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Fifty-Year Study Shows Blood Pressure BMI Connection

If you need a good reason to avoid weight gain over your lifetime, you’ll find it in an online research report from Johns Hopkins School of Medicine. (Circulation, November 14, 2012) They found that creeping obesity is more often than not accompanied by creeping blood pressure. (The study was also reported in Medscape on November 16, 2012.)

Most of us gain weight over the course of our lifetime. On average we put on about 45 pounds of fat by age 55. In the US today, two-thirds of adults are overweight or obese; 32% of our youth (12 to 19) fall into the same category. Hasan M. Shihab, MDChB, MPH, and colleagues found that the rate of change in body mass tracks hypertension in a dose-response fashion. The highest risk was for those who gained the most body mass.  Body-mass index (BMI) and BP go up hand in hand.

This is a powerful study.

The strength of the study lies in its subjects and a very long follow-up. The study tracked body-mass index (BMI) and blood pressure in male medical students for up to 50 years; the longest follow-up period previously reported for this kind of analysis was about 23 years. The fact that the participants were doctors made their responses unusually reliable. Other strengths include very high response rates, validation of hypertension diagnosis, and repeated measures of BP.

Shihab et al studied the association between BMI and hypertension in 1132 Johns Hopkins medical students—in young adulthood (~25), middle age (~45), and late in life (~65). The oldest participants were up to 85 and the average follow-up period was 46 years. Over that period of time, almost half of the men (508) developed hypertension.

Obesity in young adulthood tripled the risk of developing hypertension, while being overweight signaled a two fold increase in risk.

One hopeful finding was that men who were overweight or obese at 25 and returned to normal weight at 45 were not at increased risk; their risk was about the same as men of normal weight at both ages. Overweight or obese individuals, of any age, can improve their prospects by bringing their weight down and keeping it down.

The best plan, of course, is to maintain a normal bodyweight throughout life.

“Our findings suggest even a modest gain in weight beginning early in life was associated with a substantially higher risk of hypertension,” Shihab et al wrote in summarizing their findings. “Obesity and overweight continued to confer higher risk of hypertension even when they occurred late in life.”

*  *  *

Although I didn’t understand the connection in my early years, I’m an example of someone who has benefited from keeping an eye on his weight and BP. While I have never thought of myself as overweight, I saw 200 on our bathroom scale briefly during my competitive lifting days. I was happy about it, but my first wife was appalled. I don’t remember dieting, but I never weighed that much again. Some fifty years later, I’m leaner and weigh about 50 pounds less. Moreover, my resting blood pressure is the lowest it has ever been.

“Being overweight will put you at greater risk for high blood pressure and may be the primary factor contributing to hypertension,” Dr. Kenneth Cooper wrote in Overcoming Hypertension, published in 1990. Dr. Cooper was ahead of the research, as he has been in many areas of preventive medicine.

The son of a doctor, I have always monitored my blood pressure. Mine has almost always been normal. I had a vague idea of the connection between BP and bodyweight, but I didn’t appreciate that bodyweight may be the primary factor until I read Dr. Cooper’s book.

My first alert that blood pressure could be a problem for me came during my draft board physical after graduating from college. Among other not so pleasant things, we were instructed to strip naked and line up for the doctor to look us over. I remember being asked if I lifted weights. But what I remember most is being escorted to a side room and told to lie down before they took my blood pressure a second time. They didn’t tell me what was going on, but it was clear that they weren’t too happy with my blood pressure. It must’ve been okay the second time, because I was declared eligible for the draft.

I immediately went to my dad’s office and had them take my blood pressure again. It was perfect at 120 over 80. Clearly, the stress of the draft board physical shot my blood pressure up; I didn’t want to be there and my BP reflected it. I’ve had the same up and down experience in other medical settings. If I'm comfortable, my BP is usually okay; if I'm not, it's not.

During my first visit to the Cooper Clinic in 1988, Dr. Arnie Jensen found my blood pressure to be normal at 120/80 and “very appropriate” in response to exercise. Arnie had visited us in Albuquerque before the first exam and I was comfortable with him. Arnie took my BP many times over the years and always found it to be fine.

I suffer from White Coat Hypertension; my BP spikes in medical and other settings that make me uneasy. Dr. Jensen told me that he had the same problem at times. He said we were both “hot responders,” and needed to practice good stress management. Taking a walk works best for me, but that’s not always possible. (For more information about White Coat Hypertension and stress management, see my earlier article on the topic: http://www.cbass.com/CoronaryCal.htm ).

I now monitor my resting BP regularly. It averages around 105 over 65 sitting at my desk.

I also try not to get upset about trivial things, with mixed results.

Taking the advice of Drs. Jensen, Cooper, and Shihab has worked for me. It will very likely work for you as well.

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