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Epidemiology and Population Health

Time-varying association between body mass index and all-cause mortality in patients with hypertension

International Journal of Obesity volume 46, pages 316–324 (2022)Cite this article

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Abstract

Background

Relationship between BMI and all-cause mortality in patients with hypertension remains controversial. This study aimed to evaluate the time-varying association between BMI in patients with hypertension and all-cause mortality.

Methods

This population-based cohort study included 212,394 Chinese adults with hypertension from 2007 to 2015 and was followed up until death, loss-to-follow-up, or December 31, 2018. According to the World Health Organization criteria for Asians, BMI was categorized into five groups: underweight (BMI < 18.5 kg/m2), normal weight (18.5–22.9 kg/m2), overweight (23–24.9 kg/m2), class I obesity (25–29.9 kg/m2) and class II obesity (BMI ≥ 30 kg/m2). Cox model was used to estimate the time-varying association of BMI on the risk of mortality by including the interaction term between BMI and time using restricted cubic spline.

Results

Compared with normal weight, underweight and class II obesity were associated with higher mortality (Hazard ratio [HRs] at 1 and 10 years of follow-up: 1.51 [95% CI: 1.39–1.65], and 1.27 (1.15–1.41) for underweight, respectively; 1.08 (0.96–1.21), and 1.16 (1.03–1.30) for class II obesity, respectively). However, overweight and class I obesity were associated with lower mortality, although the protective effects gradually attenuated over time (HRs at 1 and 10 years of follow-up: 0.85 (0.81–0.90), and 0.96 (0.91–1.02) for overweight, respectively; 0.80 (0.76–0.84), and 1.04 (0.99–1.10) for class I obesity, respectively).

Conclusions

We found increased mortality among hypertensive patients with underweight and class II obesity while decreased mortality with overweight and class I obesity was observed during the first 5 years of follow-up. Management efforts for hypertension may target controlling body weight in a reasonable range for patients, and probably more attention should be given to underweight patients.

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Fig. 1: Overall survival among hypertensive patients with different BMI levels.
Fig. 2: Time-varying HRs and 95% CIs of BMI on all-cause mortality among patients with hypertension in the crude and adjusted model.
Fig. 3: Time-varying HRs for BMI in association with all-cause mortality among patients aged 20–85 years with hypertension.

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Data availability

The datasets generated and analyzed in the study are not publicly available but are available from the corresponding authors on reasonable request.

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Acknowledgements

The authors would like to thank the research participants and the staff of the Minhang District community in Shanghai, China for their contributions to the research.

Funding

This study was supported by Shanghai Municipal Nature Science Foundation (19ZR1445900), Nature Science Foundation of Minhang district, Shanghai, China (2020MHZ043), the National Nature Science Foundation of China (NO: 11871164 and No 82073570), Minhang district key disciplines in public health (MGWXK01) and Health Consortium Foundation of Fudan University and Minhang District Health Committee (NO: 2019FM02).

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Author notes

  1. These authors contributed equally: Jingjing Zhu, Xiaohua Liu.

Authors and Affiliations

  1. Department of Biostatistics, School of Public Health, Fudan University, Shanghai, PR China

    Jingjing Zhu, Chen Huang, Yongfu Yu & Guoyou Qin

  2. Shanghai Minhang Center for Disease Control and Prevention, 965 Zhong Yi Road, Shanghai, 201101, PR China

    Xiaohua Liu, Jinling Zhang, Jun Li, Linli Chen & Huilin Xu

  3. Minhang District Branch of School of Public Health, Fudan University, Shanghai, PR China

    Xiaohua Liu & Huilin Xu

  4. Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus University, Aarhus N, 8200, Denmark

    Jiong Li

  5. Key Lab of Health Technology Assessment, National Health Commission of the People’s Republic of China, Fudan University, Shanghai, 200032, PR China

    Guoyou Qin

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Contributions

YFY, HLX, and GYQ had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. YFY, HLX, and GYQ conceived the idea, JJZ and HLX conducted data extraction and statistical analyses. JJZ wrote the first draft of the manuscript. JLZ, JL, and LLC involved in data acquisition and check. YFY, HLX, and GYQ contributed to data interpretation. All authors revised the manuscript for important intellectual content. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Yongfu Yu, Huilin Xu or Guoyou Qin.

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The authors declare no competing interests

Ethics approval and consent to participate

The study was approved by the Institutional Review Board of center for disease control and prevention in Minhang District, Shanghai (NO: EC-P-2019-009). Informed consent from participants involved in the study was waived due to the fact that anonymized data compiled from electronic medical records was applied in the study.

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Zhu, J., Liu, X., Zhang, J. et al. Time-varying association between body mass index and all-cause mortality in patients with hypertension. Int J Obes 46, 316–324 (2022). https://doi.org/10.1038/s41366-021-00994-0

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