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Four-year adiposity change and remission of hypertension: an observational evaluation from the Longitudinal Study of Adult Health (ELSA-Brasil)

Journal of Human Hypertension volume 34, pages 68–75 (2020)Cite this article

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Abstract

The degree to which weight reduction leads to the remission of hypertension in population studies is not clear. We investigated whether the changes in adiposity measures predicted the remission of hypertension in a racially admixed population over a mean 4-year follow-up. All 4847 hypertensive individuals at baseline (2008–2010) from the multicenter Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were included. Changes in weight, waist circumference (WC), or body mass index (BMI) (reduction or increase ≥5% from baseline values, vs stability) and remission of hypertension (SBP < 140 and DBP < 90 mmHg and no use of antihypertensive medication at follow-up visit, in 2012–2014) were investigated using mixed effects logistic regression models. Proportional attributable benefit was additionally calculated. Analyses were stratified by sex and antihypertensive medication use at baseline. Remission of hypertension was 11.3% (n = 546). Among men, after adjustments, the reduction of weight (OR = 1.52 95% CI 1.10–2.10), WC (OR = 1.56 95% CI 1.04–2.35) or BMI (OR = 1.60 95% CI 1.13–2.27) was associated with the remission of hypertension. Among those not taking antihypertensive medication at baseline, after adjustments, the reduction of weight (OR = 1.64 95% CI 1.18–2.27), WC (OR = 1.76 95% CI 1.18–2.61) or BMI (OR = 1.57 95% CI 1.10–2.25) was associated with the remission of hypertension. Proportional attributable benefit among those with adiposity reduction was about 30%, indicating its potential for prevention. In conclusion, our study reinforces the role of adiposity-reducing strategies (e.g., healthy diet and regular physical activity) for the treatment and prevention of hypertension, which might have potential applications for clinical practice.

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References

  1. Kerney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He H. Global burden of hypertension: analysis of worldwide data. Lancet 2005;365:217–23.

    Article  Google Scholar 

  2. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation 2016;134:441–50.

    Article  Google Scholar 

  3. Landsberg L, Aronne LJ, Beilin LJ, Burke V, Igel LI, Lloyd-Jones D, et al. Obesity-related hypertension: pathogenesis, cardiovascular risk, and treatment—a position paper of the The Obesity Society and The American Society of Hypertension. Obesity. 2013;21:8–24.

    Article  Google Scholar 

  4. Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014;129:S76–99.

    Article  Google Scholar 

  5. Aquino EML, Barreto SM, Bensenor IM, Carvalho MS, Chor D, Duncan BB, et al. Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): objectives and design. Am J Epidemiol 2012;175:315–24.

    Article  Google Scholar 

  6. Schmidt MI, Duncan BB, Mill JG, Lotufo PA, Chor D, Barreto SM, et al. Cohort Profile: Longitudinal Study of Adult Health (ELSA-Brasil). Int J Epidemiol 2015;44:68–75.

    Article  Google Scholar 

  7. Chor D, Ribeiro ALP, Carvalho MS, Duncan BB, Lotufo PA, Nobre AA, et al. Prevalence, awareness, treatment and influence of socioeconomic variables on control of high blood pressure: results of the ELSA-Brasil Study. PLoS One 2015;10:e0127382.

    Article  Google Scholar 

  8. Aquino EML, Vasconcellos-Silva PR, Coeli CM, Araújo MJ, Santos SM, Figueiredo RC, et al. Ethical issues in longitudinal studies: the case of ELSA-Brasil. Rev Saude Pública 2013;47:19–26.

    Article  Google Scholar 

  9. Mill JG, Pinto K, Griep RH, Goulart A, Foppa M, Lotufo PA, et al. Medical assessments and measurements in ELSA-Brasil. Rev Saude Publica 2013;47:54–62.

    Article  Google Scholar 

  10. Douketis JD, Macie C, Thabane L, Williamson DF. Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. Int J Obes 2005;29:1153–67.

    Article  CAS  Google Scholar 

  11. Winnicki M, Bonso E, Dorigatti F, Longo D, Zaetta V, Mattarei M, et al. Effect of body weight loss on blood pressure after 6 years of follow-up in stage 1 hypertension. Am J Hypertens 2006;19:1103–09.

    Article  Google Scholar 

  12. Fogari R, Zoppi A, Corradi L, Preti P, Mugellini A, Lazzari P, et al. Effect of body weight loss and normalization on blood pressure in overweight non-obese patients with stage 1 hypertension. Hypertens Res 2010;33:236–42.

    Article  Google Scholar 

  13. Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. Champaign: Human Kinetics Books; 1988.

  14. Schmidt MI, Griep RH, Passos VM, Luft VC, Goulart AC, Menezes GM, et al. Strategies and development of quality assurance and control in the ELSA-Brasil. Rev Saúde Pública 2013;47:105–12.

    Article  Google Scholar 

  15. Chor D, Alves MGM, Giatti L, Cade NV, Nunes MA, Molina MC. et al. Questionnaire development in ELSA-Brasil: challenges of a multidimensional instrument. Rev Saude Publica. 2013;47:27–36.

    Article  Google Scholar 

  16. Fedeli LG, Vidigal PG, Leite CM, Castilhos CD, Pimentel RA, Maniero VC, et al. Logistics of collection and transportation of biological samples and the organization of the central laboratory in the ELSA-Brasil. Rev Saude Publica 2013;47:63–71.

    Article  Google Scholar 

  17. Schmidt MI, Hoffmann JF, Diniz MdeFS, Lotufo PA, Griep RH, Bensenor IM, et al. High prevalence of diabetes and intermediate hyperglycemia—the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Diabetol Metab Syndr 2014;6:123.

    Article  Google Scholar 

  18. Barreto SM, Ladeira RM, Duncan BB, Schmidt MI, Lopes AA, Bensenor IM, et al. Chronic kidney disease among adult participants of the ELSA-Brasil cohort: association with race and socioeconomic position. J Epidemiol Community Health 2016;70:380–9.

    Article  Google Scholar 

  19. Miranda EJFP, Bittencourt MS, Santos IS, Lotufo PA, Bensenor IM. Thyroid function and high-sensitivity C-reactive protein in cross sectional results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): Effect of adiposity and insulin resistance. Eur. Thyroid J 2016;5:240–6.

    Article  Google Scholar 

  20. Porta M. A Dictionary of Epidemiology. New York: Oxford University Press; 2008.

  21. Gordis L. Epidemiology. Philadelphia: Elsevier Saunders; 2004.

  22. Neter JE, Stam BE, Kok FJ, Grobbee DE, Geleijnse JM. Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 2003;42:878–84.

    Article  CAS  Google Scholar 

  23. Juhaeri Stevens J, Chambless LE, Nieto FJ, Jones D, Schreiner P, et al. Associations of weight loss and changes in fat distribution with the remission of hypertension in a bi-ethnic cohort: the Atherosclerosis Risk in Communities Study. Prev Med 2003;36:330–9.

    Article  CAS  Google Scholar 

  24. Adams TD, Davidson LE, Litwin SE, Kim J, Kolotkin RL, Nanjee MN, et al. Weight and Metabolic Outcomes 12 Years after Gastric Bypass. N Engl J Med 2017;377:1143–55.

    Article  Google Scholar 

  25. Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990–2015. JAMA. 2017;317:165–82.

    Article  Google Scholar 

  26. Schiavon CA, Bersch-Ferreira AC, Santucci EV, Oliveira JD, Torreglosa CR, Bueno PT, et al. Effects of bariatric surgery in obese patients with hypertension: The GATEWAY Randomized Trial (Gastric Bypass to Treat Obese Patients With Steady Hypertension). Circulation. 2018;137:1132–42.

    Article  Google Scholar 

  27. Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–04.

    Article  Google Scholar 

Download references

Acknowledgements

We thank all ELSA-Brasil participants who agreed to take part in the study.

Funding

ELSA-Brasil was supported by the Brazilian Ministry of Health (Department of Science and Technology) and the Ministry of Science, Technology and Innovation (FINEP, Financiadora de Estudos e Projetos) (grant numbers 01 06 0010.00, 01 06 0212.00, 01 06 0300.00, 01 06 0278.00, 01 06 0115.00, 01 06 0071.00) and CNPq (the National Council for Scientific and Technological Development). This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES) (postdoctoral fellowship to JMNG)—Finance Code 001.

Author contributions

JMNG conceived the paper, conducted the analysis, interpreted the results and wrote the paper. RHG, MJMF, BBD, MIS, JGM, PAL, IJB, SMB, LG, SMAM, MDCM, and DC are the PI’s of the ELSA-Brasil study and contributed to the interpretation of results. AGP contributed to the statistical analysis and interpretation of results. All authors significantly contributed with intellectual content to the paper, commented extensively on subsequent revisions, revised the paper and approved the final version.

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Authors and Affiliations

  1. Department of Epidemiology and Quantitative Methods, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil

    Joanna M. N. Guimarães, Maria J. M. Fonseca & Dora Chor

  2. Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil

    Rosane H. Griep

  3. Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil

    Bruce B. Duncan & Maria I. Schmidt

  4. Department of Physiological Sciences, Federal University of Espírito Santo, Vitoria, ES, Brazil

    José G. Mill & Maria delC B. Molina

  5. Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, SP, Brazil

    Paulo A. Lotufo & Isabela J. Bensenor

  6. Faculty of Medicine and Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil

    Sandhi M. Barreto & Luana Giatti

  7. Institute of Collective Health, Federal University of Bahia, Salvador, BA, Brazil

    Sheila M. A. Matos

  8. Scientific Computing Program, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil

    Antonio G. Pacheco

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  1. Joanna M. N. Guimarães
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  9. Sandhi M. Barreto
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  11. Sheila M. A. Matos
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  12. Maria delC B. Molina
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Correspondence to Dora Chor.

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Guimarães, J.M.N., Griep, R.H., Fonseca, M.J.M. et al. Four-year adiposity change and remission of hypertension: an observational evaluation from the Longitudinal Study of Adult Health (ELSA-Brasil). J Hum Hypertens 34, 68–75 (2020). https://doi.org/10.1038/s41371-019-0289-5

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