Skip to main content
Log in

Associations Between Hypertension and Body Mass Index and Waist Circumference in U.S. Adults: A Comparative Analysis by Gender

  • Original Article
  • Published:
High Blood Pressure & Cardiovascular Prevention Aims and scope Submit manuscript

Abstract

Introduction

The body mass index (BMI) and waist circumference (WC) are a risk of hypertension, but their potentially multiplicative effect on hypertension is underexplored.

Aim

To examine modifying effects of BMI and WC on hypertension using a nationally representative U.S. adult sample stratified by gender.

Methods

Data were derived from the 2009–2010 NHANES. Overweight and obesity were based on BMI of 25.0–29.9 and ≥30 kg/m2, respectively. High-risk WC was based on ≥102.0 and ≥88.0 cm for males and females, respectively. Hypertension was determined by systolic/diastolic blood pressure of ≥140/≥90 mmHg, or taking prescribed medications. Logistic regression was used to examine the association between hypertension and BMI and WC by gender. Interaction terms were added to examine if BMI modified the effect of WC on hypertension.

Results

Both BMI and WC were significant predictors of hypertension in overall population. Gender-specific models indicated that BMI played an important role in hypertension risk among males, but WC in females. The interaction effects were present among males implying that the association of WC with hypertension was stronger if subjects were overweight or obese. This effect, however, was not present in females.

Conclusion

BMI and WC may influence hypertension differently among males and females.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. CDC. Vital signs: prevalence, treatment, and control of hypertension-United States, 1999–2002 and 2005–2008. Morb Mortal Wkly Rep. 2011;60(4):103–8.

    Google Scholar 

  2. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden VB, et al. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013;127:e9–245.

    Article  Google Scholar 

  3. Vasan RS, Beiser A, Seshadri S, Larson MG, Kannel WB, D’Agostino RB, et al. Residual lifetime risk for developing hypertension in middle-aged women and men: the Framingham Heart Study. JAMA. 2002;287(8):1003–10.

    Article  PubMed  Google Scholar 

  4. Wang TJ, Vasan RS. Contemporary reviews in cardiovascular medicine: epidemiology of uncontrolled hypertension in the United States. Circulation. 2005;112:1651–62.

    Article  PubMed  Google Scholar 

  5. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012;307(5):491–7.

    Article  PubMed  Google Scholar 

  6. Montani JP, Antic V, Yang Z, Dulloo A. Pathways from obesity to hypertension: from the perspective of a vicious triangle. Int J Obes Relat Metab Disord. 2002;26(Suppl 2):S28–38.

    Article  CAS  PubMed  Google Scholar 

  7. Narkiewicz K. Obesity and hypertension—the issue is more complex than we thought. Nephrol Dial Transplant. 2006;21:264–7.

    Article  PubMed  Google Scholar 

  8. Kotsis V, Stabouli S, Papakatsika S, Rizos Z, Parati G. Mechanisms of obesity-induced hypertension. Hypertens Res. 2010;33:386–93.

    Article  PubMed  Google Scholar 

  9. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206–52.

    Article  CAS  PubMed  Google Scholar 

  10. Nyamdorj R, Qiao Q, Soderberg S, Pitkaniemi J, Zimmet P, Shaw J, et al. Comparison of body mass index with waist circumference, waist-to-hip ratio, and waist-to-stature ratio as a predictor of hypertension incidence in Mauritius. J Hypertens. 2008;26(5):866–70.

    Article  CAS  PubMed  Google Scholar 

  11. Ho SY, Lam TH, Janus ED, Hong Kong Cardiovascular Risk Factor Prevalence Study Steering Committee. Waist to stature ratio is more strongly associated with cardiovascular risk factors than other simple anthropometric indices. Ann Epidemiol. 2003;13(10):683–91.

    Article  PubMed  Google Scholar 

  12. Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr. 2004;79(3):379–84.

    CAS  PubMed  Google Scholar 

  13. Deng WW, Wang J, Liu MM, Wang D, Zhao Y, Liu YQ, et al. Body mass index compared with abdominal obesity indicators in relation to prehypertension and hypertension in adults: the CHPSNE study. Am J Hypertens. 2013;26(1):58–67.

    Article  PubMed  Google Scholar 

  14. Sakurai M, Miura K, Takamura T, Ota T, Ishizaki M, Morikawa Y, et al. Gender differences in the association between anthropometric indices of obesity and blood pressure in Japanese. Hypertens Res. 2006;29:75–80.

    Article  PubMed  Google Scholar 

  15. Luo W, Guo Z, Hao C, Yao X, Zhou Z, Wu M, et al. Interaction of current alcohol consumption and abdominal obesity on hypertension risk. Physiol Behav. 2012. doi:10.1016/j.physbeh.2012.10.004.

  16. Niskanen L, Laaksonen DE, Nyyssonen K, Punnonen K, Valkonen V-P, Fuentes R, et al. Inflammation, abdominal obesity, and smoking as predictors of hypertension. Hypertension. 2004;44:859–65.

    Article  CAS  PubMed  Google Scholar 

  17. Pitsavos C, Chrysohoou C, Panagiltakos DB, Lentzas Y, Stefanadis C. Abdominal obesity and inflammation predicts hypertension among prehypertensive men and women: the ATTICA Study. Heart Vessels. 2008;23(2):96–103.

    Article  PubMed  Google Scholar 

  18. Buemann B, Tremblay A. Effects of exercise training on abdominal obesity and related metabolic complications. Sports Med. 1996;21(3):191–212.

    Article  CAS  PubMed  Google Scholar 

  19. Ostchega Y, Hughes JP, Terry A, Fakhouri TH, Miller I. Abdominal obesity, body mass index, and hypertension in US adults: NHANES 2007–2010. Am J Hypertens. 2013;25(12):1271–8.

    Google Scholar 

  20. Gallant MP, Dorn GP. Gender and race differences in the predictors of daily health practices among older adults. Health Educ Res. 2001;16(1):21–31.

    Article  CAS  PubMed  Google Scholar 

  21. Steptoe A, McMunn A. Health behaviour patterns in relation to hypertension: the English Longitudinal Study of Ageing. J Hypertens. 2009;27(2):224–30.

    Article  CAS  PubMed  Google Scholar 

  22. Hays NP, Bathalon GP, McCrory MA, Roubenoff R, Lipman R, Roberts SB. Eating behavior correlates of adult weight gain and obesity in healthy women aged 55–65 y. Am J Clin Nutr. 2002;75(3):476–83.

    CAS  PubMed  Google Scholar 

  23. Flom PL, Strauss SM. Some graphical methods for interpreting interactions in logistic and OLS regression. Mult Linear Regres Viewp. 2003;29(1):1–7.

    Google Scholar 

  24. Bennett JA. Mediator and moderator variables in nursing research: conceptual and statistical differences. Res Nurs Health. 2000;23:415–20.

    Article  CAS  PubMed  Google Scholar 

  25. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173–82.

    Article  CAS  PubMed  Google Scholar 

  26. Han TS, Williams K, Sattar N, Hunt KJ, Lean ME, Haffner SM. Analysis of obesity and hyperinsulinemia in the development of metabolic syndrome: San Antonio Heart Study. Obes Res. 2002;10(9):923–31.

    Article  PubMed  Google Scholar 

  27. Ghosh JR, Bandyopadhyay AR. Comparative evaluation of obesity measures: relationship with blood pressures and hypertension. Singap Med J. 2007;48(3):232–5.

    CAS  Google Scholar 

  28. Hirani V, Zaninotto P, Primalesta P. Generalized and abdominal obesity and risk of diabetes, hypertension and hypertension-diabetes co-morbidity in England. Public Health Nutr. 2007;11(5):521–7.

    PubMed  Google Scholar 

  29. Yalcin BM, Sahin EM, Yalcin E. Which anthropometric measurements is most closely related to elevated blood pressure? Fam Pract. 2005;22(5):541–7.

    Article  PubMed  Google Scholar 

  30. Decoda Study Group, Nyamdorj R, Qiao Q, Lam TH, Tuomilehto J, Ho SY, et al. BMI compared with central obesity indicators in relation to diabetes and hypertension in Asians. Obesity. 2008;16(7):1622–35.

    Article  Google Scholar 

  31. Benetou V, Bamia C, Trichopoulos D, Mountokalakis T, Psaltopoulou T, Trichopoulou A. The association of body mass index and waist circumference with blood pressure depends on age and gender: a study of 10,928 non-smoking adults in the Greek EPIC cohort. Eur J Epidemiol. 2004;19(8):803–9.

    Article  PubMed  Google Scholar 

  32. Howel D. Waist circumference and abdominal obesity among older adults: patterns, prevalence and trends. PLoS One. 2012;7(10):e48528.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  33. Zhu S, Heshka S, Wang Z, Shen W, Allison DB, Ross R, et al. Combination of BMI and waist circumference for identifying cardiovascular risk factors in whites. Obes Res. 2004;12(4):633–45.

    Article  PubMed  Google Scholar 

  34. Blaak E. Gender differences in fat metabolism. Curr Opin Clin Nutr Metab Care. 2001;4:499–502.

    Article  CAS  PubMed  Google Scholar 

  35. Chei C-L, Iso H, Yamagishi K, Tanigawa T, Cui R, Imano H, et al. Body fat distribution and the risk of hypertension and diabetes among Japanese men and women. Hypertens Res. 2008;31(5):851–7.

    Article  PubMed  Google Scholar 

  36. Maas AHEM, Franke HR. Women’s health in menopause with a focus on hypertension. Neth Heart J. 2009;17(2):68–72.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  37. Williams PT. A cohort study of incident hypertension in relation to changes in vigorous physical activity in men and women. J Hypertens. 2008;26(6):1085–93.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  38. Denton M, Walters V. Gender differences in structural and behavioral determinants of health: an analysis of the social production of health. Soc Sci Med. 1999;48(9):1221–35.

    Article  CAS  PubMed  Google Scholar 

  39. Williams PT. A cohort study of incident hypertension in relation to changes in vigorous physical activity in men and women. J Hypertens. 2008;26(6):1086–93.

    Article  Google Scholar 

Download references

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Akihiko Michimi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Roka, R., Michimi, A. & Macy, G. Associations Between Hypertension and Body Mass Index and Waist Circumference in U.S. Adults: A Comparative Analysis by Gender. High Blood Press Cardiovasc Prev 22, 265–273 (2015). https://doi.org/10.1007/s40292-015-0106-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40292-015-0106-3

Keywords

Navigation