| Obesity paradox in patients with hypertension and coronary artery disease. | |
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MedLine Citation:
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PMID: 17904457 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Seth Uretsky; Franz H Messerli; Sripal Bangalore; Annette Champion; Rhonda M Cooper-Dehoff; Qian Zhou; Carl J Pepine |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: The American journal of medicine Volume: 120 ISSN: 1555-7162 ISO Abbreviation: Am. J. Med. Publication Date: 2007 Oct |
Date Detail:
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Created Date: 2007-10-01 Completed Date: 2007-10-30 Revised Date: 2008-07-29 |
Medline Journal Info:
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Nlm Unique ID: 0267200 Medline TA: Am J Med Country: United States |
Other Details:
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Languages: eng Pagination: 863-70 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiology, St Luke's-Roosevelt Hospital, New York, NY, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Age Distribution Aged Antihypertensive Agents / therapeutic use Atenolol / therapeutic use Body Mass Index Causality Cohort Studies Comorbidity Coronary Artery Disease / drug therapy, epidemiology* Female Humans Hypertension / drug therapy, epidemiology* Male Middle Aged Multivariate Analysis Obesity / classification, epidemiology* Outcome and Process Assessment (Health Care) Risk Factors Sex Distribution Survival Analysis United States / epidemiology Vasodilator Agents / therapeutic use Verapamil / therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Antihypertensive Agents; 0/Vasodilator Agents; 29122-68-7/Atenolol; 52-53-9/Verapamil |
| Comments/Corrections | |
Comment In:
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Am J Med. 2007 Oct;120(10):825-6
[PMID:
17904447
]
Am J Med. 2008 May;121(5):e13 [PMID: 18456013 ] Am J Med. 2008 May;121(5):e11 [PMID: 18456012 ] Am J Med. 2008 Jul;121(7):e7; author reply e9 [PMID: 18589044 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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