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Individuals with hypertension have lower plasma volume regardless of weight status


Increased plasma volume is often reported as a cause or symptom of hypertension in individuals with obesity. However, these individuals are often compared to normal weight normotensive individuals. Since higher plasma volumes have been reported in larger individuals, it is possible that plasma volume is actually lower in obese hypertensive individuals compared to normotensive obese individuals. This may be important for better understanding the clinical manifestation of hypertension between weight categories. National Health and Nutritional Examination Survey (cycles 1999–2018) data were used to examine the relationship between plasma (derived from the Straus formula), blood pressure (measured with an automated device) and body mass index. We observed an inverse relationship between estimated plasma volume and systolic (B = −1.68 (95% CI: −2.06, −1.30) mmHg), p < 0.0001), diastolic (B = −3.35 (95% CI: −3.61, −3.08) mmHg) p < 0.0001), and mean arterial pressure (B = −2.79 (95% CI: −3.05, −2.53) mmHg) p < 0.0001). The relationship between estimated plasma volume and diastolic blood pressure (interaction term: B = −0.069 (−0.10, −0.03), p < 0.0001) did depend on BMI. The “normal weight” group had the lowest slope and this slope was significantly different from the “obese” (B = −1.47 (95% CI: −1.88, −1.07)) and “overweight” (B = −1.11 (−1.55, −0.67)) groups. Plasma volume is lower in hypertensive individuals regardless of weight status, but this relationship is more pronounced among obese individuals.

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Fig. 1: The relationship between estimated plasma volume (dL/g) and diastolic blood pressure (mmHg) separated by body mass index (BMI).
Fig. 2: The relationship between estimated plasma volume (dL/g) and mean arterial pressure (mmHg) separated by body mass index (BMI).

Data availability

The data used for this analysis can be found on the NHANES website


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RWS, PDL, and JPL conceived of the idea. PDL performed the statistical analysis. RWS wrote the paper. RWS, PDL, and JPL edited and approved the final manuscript.

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Correspondence to Jeremy P. Loenneke.

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Spitz, R.W., Loprinzi, P.D. & Loenneke, J.P. Individuals with hypertension have lower plasma volume regardless of weight status. J Hum Hypertens (2022).

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