Association between weight variability, weight change and clinical outcomes in hypertension

The effect of body weight variability (BWV) and body weight change (BWC) in high-risk individuals with hypertension, but without diabetes mellitus (DM) remains unclear. We examined the effect of BWV and BWC on the primary outcome the composite of myocardial infarction (MI), other acute coronary syndromes, stroke, acute decompensated heart failure (HF), or cardiovascular (CV) death and all-cause mortality in the Systolic Blood Pressure Intervention Trial (SPRINT). In this post-hoc analysis, we used multivariate Cox regression models to examine the risk associated with BWV and BWC for the primary outcome in SPRINT. BWV was defined as the intra-individual average successive variability (ASV). BWC was defined as baseline weight minus final weight. A total of 8714 SPRINT participants (mean age 67.8±9.4 years, 35.1% women, 58.9% Whites) who had data on weight were included. The median follow-up was about 3.9 years (IQR, 3.3-4.4). In multivariable-adjusted Cox models, each 1 unit standard deviation (SD) of BWV was significantly associated with a higher risk for the primary outcome, all-cause mortality, HF, MI, and stroke HR(95% CI): 1.13 (1.07 - 1.19; p <.0001), 1.22 (1.14 - 1.30; p<.0001), 1.16 (1.07 - 1.26; p<.001), 1.10 (1.00 - 1.20; p=0.047), and 1.15 (1.05 - 1.27; p=0.005), respectively. Similarly, each 1 unit SD of BWC was significantly associated with a higher risk of the primary outcome, all-cause mortality, MI, and HF: 1.11(1.02 - 1.21; p=0.017), 1.44 (1.26 - 1.65; p<.0001), 1.16 (1.01 - 1.32; p=0.041) and 1.19 (1.02 - 1.40; p=0.031) respectively. However, there was no significant association with CV death (for both BWV and BWC) or stroke (BWC). In high-risk hypertension, BWV and BWC were both associated with higher risk of the primary outcome and all-cause mortality. These results further stress the clinical importance of sustained weight loss and minimizing fluctuations in weight in hypertension.