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Review paper The associations of obesity phenotypes with the risk of hypertension and its transitions among middle-aged and older Chinese adults
Ziyue Sheng1orcid , Shang Lou1orcid , Jin Cao1orcid , Weidi Sun1orcid , Yaojia Shen1,2orcid , Yunhan Xu1orcid , Ziyan Ren1orcid , Wen Liu1orcid , Qian Yi1orcid , Peige Song1orcid
Epidemiol Health 2023;e2023043
DOI: https://doi.org/10.4178/epih.e2023043 [Accepted]
Published online: April 10, 2023
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1School of Public Health, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
2School of Public Health, Department of Maternal and Child Health, Health Science Center, Peking University, China, Beijing, Korea
Corresponding author:  Peige Song,
Email: peigesong@zju.edu.cn
Received: 3 November 2022   • Revised: 25 February 2023   • Accepted: 14 March 2023
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Abstract

Objectives
This study aimed to investigate the associations of obesity phenotypes with hypertension stages, phenotypes, and transitions among middle-aged and older Chinese.
Methods
Using the 2011–2015 waves of the China Health and Retirement Longitudinal Study (CHARLS), we conducted a cross-sectional analysis included 9015 subjects and a longitudinal analysis included 4961 subjects, with 4872 having full data on the hypertension stage and 4784 having full data on the hypertension phenotype. Based on body mass index and waist circumstance, subjects were categorized into 4 mutually exclusive obesity phenotypes: normal weight with no central obesity (NWNCO), abnormal weight with no central obesity (AWNCO), normal weight with central obesity (NWCO), and abnormal weight with central obesity (AWCO). Hypertension stages were classified into normotension, pre-hypertension, stage 1 hypertension, and stage 2 hypertension. Hypertension phenotypes were categorized as normotension, pre-hypertension, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). The association between obesity phenotypes and hypertension was estimated by logistic regression. A comparison between different sexes was conducted by testing the interaction effect of sex.
Results
NWCO was associated with normal → stage 2 (OR: 1.95, 95% CI: 1.11-3.42), maintained stage 1 (OR: 1.62, 95% CI: 1.14-2.29), and normal → ISH (OR: 1.39, 95% CI: 1.05-1.85). AWCO was associated with normal → stage 1 (OR: 1.75, 95% CI: 1.40-2.19), maintained stage 1 (OR: 2.77, 95% CI: 2.06-3.72), maintained stage 2 (OR: 2.80, 95% CI: 1.50-5.25), normal → ISH (OR: 1.56, 95% CI: 1.20-2.02), and normal → SDH (OR: 2.54, 95% CI: 1.72-3.75). An interaction effect of sex existed in the association between obesity phenotypes and hypertension stages.
Conclusions
This study highlights the importance of various obesity phenotypes and sex differences in hypertension progression. Tailored interventions for different obesity phenotypes may be warranted in hypertension management, taking into account sex-specific differences to improve outcomes.

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