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Blood pressure and adiposity in midlife Singaporean women


Hypertension is a major risk factor for cardiac events and stroke. Visceral adipose tissue (VAT) is known to increase the risk of incident hypertension in adults. Although adiposity has been linked to markers of inflammation, few studies have examined these markers as potential mediators of the association between visceral adiposity and elevated blood pressure. We evaluated sociodemographic, reproductive, and lifestyle risk factors for elevated blood pressure among midlife Singaporean women. A total of 1189 women, with a mean age of 56.3 ± 6.2 years, from the Integrated Women’s Health Program (IWHP) at National University Hospital, Singapore were studied. Hypothesized risk factors and levels of inflammatory markers were examined in relation to systolic blood pressure (SBP) and diastolic blood pressure (DBP) using multivariable linear regression models. Prehypertension (SBP 120–139 mmHg and/or DBP 80–89 mmHg) and hypertension (SBP ≥140 mmHg and/or DBP ≥90 mmHg) were observed in 518 (43.6%) and 313 (26.3%) women, respectively. Compared to women in the lowest tertiles, women in the middle and upper tertiles of VAT had 7.1 (95% CI, 4.4, 9.8) mmHg and 10.2 (95% CI, 6.7, 13.7) mmHg higher adjusted SBP, respectively. Nulliparous older women with a lower education level and those with no or mild hot flashes also had a significantly higher adjusted SBP. No significant independent risk factors were observed for DBP. Adjustments for IL-6, TNF-α, and hs-CRP did not attenuate the association between VAT and SBP. In summary, we found an independent positive association between VAT and SBP. Elevated levels of inflammatory markers did not mediate the increase in SBP in women with high VAT.

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The authors thank the study participants and study coordinators of IWHP. They are also grateful to Ms Tan Sze Yee from the Department of Orthopedic Surgery for conducting whole body DXA scans and to Dr Li Jun for grant management and the procurement of study materials.


This study was partially funded by a Singapore National Medical Research Council Grant (Number: NMRC/CSA-SI/0010/2017) provided to ELY.

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Correspondence to Eu-Leong Yong.

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Thu, W.P.P., Sundström-Poromaa, I., Logan, S. et al. Blood pressure and adiposity in midlife Singaporean women. Hypertens Res 44, 561–570 (2021).

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  • Adiposity
  • Blood pressure
  • Inflammation
  • Menopause
  • Midlife


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