Abstract 128: Visit-to-visit Variability of Systolic BP and Renal Outcomes in the SPRINT Trial

Increased visit-to-visit variability (VVV) in systolic blood pressure is a known predictor of adverse CV events & in diabetics, is associated with higher risk of incident albuminuria & chronic kidney disease. However, the impact of VVV in SBP on renal outcomes in the absence of diabetes is unknown. We investigated the association between VVV in SBP & adverse CVE & renal events among non-diabetic participants in SPRINT cohort. Methods: Primary exposure was quartile of within-person standard deviation of systolic blood pressure (SDBP). Primary outcomes 1) primary composite CV outcome from SPRINT study, 2) primary SPRINT renal outcome among those without CKD 3) incident albuminuria among those with & without CKD. We compared covariates by SDBP quartile, using ANOVA or chi-square tests. We fit incremental Cox hazards models to examine associations between SDBP & events. We performed sensitivity analyses for # visits in all models. Results: Among 9361 participants, 8589 (92%) met inclusion criteria & comprised the primary analytic sample. The mean SBP across all quartiles was similar (137 - 141 mmHg). There was no association between quartile of SDBP and the primary composite cardiovascular outcome. There was a significant association between quartile of SDBP and incident CKD among those without baseline CKD. Among 3350 participants without baseline CKD and 942 participants with CKD, higher VVV in SBP was independently associated with increased risk of incident albuminuria, regardless of baseline CKD status. This association was robust after adjustment for the number of visits. The interaction between SDBP and the primary intervention was not statistically significant in the no CKD (p=0.11) or CKD groups (p=0.93). Discussion: In this post-hoc analysis of SPRINT, we found that higher VVV in SBP is associated with greater risk of incident albuminuria among non-diabetic adults with and without baseline CKD. This association remained significant after adjustment for numerous potential confounders across follow-up. Our analysis demonstrates a significant association between VVV of SBP and incident albuminuria in patients with and without baseline CKD. This novel finding in an exclusively non-diabetic, hypertensive population deserves further investigation.

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Association between systolic blood pressure and first ischemic stroke in the Chinese older hypertensive population

Journal of International Medical Research ◽

10.1177/0300060520920091 ◽

2020 ◽

Vol 48 (4) ◽

pp. 030006052092009

Author(s):

Yuling Yu ◽

Lin Liu ◽

Jiayi Huang ◽

Geng Shen ◽

Chaolei Chen ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Systolic Blood Pressure ◽

Retrospective Cohort ◽

Continuous Variable ◽

Categorical Variable ◽

Hypertensive Population ◽

Increased Risk ◽

Adjusted Model

Objective This study aimed to evaluate the association between systolic blood pressure (SBP) and first ischemic stroke in older people with hypertension in the community. Methods This retrospective cohort study included 3315 residents who were hypertensive and older than 60 years in Guangdong, China. Results A total of 1475 men and 1840 women aged 71.41±7.20 years were included. All subjects had a median follow-up duration for 5.5 years and 206 subjects reached the endpoint. The prevalence of first ischemic stroke increased with a higher SBP. SBP expressed as a continuous variable (hazard ratio [HR], 1.01; 95% confidence interval [CI], 1.00–1.02) and categorical variable (HRs, 1.00, 1.06, 1.17, 1.39, and 1.60 for increasing blood pressure from < 120–≥150 mmHg), was significantly associated with a higher risk of first ischemic stroke. Moreover, a fully adjusted model indicated an obvious increased risk in the SBP ≥150 mmHg group (HR, 1.60; 95% CI, 1.15–2.71) and the SBP 140–149 mmHg group (HR, 1.39; 95% CI, 1.01–2.39). Conclusions High SBP was independently associated with the risk of first ischemic stroke in hypertensive residents in the community aged older than 60 years. SBP ≥140 mmHg increases the risk of first ischemic stroke.

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Long-Term Blood Pressure Variability and Risk of Cardiovascular Disease Events Among Community-Dwelling Elderly

Hypertension ◽

10.1161/hypertensionaha.120.16209 ◽

2020 ◽

Vol 76 (6) ◽

pp. 1945-1952

Author(s):

Michael E. Ernst ◽

Enayet K. Chowdhury ◽

Lawrence J. Beilin ◽

Karen L. Margolis ◽

Mark R. Nelson ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Older Adults ◽

Blood Pressure Variability ◽

Community Dwelling ◽

Sensitivity Analyses ◽

Link Type ◽

Increased Risk ◽

The Impact

High office blood pressure variability (OBPV) in midlife increases the risk of cardiovascular disease (CVD), but the impact of OBPV in older adults without previous CVD is unknown. We conducted a post hoc analysis of ASPREE trial (Aspirin in Reducing Events in the Elderly) participants aged 70-years and older (65 for US minorities) without history of CVD events at baseline, to examine risk of incident CVD associated with long-term, visit-to-visit OBPV. CVD was a prespecified, adjudicated secondary end point in ASPREE. We estimated OBPV using within-individual SD of mean systolic BP from baseline and first 2 annual visits. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% CI for associations with CVD events. In 16 475 participants who survived to year 2 without events, those in the highest tertile of OBPV had increased risk of CVD events after adjustment for multiple covariates, when compared with participants in the lowest tertile (HR, 1.36 [95% CI, 1.08–1.70]; P =0.01). Similar increased risk was observed for ischemic stroke (HR, 1.56 [95% CI, 1.04–2.33]; P =0.03), heart failure hospitalization, or death (HR, 1.73 [95% CI, 1.07–2.79]; P =0.02), and all-cause mortality (HR, 1.27 [95% CI, 1.04–1.54]; P =0.02). Findings were consistent when stratifying participants by use of antihypertensive drugs, while sensitivity analyses suggested the increased risk was especially for individuals whose BP was uncontrolled during the OBPV estimation period. Our findings support increased OBPV as a risk factor for CVD events in healthy older adults with, or without hypertension, who have not had such events previously. Registration— URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT01038583; URL: https://www.isrctn.com ; Unique identifiers: ISRCTN83772183.

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Immunofluorescence deposits in the mesangial area and glomerular capillary loops did not affect the prognosis of immunoglobulin a nephropathy except C1q:a single-center retrospective study

BMC Nephrology ◽

10.1186/s12882-021-02237-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Lingzhi Wu ◽

Di Liu ◽

Ming Xia ◽

Guochun Chen ◽

Yu Liu ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Cox Regression ◽

Immunoglobulin A ◽

Study Endpoint ◽

Immunoglobulin A Nephropathy ◽

Renal Outcomes ◽

Kaplan Meier ◽

Renal Prognosis ◽

The Impact

Abstract Background Immunoglobulin A nephropathy (IgAN) is identified as mesangial IgA deposition and is usually accompanied by other immunofluorescence deposits. The impact of immunofluorescent features in IgAN patients, however, remains unclear. Methods Baseline clinicopathologic parameters and renal outcomes of 337 patients diagnosed with IgAN between January 2009 and December 2015 were analyzed. We then categorized these patients into four groups: without immunofluorescence deposits, mesangial-only, mesangial and glomerular capillary loops (GCLs), and GCLs-only. The study endpoint was end-stage kidney disease (ESKD) or a ≥ 50% decline in the estimated glomerular filtration rate (eGFR). Kaplan–Meier and Cox regression analyses were performed to calculate renal survival. Results Of the 337 IgAN patients, women comprised 57.0%. Compared to patients with IgA deposition in the mesangial-only group, patients with IgA deposition in the mesangial +GCLs group were much heavier, and exhibited higher systolic blood pressure, lower serum IgG levels, and heavier proteinuria (all P < 0.05). Patients with IgG deposition in the mesangial +GCLs group presented with higher levels of cholesterol, heavier proteinuria than IgG deposition in the mesangial-only group (both P < 0.05). Compared with the mesangial-only group exhibiting C3 deposits, patients in the mesangial +GCLs group with C3 deposition had a higher systolic blood pressure (P = 0.028). A total of 38 patients (11.3%) continued to the study endpoint after a median follow-up time of 63.5 months (range,49.8–81.4). Kaplan–Meier analysis and Cox regression analysis showed that C1q deposition in the mesangial +GCLs group predicted a poor renal prognosis. Conclusions IgA and IgG deposits in the mesangial region and GCLs were associated with more unfavorable clinical and histopathologic findings in IgAN patients. C1q deposition in the mesangial region and GCLs predicted a poor renal prognosis. However, the impact of the pattern of immunofluorescence deposits on renal outcomes remains to be proven by further investigation.

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Should we redifine Hypertensive response in stress test to better predict cardiovascular risk?

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.145 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

P Silverio Antonio ◽

P Alves Da Silva ◽

J Valente Silva ◽

J Brito ◽

T Rodrigues ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Protective Factor ◽

Antihypertensive Drugs ◽

Stress Test ◽

Treatment Strategies ◽

High Rate ◽

Coronary Syndrome ◽

Increased Risk

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Systolic blood pressure (SBP) rise during exercise is normal, but some patients present with hypertensive response to exercise (HRE). The clinical implication of such phenomenon is not fully elucidated, and treatment strategies are still uncertain. Purpose To evaluate the relationship between HRE and the development of major cardiovascular events (MACE) - death, acute coronary syndrome (ACS) and stroke. Methods Single-center retrospective study of consecutive patients submitted to exercise test (ET) from 2012 to 2015. Patient’s demographics, baseline clinical characteristics, vital signs during ET and MACE occurrence during follow-up were analysed. HRE was defined as a peak systolic blood pressure (PSBP) >210 mmHg in men and >190 mmHg in women, or a rise of the SBP of 60 mmHg in men or 50 mmHg in women or as a diastolic blood pressure >90 mmHg or a rise of 10 mmHg. Results We included 458 patients with HRE (76% men, 57.5 ± 10.83 years). The most frequent comorbidities were hypertension (83%) and dyslipidaemia (61%). During a mean follow-up of 60 ± 2 months, the incidence of MACE was 9.2% with ACS being the most frequent (4.2%), followed by mortality (3.8%) and stroke (2.1%). Patients with inconclusive ET had a fourfold higher risk of acute coronary events (OR 4.1, CI 95% 1.55-11.14, p = 0.005). Baseline SBP and PSBP were predictors of MACE occurrence (OR 1.022, CI 95% 1.004-1.04, p = 0.016, OR 1.031 CI 95% 1.012-1.051, p = 0.001, respectively) and were both associated with cardiovascular hospitalization (p = 0.006; p < 0.001, respectively). PSBP had moderate ability to predict hospitalization of cardiovascular (CV) cause (AUC 0.71, p < 0.001) with a cut-off of 193 mmHg (sensibility 91%, specify 40%) and had moderate ability to predict MACE (AUC 0.67, p < 0.001) with a cut-off of 198 mmHg (sensibility 78.6%, specify 46.1%). Regarding mortality, antihypertensive therapy prior to ET was protective (p = 0.042), with no difference between different classes of drugs. Conclusion Our data reveal a high rate of MACE occurrence between patients with HRE. The finding of diagnosed hypertension as a protective factor of stroke may be explained by the cardioprotective effect of antihypertensive drugs. An increased risk of ACS between patients with an inconclusive ET should lead to consider then for further investigation. HRE should be considered as part of CV risk assessment and adjusted lower HRE cut-off values should be considered in order to better predict MACE occurrence, particularly in high risk patients. Abstract Figure.

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Increased Blood Pressure Variability and the Risk of Probable Dementia or Mild Cognitive Impairment: A Post Hoc Analysis of the SPRINT MIND Trial

Journal of the American Heart Association ◽

10.1161/jaha.121.022206 ◽

2021 ◽

Author(s):

Adam de Havenon ◽

Mohammad Anadani ◽

Shyam Prabhakaran ◽

Ka‐Ho Wong ◽

Shadi Yaghi ◽

...

Keyword(s):

Blood Pressure ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Systolic Blood Pressure ◽

Blood Pressure Variability ◽

Pressure Control ◽

Post Hoc Analysis ◽

The Mean ◽

Post Hoc

Background Increased systolic blood pressure variability (BPV) is associated with stroke, cardiovascular disease, and dementia and mild cognitive impairment. However, prior studies assessing the relationship between BPV and dementia or mild cognitive impairment had infrequent measurement of blood pressure or suboptimal blood pressure control. Methods and Results We performed a post hoc analysis of the SPRINT (Systolic Blood Pressure Intervention Trial) MIND (Memory and Cognition in Decreased Hypertension) trial. The primary outcome was probable dementia during follow‐up. We defined our exposure period, during which blood pressures were collected, as the first 600 days of the trial, and outcomes were ascertained during the subsequent follow‐up. BPV was measured as tertiles of systolic blood pressure standard deviation. We fit Cox proportional hazards models to our outcome. We included 8379 patients. The mean follow‐up was 3.2±1.4 years, during which 316 (3.8%) patients developed dementia. The mean number of blood pressure measurements was 7.8, and in the tertiles of BPV, the SD was 6.3±1.6, 10.3±1.1, and 16.3±3.6 mm Hg, respectively. The rate of dementia was 2.4%, 3.6%, and 5.4% by ascending tertile, respectively ( P <0.001). In the Cox models, compared with the lowest tertile of BPV, the highest tertile of BPV increased the risk of dementia in both unadjusted (hazard ratio [HR], 2.36; 95% CI, 1.77–3.15) and adjusted (HR, 1.69; 95% CI, 1.25–2.28) models. Conclusions In a post hoc analysis of the SPRINT MIND trial, we found that higher BPV was associated with the development of probable dementia despite excellent blood pressure control. Additional research is needed to understand how to reduce BPV and if its reduction lowers the risk of cognitive impairment and dementia.

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Combined lack of blood pressure and lipid control is a major risk factor for mortality in hypertensive patients: a single-center study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2743 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N Magkas ◽

G Georgiopoulos ◽

D Konstantinidis ◽

E Manta ◽

M Kouremeti ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Baseline Risk ◽

Effective Control ◽

Hypertensive Patients ◽

Increased Risk ◽

All Cause Mortality ◽

Lipid Control ◽

The Impact

Abstract Background Hypertension and dyslipidemia are well-known risk factors for cardiovascular disease (CVD). In such patients, lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) and targeting to values below pre-specified cut-offs prevents CV events and improves prognosis. However, the impact of both BP and LDL-C control as compared to control of only one and/or none of these two risk factors is not well-studied. Methods Among 2,380 treated patients with hypertension and no overt CVD at baseline, we assessed the trajectory of BP control in 1,142 subjects with 4 or more follow up visits; BP control was defined as BP<140/90 mmHg in half or more visits. In the same subgroup, data on lipid control according to LDL-C goals were available in 1,032 patients in 2 or 3 visits. The HeartScore was used to estimate the risk of all-cause death at baseline. Results Across a median follow up of 108 months, 26 deaths (2.44%) were recorded. Despite appropriate anti-hypertensive treatment, 376 patients (32.92%) did not achieve conventional BP control in half or more of follow-up visits. Respectively, 59.83% of the study population did not meet the LDL-C goals in at least one assessment. Patients with suboptimal BP control had almost 3-fold increased risk for all-cause mortality (HR=2.85, 95% CI 1.31–6.21, P=0.008) as compared to subjects with effective control. This association was not attenuated after taking into account age, gender, body mass index, smoking, and diabetes mellitus (adjusted HR=2.54, 95% CI 1.13–5.72, P=0.025). Ineffective LDL-C control was not related to death (HR=1.31, 95% CI 0.688–2.48). However, patients who did not reach treatment goals for both BP and LDL showed substantially increased risk for all-cause mortality (HR=5.42, 95% CI 1.09–26.9, P=0.039). Importantly, suboptimal BP control in our cohort of hypertensive patients was associated with death independently of the HeartScore (adjusted HR=2.65, 95% CI 1.22–5.77, P=0.014) and conferred incremental reclassification value on top of the baseline risk (continuous NRI=0.467, P=0.016). Conclusions Suboptimal BP control was related to all-cause mortality in our cohort of hypertensive patients; importantly, this association was substantially stronger in concurrent presence of LDL-C values above treatment targets, thus, highlighting the need for combined achievement of BP and LDL-C control. Moreover, association of suboptimal BP controlwith death was independent of the HeartScore, suggesting that BP control should be considered in risk stratification of hypertensive patients Funding Acknowledgement Type of funding source: None

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The impact of homocysteine on the risk of coronary artery diseases in individuals with diabetes: a Mendelian randomization study

Acta Diabetologica ◽

10.1007/s00592-020-01608-3 ◽

2020 ◽

Author(s):

Tian Xu ◽

Songzan Chen ◽

Fangkun Yang ◽

Yao Wang ◽

Kaijie Zhang ◽

...

Keyword(s):

Coronary Artery ◽

Confidence Interval ◽

Mendelian Randomization ◽

Sensitivity Analyses ◽

European Ancestry ◽

Causal Association ◽

Increased Risk ◽

The Impact ◽

Cad Risk

Abstract Aims Observational studies have reported that homocysteine (Hcy) is associated with an increased risk of coronary artery disease (CAD) in individuals with diabetes, though controversy remains. The present study aimed to investigate the causal association between Hcy and CAD in individuals with diabetes. Methods A 2-sample Mendelian randomization (MR) study was designed to infer causality. Genetic summary data on the association of single nucleotide polymorphisms (SNPs) with Hcy were extracted from the hitherto largest genome-wide association study (GWAS) of up to 44,147 individuals of European ancestry. SNP-CAD data were obtained from another recently published GWAS which included 15,666 individuals with diabetes (3,968 CAD cases, 11,696 controls). The fixed-effects inverse variance-weighted method was employed to calculate the effect estimates. Other robust methods and leave-one-out analyses were used in the follow-up sensitivity analyses. Potential pleiotropy was assessed with the MR-Egger intercept test. Results The 2-sample MR analysis suggested no evidence of an association between genetically predicted plasma Hcy levels and CAD risk in individuals with diabetes (odds ratio = 1.14, 95% confidence interval: 0.82–1.58, p = 0.43) using 9 SNPs as instrumental variables. Similar results were observed in the follow-up sensitivity analyses. The MR-Egger intercept test indicated no evidence of directional pleiotropy (intercept = 0.03, 95% confidence interval: − 0.08–0.03, p = 0.35). Conclusion This 2-sample MR analysis found no evidence of a causal association between plasma Hcy levels and CAD risk in individuals with diabetes.

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5α-reductase inhibitors and the risk of grade reclassification for men with long-term follow-up on active surveillance for prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.92 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. 92-92

Author(s):

Antonio Finelli ◽

Narhari Timilshina ◽

Maria Komisarenko ◽

Robert Sowerby ◽

Robert James Hamilton ◽

...

Keyword(s):

Prostate Cancer ◽

Active Surveillance ◽

Cox Proportional Hazards ◽

Sensitivity Analyses ◽

Original Cohort ◽

Reductase Inhibitors ◽

Increased Risk ◽

The Impact

92 Background: The role of 5α-reductase inhibitors (5-ARIs) in prostatic diseases remains controversial because of an FDA black box label. We have previously published on the impact of 5-ARIs in men managed with active surveillance (AS), demonstrating their protective effect against progression. However, the long-term safety of 5-ARIs in the setting of AS has never been described, thus we sought to assess this. Methods: This is a single-institution, prospectively maintained, retrospective cohort study comparing men taking a 5-ARI versus no 5-ARI while on AS for PCa. Pathologic progression was evaluated and defined as Gleason score > 6, maximum core involvement > 50%, or more than 3 cores positive on a follow-up prostate biopsy. Time dependent covariate analysis to account for time on AS but not on 5-ARI was conducted to diminish the likelihood of overestimating the benefit. To account for differences in prostate volume at baseline between 5-ARI and non-5-ARI groups sensitivity analyses were performed, restricting men in the non-5-ARI group to those with larger glands (volume > 40 ml). Kaplan-Meier analyses were conducted along with multivariable Cox proportional hazard regression modeling for predictors of pathologic progression. Results: The original cohort of 288 men on AS were analyzed. The median follow-up was 61.2 months (IQR: 29.8-95.24) with 124 men (43%) experiencing pathologic progression and 119 men (41.3%) abandoning AS. Men taking a 5-ARI experienced a lower rate of pathologic progression (24.3% vs 49.1%; p < 0.001) and were less likely to abandon AS (25.7% vs 46.3%; p = 0.002). On multivariable Cox proportional hazards analysis, lack of 5-ARI use was most strongly associated with pathologic progression (HR: 2.56; 95% confidence interval, 1.32-5.02). Sensitivity analyses done to account for gland size demonstrated that lack of 5-ARI use was still predictive of progression (HR: 2.76; CI, 1.45–5.25; p = 0.002). Importantly, 5-ARI use was not associated with increased risk of high-grade prostate cancer. Conclusions: 5-ARIs were associated with a significantly lower rate of pathologic progression and abandonment of AS in men with median follow-up of 5 years.

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Diagnosis of Gout is not Associated with Growth of Abdominal Aortic Aneurysms

10.21203/rs.3.rs-656782/v1 ◽

2021 ◽

Author(s):

Shivshankar Thanigaimani ◽

James Phie ◽

Frank Quigley ◽

Michael Bourke ◽

Bernie Bourke ◽

...

Keyword(s):

Aortic Aneurysms ◽

Sensitivity Analyses ◽

Medication Prescription ◽

Abdominal Aortic ◽

Increased Risk ◽

Systemic Inflammatory Disease ◽

Surveillance Programs ◽

Independent Association ◽

The Impact

Abstract IntroductionGout is a systemic inflammatory disease which has been associated with an increased risk of cardiovascular events but its association with abdominal aortic aneurysm (AAA) progression is unknown. The aim of this study was to investigate the association of gout with growth of small AAA. MethodsPatients with initial AAA diameter measuring 30-54mm were recruited from surveillance programs at four Australian centres. Maximum AAA diameter was measured with a standardised and reproducible protocol to monitor AAA growth. Presence of gout was defined by clinical diagnosis by clinician or prescription of medications used to treat gout. Linear mixed effects modelling was performed to examine the independent association of gout with AAA growth. ResultsA total of 637 participants, including 66 (10.3%) diagnosed with gout, received a median of 4 (Inter-quartile range (IQR): 3, 6) scans over a median follow-up of 1.8 (IQR: 1.0, 3.0) years. In unadjusted analyses, participants with diagnosis of gout had a slower mean annual AAA growth of -0.3 mm/year (95% CI: -0.7, 0.2; p=0.25) than those without gout. After adjusting for potential confounders including initial AAA diameter, body mass index, prior stroke and anti-hypertensive medication prescription, gout was not significantly associated with AAA growth (-0.3 mm/year; 95% CI: -0.7, 0.2; p=0.24). Sensitivity analyses investigating the impact of initial AAA diameter on the association of gout with AAA growth found no interaction. ConclusionThis study suggests diagnosis of gout is not associated with growth of small AAA.

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Body mass index and risk of all-cause mortality in normotensive and hypertensive adults: The Rural Chinese Cohort Study

Public Health Nutrition ◽

10.1017/s1368980021001592 ◽

2021 ◽

pp. 1-25

Author(s):

Qionggui Zhou ◽

Xuejiao Liu ◽

Yang Zhao ◽

Pei Qin ◽

Yongcheng Ren ◽

...

Keyword(s):

Cohort Study ◽

Population Based ◽

Normal Weight ◽

Sensitivity Analyses ◽

Hypertension Status ◽

Moderation Effect ◽

Increased Risk ◽

All Cause Mortality ◽

Chinese Cohort ◽

The Impact

Abstract Objective: The impact of baseline hypertension status on the BMI–mortality association is still unclear. We aimed to examine the moderation effect of hypertension on the BMI–mortality association using a rural Chinese cohort. Design: In this cohort study, we investigated the incident of mortality according to different BMI categories by hypertension status. Setting: Longitudinal population-based cohort Participants: 17,262 adults ≥18 years were recruited from July to August of 2013 and July to August of 2014 from a rural area in China. Results: During a median 6-year follow-up, we recorded 1109 deaths (610 with and 499 without hypertension). In adjusted models, as compared with BMI 22-24 kg/m2, with BMI ≤18, 18-20, 20-22, 24-26, 26-28, 28-30 and >30 kg/m2, the HRs (95% CI) for mortality in normotensive participants were 1.92 (1.23-3.00), 1.44 (1.01-2.05), 1.14 (0.82-1.58), 0.96 (0.70-1.31), 0.96 (0.65-1.43), 1.32 (0.81-2.14), and 1.32 (0.74-2.35) respectively, and in hypertensive participants were 1.85 (1.08-3.17), 1.67 (1.17-2.39), 1.29 (0.95-1.75), 1.20 (0.91-1.58), 1.10 (0.83-1.46), 1.10 (0.80-1.52), and 0.61 (0.40-0.94) respectively. The risk of mortality was lower in individuals with hypertension with overweight or obesity versus normal weight, especially in older hypertensives (≥60 years old). Sensitivity analyses gave consistent results for both normotensive and hypertensive participants. Conclusions: Low BMI was significantly associated with increased risk of all-cause mortality regardless of hypertension status in rural Chinese adults, but high BMI decreased the mortality risk among individuals with hypertension, especially in older hypertensives.

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