Asian populations, we aimed to elucidate the association of weight changes from young to middle adulthood with blood pressure and hypertension among Chinese adults. METHODS: We used data from the China Health Evaluation and Risk Reduction Through Nationwide Teamwork (ChinaHEART) project conducted in Shandong Province, China between December 2015 and November 2022. Within the ChinaHEART project, participants aged 35 to 64 years were selected, and standardised measurements (including questionnaires, physical examinations, and laboratory measurements) were performed. We used multivariable adjusted restricted cubic splines, linear regression models and logistic regression models for analysis. RESULTS: We included 56 459 participants for analysis. Compared to stable normal weight, all other weight trajectories (maximum overweight, obesity to non-obesity, non-obesity to obesity, and stable obesity) showed positive associations with systolic and diastolic blood pressure. Hypertension risk increased progressively across these groups, with adjusted odds ratios (OR) of 1.83 (95% confidence interval (CI) = 1.73, 1.94), 2.29 (95% CI = 1.81, 2.89), 3.88 (95% CI = 3.62, 4.17), and 4.96 (95% CI = 4.09, 6.00), respectively. CONCLUSIONS: Weight gain from young to middle adulthood independently predicts elevated blood pressure and hypertension. Public health strategies should prioritise weight management across the life course to mitigate hypertension burden.