The Relationship of Body Mass and Fat Distribution With Incident Hypertension: Observations From the Dallas Heart Study

Study Questions:

Is adipose distribution associated with incident hypertension?


Data from the Dallas Heart Study (DHS), a cohort study of adults (ages 18-65 years) residing in Dallas County, were used for the present analysis. Participants with hypertension as baseline (defined as systolic blood pressure [SBP] ≥140, diastolic blood pressure [DBP] ≥90, or on antihypertensive medications) or borderline elevations (SBP ≥130 or DBP ≥85) at baseline were excluded. Normotensive participants were followed for a median of 7 years for the development of hypertension (SBP ≥140, DBP ≥90, or initiation of blood pressure medications). Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were quantified by magnetic resonance imaging and proton-spectroscopic imaging, and lower body fat (LBF) was imaged by dual-energy X-ray absorptiometry. Multivariable relative risk regression was performed to test the association between individual fat depots and incident hypertension, adjusting for age, gender, race/ethnicity, diabetes, smoking, SBP, and body mass index (BMI).


Among 903 participants (median age, 40 years; 57% women; 60% nonwhite; median BMI 27.5 kg/m2), 230 (25%) developed incident hypertension. After a median of 7 years of follow-up, 230 participants (25%) developed hypertension. Those who developed hypertension were older, more commonly Black, had a higher prevalence of diabetes, and higher baseline BP at the baseline examination. They also had higher measures of adiposity, including higher BMI, VAT (including retroperitoneal and intraperitoneal fat), SAT, and LBF. Although the baseline BMI was higher among participants who developed hypertension than those who did not (29.9 kg/m2 vs. 26.8 kg/m2, p < 0.0001), the median interval weight increase between groups was essentially identical (3.5 kg vs. 3.6 kg, p = 0.70). In multivariable analyses, higher BMI was significantly associated with incident hypertension (relative risk, 1.24; 95% confidence interval, 1.12-1.36, per 1-standard deviation [SD] increase). When VAT, SAT, and LBF were added to the model, only VAT remained independently associated with incident hypertension (relative risk, 1.22; 95% confidence interval, 1.06-1.39, per 1-SD increase).


The investigators concluded that increased visceral adiposity, but not total or subcutaneous adiposity, was significantly associated with incident hypertension.


These data provide further evidence that visceral adiposity differs from subcutaneous, and prevention of visceral adiposity may protect against cardiovascular risk factors such as hypertension. Further research on the mechanism for this association is warranted.

Clinical Topics: Noninvasive Imaging, Prevention, Magnetic Resonance Imaging, Hypertension, Smoking

Keywords: Absorptiometry, Photon, Blood Pressure, Risk Factors, Magnetic Resonance Imaging, Smoking, Intra-Abdominal Fat, Body Mass Index, Protons, Adiposity, Confidence Intervals, Hypertension, Diabetes Mellitus, Subcutaneous Fat

< Back to Listings