Obesity Paradox in Patients with Hypertension and Coronary Artery Disease

Seth Uretsky, Franz H. Messerli, Sripal Bangalore, Annette Champion, Rhonda M. Cooper-DeHoff, Qian Zhou, Carl J. Pepine

Research output: Contribution to journalArticle

333 Citations (Scopus)

Abstract

Purpose: An obesity paradox, a "paradoxical" decrease in morbidity and mortality with increasing body mass index (BMI), has been shown in patients with heart failure and those undergoing percutaneous coronary intervention. However, whether this phenomenon exists in patients with hypertension and coronary artery disease is not known. Methods: A total of 22,576 hypertensive patients with coronary artery disease (follow-up 61,835 patient years, mean age 66 ± 9.8 years) were randomized to a verapamil-SR or atenolol strategy. Dose titration and additional drugs (trandolapril and/or hydrochlorothiazide) were added to achieve target blood pressure control according to the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure targets. Patients were classified into 5 groups according to baseline BMI: less than 20 kg/m2 (thin), 20 to 25 kg/m2 (normal weight), 25 to 30 kg/m2 (overweight), 30 to 35 kg/m2 (class I obesity), and 35 kg/m2 or more (class II-III obesity). The primary outcome was first occurrence of death, nonfatal myocardial infarction, or nonfatal stroke. Results: With patients of normal weight (BMI 20 to <25 kg/m2) as the reference group, the risk of primary outcome was lower in the overweight patients (adjusted hazard ratio [HR] 0.77, 95% confidence interval [CI], 0.70-0.86, P <.001), class I obese patients (adjusted HR 0.68, 95% CI, 0.59-0.78, P <.001), and class II to III obese patients (adjusted HR 0.76, 95% CI, 0.65-0.88, P <.001). Class I obese patients had the lowest rate of primary outcome and death despite having smaller blood pressure reduction compared with patients of normal weight at 24 months (-17.5 ± 21.9 mm Hg/-9.8 ± 12.4 mm Hg vs -20.7 ± 23.1 mm Hg /-10.6 ± 12.5 mm Hg, P <.001). Conclusion: In a population with hypertension and coronary artery disease, overweight and obese patients had a decreased risk of primary outcome compared with patients of normal weight, which was driven primarily by a decreased risk of all-cause mortality. Our results further suggest a protective effect of obesity in patients with known cardiovascular disease in concordance with data in patients with heart failure and those undergoing percutaneous coronary intervention.

Original languageEnglish (US)
Pages (from-to)863-870
Number of pages8
JournalAmerican Journal of Medicine
Volume120
Issue number10
DOIs
StatePublished - Oct 1 2007
Externally publishedYes

Fingerprint

Coronary Artery Disease
Obesity
Hypertension
Weights and Measures
trandolapril
Body Mass Index
Confidence Intervals
Percutaneous Coronary Intervention
Heart Failure
Blood Pressure
Hydrochlorothiazide
Atenolol
Mortality
Verapamil
Cardiovascular Diseases
Stroke
Myocardial Infarction
Morbidity

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Uretsky, S., Messerli, F. H., Bangalore, S., Champion, A., Cooper-DeHoff, R. M., Zhou, Q., & Pepine, C. J. (2007). Obesity Paradox in Patients with Hypertension and Coronary Artery Disease. American Journal of Medicine, 120(10), 863-870. https://doi.org/10.1016/j.amjmed.2007.05.011
Uretsky, Seth ; Messerli, Franz H. ; Bangalore, Sripal ; Champion, Annette ; Cooper-DeHoff, Rhonda M. ; Zhou, Qian ; Pepine, Carl J. / Obesity Paradox in Patients with Hypertension and Coronary Artery Disease. In: American Journal of Medicine. 2007 ; Vol. 120, No. 10. pp. 863-870.
@article{4245906b8f744b41bd76c563d76e7e6b,
title = "Obesity Paradox in Patients with Hypertension and Coronary Artery Disease",
abstract = "Purpose: An obesity paradox, a {"}paradoxical{"} decrease in morbidity and mortality with increasing body mass index (BMI), has been shown in patients with heart failure and those undergoing percutaneous coronary intervention. However, whether this phenomenon exists in patients with hypertension and coronary artery disease is not known. Methods: A total of 22,576 hypertensive patients with coronary artery disease (follow-up 61,835 patient years, mean age 66 ± 9.8 years) were randomized to a verapamil-SR or atenolol strategy. Dose titration and additional drugs (trandolapril and/or hydrochlorothiazide) were added to achieve target blood pressure control according to the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure targets. Patients were classified into 5 groups according to baseline BMI: less than 20 kg/m2 (thin), 20 to 25 kg/m2 (normal weight), 25 to 30 kg/m2 (overweight), 30 to 35 kg/m2 (class I obesity), and 35 kg/m2 or more (class II-III obesity). The primary outcome was first occurrence of death, nonfatal myocardial infarction, or nonfatal stroke. Results: With patients of normal weight (BMI 20 to <25 kg/m2) as the reference group, the risk of primary outcome was lower in the overweight patients (adjusted hazard ratio [HR] 0.77, 95{\%} confidence interval [CI], 0.70-0.86, P <.001), class I obese patients (adjusted HR 0.68, 95{\%} CI, 0.59-0.78, P <.001), and class II to III obese patients (adjusted HR 0.76, 95{\%} CI, 0.65-0.88, P <.001). Class I obese patients had the lowest rate of primary outcome and death despite having smaller blood pressure reduction compared with patients of normal weight at 24 months (-17.5 ± 21.9 mm Hg/-9.8 ± 12.4 mm Hg vs -20.7 ± 23.1 mm Hg /-10.6 ± 12.5 mm Hg, P <.001). Conclusion: In a population with hypertension and coronary artery disease, overweight and obese patients had a decreased risk of primary outcome compared with patients of normal weight, which was driven primarily by a decreased risk of all-cause mortality. Our results further suggest a protective effect of obesity in patients with known cardiovascular disease in concordance with data in patients with heart failure and those undergoing percutaneous coronary intervention.",
author = "Seth Uretsky and Messerli, {Franz H.} and Sripal Bangalore and Annette Champion and Cooper-DeHoff, {Rhonda M.} and Qian Zhou and Pepine, {Carl J.}",
year = "2007",
month = "10",
day = "1",
doi = "10.1016/j.amjmed.2007.05.011",
language = "English (US)",
volume = "120",
pages = "863--870",
journal = "American Journal of Medicine",
issn = "0002-9343",
publisher = "Elsevier Inc.",
number = "10",

}

Uretsky, S, Messerli, FH, Bangalore, S, Champion, A, Cooper-DeHoff, RM, Zhou, Q & Pepine, CJ 2007, 'Obesity Paradox in Patients with Hypertension and Coronary Artery Disease', American Journal of Medicine, vol. 120, no. 10, pp. 863-870. https://doi.org/10.1016/j.amjmed.2007.05.011

Obesity Paradox in Patients with Hypertension and Coronary Artery Disease. / Uretsky, Seth; Messerli, Franz H.; Bangalore, Sripal; Champion, Annette; Cooper-DeHoff, Rhonda M.; Zhou, Qian; Pepine, Carl J.

In: American Journal of Medicine, Vol. 120, No. 10, 01.10.2007, p. 863-870.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Obesity Paradox in Patients with Hypertension and Coronary Artery Disease

AU - Uretsky, Seth

AU - Messerli, Franz H.

AU - Bangalore, Sripal

AU - Champion, Annette

AU - Cooper-DeHoff, Rhonda M.

AU - Zhou, Qian

AU - Pepine, Carl J.

PY - 2007/10/1

Y1 - 2007/10/1

N2 - Purpose: An obesity paradox, a "paradoxical" decrease in morbidity and mortality with increasing body mass index (BMI), has been shown in patients with heart failure and those undergoing percutaneous coronary intervention. However, whether this phenomenon exists in patients with hypertension and coronary artery disease is not known. Methods: A total of 22,576 hypertensive patients with coronary artery disease (follow-up 61,835 patient years, mean age 66 ± 9.8 years) were randomized to a verapamil-SR or atenolol strategy. Dose titration and additional drugs (trandolapril and/or hydrochlorothiazide) were added to achieve target blood pressure control according to the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure targets. Patients were classified into 5 groups according to baseline BMI: less than 20 kg/m2 (thin), 20 to 25 kg/m2 (normal weight), 25 to 30 kg/m2 (overweight), 30 to 35 kg/m2 (class I obesity), and 35 kg/m2 or more (class II-III obesity). The primary outcome was first occurrence of death, nonfatal myocardial infarction, or nonfatal stroke. Results: With patients of normal weight (BMI 20 to <25 kg/m2) as the reference group, the risk of primary outcome was lower in the overweight patients (adjusted hazard ratio [HR] 0.77, 95% confidence interval [CI], 0.70-0.86, P <.001), class I obese patients (adjusted HR 0.68, 95% CI, 0.59-0.78, P <.001), and class II to III obese patients (adjusted HR 0.76, 95% CI, 0.65-0.88, P <.001). Class I obese patients had the lowest rate of primary outcome and death despite having smaller blood pressure reduction compared with patients of normal weight at 24 months (-17.5 ± 21.9 mm Hg/-9.8 ± 12.4 mm Hg vs -20.7 ± 23.1 mm Hg /-10.6 ± 12.5 mm Hg, P <.001). Conclusion: In a population with hypertension and coronary artery disease, overweight and obese patients had a decreased risk of primary outcome compared with patients of normal weight, which was driven primarily by a decreased risk of all-cause mortality. Our results further suggest a protective effect of obesity in patients with known cardiovascular disease in concordance with data in patients with heart failure and those undergoing percutaneous coronary intervention.

AB - Purpose: An obesity paradox, a "paradoxical" decrease in morbidity and mortality with increasing body mass index (BMI), has been shown in patients with heart failure and those undergoing percutaneous coronary intervention. However, whether this phenomenon exists in patients with hypertension and coronary artery disease is not known. Methods: A total of 22,576 hypertensive patients with coronary artery disease (follow-up 61,835 patient years, mean age 66 ± 9.8 years) were randomized to a verapamil-SR or atenolol strategy. Dose titration and additional drugs (trandolapril and/or hydrochlorothiazide) were added to achieve target blood pressure control according to the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure targets. Patients were classified into 5 groups according to baseline BMI: less than 20 kg/m2 (thin), 20 to 25 kg/m2 (normal weight), 25 to 30 kg/m2 (overweight), 30 to 35 kg/m2 (class I obesity), and 35 kg/m2 or more (class II-III obesity). The primary outcome was first occurrence of death, nonfatal myocardial infarction, or nonfatal stroke. Results: With patients of normal weight (BMI 20 to <25 kg/m2) as the reference group, the risk of primary outcome was lower in the overweight patients (adjusted hazard ratio [HR] 0.77, 95% confidence interval [CI], 0.70-0.86, P <.001), class I obese patients (adjusted HR 0.68, 95% CI, 0.59-0.78, P <.001), and class II to III obese patients (adjusted HR 0.76, 95% CI, 0.65-0.88, P <.001). Class I obese patients had the lowest rate of primary outcome and death despite having smaller blood pressure reduction compared with patients of normal weight at 24 months (-17.5 ± 21.9 mm Hg/-9.8 ± 12.4 mm Hg vs -20.7 ± 23.1 mm Hg /-10.6 ± 12.5 mm Hg, P <.001). Conclusion: In a population with hypertension and coronary artery disease, overweight and obese patients had a decreased risk of primary outcome compared with patients of normal weight, which was driven primarily by a decreased risk of all-cause mortality. Our results further suggest a protective effect of obesity in patients with known cardiovascular disease in concordance with data in patients with heart failure and those undergoing percutaneous coronary intervention.

UR - http://www.scopus.com/inward/record.url?scp=34548835744&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34548835744&partnerID=8YFLogxK

U2 - 10.1016/j.amjmed.2007.05.011

DO - 10.1016/j.amjmed.2007.05.011

M3 - Article

VL - 120

SP - 863

EP - 870

JO - American Journal of Medicine

JF - American Journal of Medicine

SN - 0002-9343

IS - 10

ER -

Uretsky S, Messerli FH, Bangalore S, Champion A, Cooper-DeHoff RM, Zhou Q et al. Obesity Paradox in Patients with Hypertension and Coronary Artery Disease. American Journal of Medicine. 2007 Oct 1;120(10):863-870. https://doi.org/10.1016/j.amjmed.2007.05.011