The changes of BMI in prediction of 10-year-hypertension risk in United States population- a historical cohort study

BACKGROUND This is a historical cohort study, utilizing data from the US National Health and Nutrition Examination Survey (NHANES) 2007-2018 to predict 10-year- hypertension-risk based on body mass index (BMI) variations. METHOD Participants aged 40-79 without a hypertension diagnosis 10 years before the baseline interview were included. Subjects were categorized based on five major BMI variation patterns. Various statistical analyses, including Chi-square test, T test, univariate and multivariate logistic regression, and P-trend analysis, were employed to assess hypertension incidence among groups. Restricted cubic splines (RCS) were used to examine the age-hypertension correlation. RESULTS Among 13,287 participants, Stable-Norm (maintaining normal BMI) exhibited the lowest 10-year hypertension risk. Other patterns—Max-OW (maximum BMI in overweight), OB-nOB (obese to non-obese), nOB-OB (non-obese to obese), and Stable-OB (maintaining obese)—showed increasing risks. Hypertension risk correlated quasi-linearly with age. Subgroups analysis suggested certain specific BMI variation modes and absolute weight change groups demonstrated equivalent risks to stable normal/weight groups, while others presented higher risks. CONCLUSION Maintaining normal BMI had the lowest 10-year hypertension risk, and returning to normal BMI showed equivalent risk. Weight gain remained a significant hypertension risk factor in US adults, particularly with advancing age.