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Body Mass Index and Risk of Incident Hypertension Over the Life Course: The Johns Hopkins Precursors Study

Date Posted: March 15, 2013

Authors: Shihab HM, Meoni LA, Chu AY, et al.

Citation: Circulation 2012;126:2983-2989.
[®PubMed abstract]

Study Question:
What is the association of body mass index (BMI) in young adulthood, into middle age, and through late life with risk of developing hypertension?

The association of BMI over the lifetime of white men and the development of hypertension was evaluated in 1,132 participants in The Johns Hopkins Precursors Study, a prospective cohort study. Estimated cumulative incidence of hypertension was assessed by BMI category of normal to obese and as a time-dependent continuous variable with BMI at ages 25, 45, and 65 years.

Over a median follow-up period of 46 years, 508 men developed hypertension. Obesity (BMI ≥=30 kg/m2) in young adulthood was strongly associated with incident hypertension (hazard ratio [HR], 4.17; 95% confidence interval [CI], 2.34-7.42). Overweight (BMI 25 to <30 kg/m2) also signaled increased risk (HR, 1.58; 95% CI, 1.28-1.96). Men of normal weight at age 25 years who became overweight or obese at age 45 years were at increased risk compared with men of normal weight at both times (HR, 1.57; 95% CI, 1.20-2.07), but not men who were overweight or obese at age 25 years who returned to normal weight at age 45 years (HR, 0.91; 95% CI, 0.43-1.92). After adjustment for time-dependent number of cigarettes smoked, cups of coffee, alcohol intake, physical activity, parental premature hypertension, and baseline BMI, the rate of change in BMI over the life course increased the risk of incident hypertension in a dose-response fashion, with the highest risk among men with the greatest increase in BMI (HR, 2.52; 95% CI, 1.82-3.49).

The findings underscore the importance of higher weight and weight gain in increasing the risk of hypertension from young adulthood through middle age and into late life.

To place this in perspective, for a 5-foot 9-inch-tall man at age 25 years, a 10-lb weight gain over the life course translates to an 18% increased risk of hypertension. When this study was designed, the relationship between blood pressure, insulin resistance, and visceral obesity was not known. More recent observational studies may help define the relationship between the lifelong development of visceral obesity, hypertension, and other variables of the metabolic syndrome.

Melvyn Rubenfire, MD, F.A.C.C. (Disclosure)

Prevention/Vascular, General Cardiology

© 2013 American College of Cardiology Foundation

The above message comes from CardioSource, who is solely responsible for its content.


Information sourced from Journal Watch:

Surgery vs. Physical Therapy for Meniscal Tears and Osteoarthritis

In a randomized trial, outcomes were similar in the two groups.

In many patients, knee osteoarthritis and meniscal tears coexist. Whether a torn meniscus is contributing to knee symptoms in a given patient with osteoarthritis often is unclear, because many meniscal tears are asymptomatic. In this randomized trial, U.S. researchers assessed the effect of arthroscopic partial meniscectomy in 351 patients with both mild-to-moderate osteoarthritis and meniscal tears extending to the meniscal surface. Enrollment criteria included having at least one symptom consistent with torn meniscus (e.g., catching, popping, giving way, pain with pivot) for at least 1 month.

Patients were assigned to either physical therapy (PT) alone or meniscectomy followed by PT; patients in the PT group were permitted to cross over to surgery if necessary. In intent-to-treat analyses, average improvement on the physical-function scale of a standardized osteoarthritis index was similar in the two groups at 6 and 12 months; pain scores also improved similarly. At 6 months, 30% of PT patients had crossed over to surgery; between 6 and 12 months, only an additional 5% underwent surgery.

Comment: This trial clearly shows that most symptomatic patients with coexisting knee osteoarthritis and torn menisci do not require surgery. For the minority of patients who experience ongoing debilitating symptoms during a period of observation, surgery remains an option. Because all patients received PT, the effectiveness of that intervention cannot be determined from this study.

Allan S. Brett, MD

Published in Journal Watch General Medicine March 28, 2013


Katz JN et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med 2013 Mar 18; [e-pub ahead of print]. [Link to free full-text NEJM article PDF | ®PubMed abstract]

Copyright © 2013. Massachusetts Medical Society. All rights reserved.

The above message comes from "Journal Watch", who is solely responsible for its content.



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