What question did this study set out to answer?

To describe how age, sex, and body mass index affect blood pressure trajectories.

March 26, 2026Open Access

Sex-specific trajectories of blood pressure and pulse pressure across body mass index categories: a descriptive study based on 13-year health checkup data

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Hypertension and blood pressure trajectories (n=213058). Intervention: Body mass index (BMI) categories vs. Normal weight and underweight categories. Primary outcome: Age-related trajectories of systolic blood pressure, diastolic blood pressure, pulse pressure, and heart rate.

Q: What does this research mean for the field?

Higher body mass index is associated with accelerated age-related increases in systolic blood pressure and an earlier peak in diastolic blood pressure. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Higher body mass index was associated with accelerated age-related increases in systolic blood pressure and an earlier peak in diastolic blood pressure, which occurred at 51.0 years in men with class 2 obesity compared to 58.6 years in normal-weight men.

Key Points

To describe how age, sex, and body mass index affect blood pressure trajectories.
Analyzed health checkup data from 213,058 individuals from 2007 to 2019.
Measured systolic blood pressure, diastolic blood pressure, heart rate, and BMI.
Visualized age-related changes using locally weighted scatterplot smoothing (LOWESS).
Stratified analyses by sex and BMI categories.
Higher BMI levels correlated with elevated systolic and diastolic blood pressure across sexes.
Systolic blood pressure increased steadily with age, especially in obese individuals.
Diastolic blood pressure plateaued or declined after middle age, leading to wider pulse pressure with age.
Age-related changes in blood pressure were more pronounced in men and those with higher BMI.

Study Design

Type

Observational (n=213,058)

Multicenter

Structured PICO

Population

Individuals who underwent annual physical examinations at Kagoshima Kouseiren Hospital in 2007–2019

Outcome

Age-related trajectories of systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure, and heart ratesurrogate

Distinct age-related blood pressure and pulse pressure changes vary by sex and BMI, with obesity accelerating vascular aging and widening pulse pressure earlier in life.

Limitations

Findings may not be generalizable beyond Japanese populations as the dataset was derived from a single health checkup facility.
Within-individual correlations were not explicitly accounted for in the LOWESS analysis.
The descriptive, non-parametric technique does not allow adjustment for potential confounders.
Cross-sectional design limits the ability to make causal inferences.
Unmeasured lifestyle factors such as diet, stress, and medication adherence were not available.
Heart rate was derived from a single resting ECG, which may be influenced by transient arrhythmias.

Abstract

Abstract The combined effects of aging, sex, and body mass index (BMI) on blood pressure trajectories remain incompletely characterized in large-scale populations. The aim was to describe age-related blood pressure trajectories according to sex and BMI, as understanding these patterns is essential to improve risk stratification and develop preventive strategies for hypertension and cardiovascular diseases. This study included individuals who underwent annual physical examinations at Kagoshima Kouseiren Hospital in 2007–2019 ( n = 213058). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, and BMI measurements were retrospectively analyzed, and age-related changes were visualized using locally weighted scatterplot smoothing (LOWESS). Analyses were stratified by sex and BMI category (underweight, normal weight, class 1 obesity, and class 2 obesity or higher). Higher BMI levels were consistently accompanied by higher SBP, DBP, pulse pressure, and heart rate in both sexes. The LOWESS curves revealed that SBP increased steadily with age, particularly in individuals with obesity, whereas DBP increased until middle age before plateauing or declining. Consequently, the pulse pressure widened with age, especially in men with obesity. Heart rates remained stable but were consistently higher in women and obese participants. The age-related divergence between SBP and DBP was more pronounced in men and in individuals with a higher BMI. Ultimately, distinct age-related blood pressure and pulse pressure changes varied by sex and BMI category, and obesity was associated with accelerated SBP and pulse pressure trajectories, suggesting features consistent with earlier vascular aging. Adopting sex- and BMI-specific approaches may help inform blood pressure monitoring and prevention.

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Cite This Study

Kawasoe et al. (Tue,) conducted a observational in Hypertension and blood pressure trajectories (n=213,058). Body mass index (BMI) categories vs. Normal weight and underweight categories was evaluated on Age-related trajectories of systolic blood pressure, diastolic blood pressure, pulse pressure, and heart rate. Higher body mass index was associated with accelerated age-related increases in systolic blood pressure and an earlier peak in diastolic blood pressure, which occurred at 51.0 years in men with class 2 obesity compared to 58.6 years in normal-weight men.

synapsesocial.com/papers/69c4cd05fdc3bde448918d15 https://doi.org/https://doi.org/10.1038/s41440-026-02607-7

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