Evidence for an Increased Risk for Hypertension With Centrally Located Body Fat and the Effect of Race and Sex on This Risk

Abstract

Data from the First Health and Nutrition Examination Survey (HANES), 1971-1974, were used to examine the relationship between blood pressure and the distribution of subcutaneous body fat in 5506 survey participants, ages 30-59. Triceps and subscapular skinfolds were used as approximations of peripheral and centrally located body fat. The effects of race, sex and age on the obesity-blood pressure relationship were analyzed. Subscapular skinfold was the better predictor of both systolic and diastolic blood pressure in each race-sex group, sharing all of the association of triceps with blood pressure and having significant predictive power unshared by triceps. The slopes of regression of subscapular skinfolds with systolic blood pressure for each race-sex group were not significantly different. A 1 mm increase in skinfold thickness increased the predicted mean systolic blood pressure by 0.63 +/- 0.03 mmHg (F = 519). Mean diastolic blood pressure rose 0.43 +/- 0.02 mmHg per unit increase of skinfold in whites (F = 549), and 0.14 +/- 0.04 mmHg less in blacks (F = 13), indicating a significant racial difference. Age and subscapular skinfold contributed independently to the variability in blood pressure in each race-sex group. These results demonstrate that the blood pressure of middle-aged Americans is more directly associated with centrally deposited body fat. This finding is true across race and sex groups, and is independent of age.

Hypertension, hyperinsulinaemia and obesity in middle-aged Finns with impaired glucose tolerance

“…27 But the biological plausibility of insulin as a hypertensive agent seems slender. 28 An independent association of obesity and weight gain with hypertension has been observed in many cross-sectional and prospective studies, [29][30][31] and several studies have shown that body fat distribution is a more powerful determinant of BP than overall measures of obesity, 32,33 In this study, the increased BMI preceded the development of hypertension, and correlated positively with the fasting insulin concentration (r = 0.54, P Ͻ 0.001). This may suggest that hyperinsulinaemia is a link between hypertension and obesity and that the association of hypertension with obesity is mediated by hyperinsulinaemia.…”

Plasma insulin, plasminogen activator inhibitor, and ankle-brachial systolic blood pressure ratio in overweight hypertensive subjects

“…21 A weaker correlation has been observed between brachial systolic blood pressure and the fat distribution in obese and non-obese subjects. 7,21,31,32 In the present study, we found that the degree of abdominal fat deposition was strongly associated with the decrease in ABI ratio. The validity of this relationship was based on two important findings: (i) the ABI ratio was no significantly correlated with body weight or body mass index, and (ii) the observed correlation did not result from a significant correlation between the WHR and brachial systolic blood pressure but rather from a negative correlation between the WHR and ankle systolic blood pressure.…”

Trends in the association between blood pressure and obesity in a Taiwanese population between 1996 and 2006

“…The android pattern of obesity, sometimes referred to as 'the apple-shape' has long been associated with increased cardiovascular risk and diabetes. [22][23][24] Although BMI is used to classify overweight and obesity, 25 it does not account for the wide variation of body fat distribution, particularly across different populations. 26 Increased muscle mass (lean body mass) increases weight and, therefore, BMI, whereas waist circumference reflects the size of the visceral fat depot and is an effective clinical tool for assessing the risk of diabetes and cardiovascular diseases.…”