Key result
Higher BMI linked to worse diastolic function and higher E/e' ratio.
Why the study?
Preclinical models of HFpEF rely on combined metabolic and mechanical stress to induce diastolic dysfunction, prompting evaluation of cardiac remodelling and filling pressures across BMI in hypertensive patients.
Is higher BMI associated with worse cardiac remodelling and diastolic function in hypertensive patients?
Cross-Sectional (n=1,820)
Is higher BMI associated with worse cardiac remodelling and diastolic function in hypertensive patients?
Effect estimate: β= 0.045 per kg/m2
p-value: p=0.005
In hypertensive patients, increasing BMI is independently associated with worsening diastolic function and increased left ventricular mass, supporting a two-hit hypothesis of metabolic and mechanical stress in the development of HFpEF.
Higher BMI was associated with worse diastolic function in hypertension; hypothesis-generating for two-hit HFpEF mechanisms, needing prospective confirmation.
Objective: Given that preclinical models of heart failure with preserved ejection fraction (HFpEF) rely on the combination of metabolic and mechanical stress to induce diastolic dysfunction, we aimed to assess cardiac remodelling and echocardiographic surrogates of left ventricular filling pressures across the body mass index (BMI) continuum in hypertensive patients, and to evaluate the association between BMI and diastolic function. Design and method: We conducted a cross-sectional retrospective observational study including consecutive hypertensive patients referred to a tertiary hypertension clinic who underwent transthoracic echocardiography. Cardiac remodelling was assessed using left ventricular mass index (LVMi). Left ventricular filling pressures were evaluated using E/e’ as an echocardiographic surrogate. The association between BMI and E/e’ was examined using multivariable regression analyses adjusted for age and sex. Results: A total of 1,820 hypertensive patients (2021-2025) were included. Mean age was 62.1 ± 25.3 years and 52.7% were men. Mean BMI was 26.7 ± 4.6 kg/m2, with 19.0% of patients classified as obese. LVMi differed significantly across BMI categories, being progressively higher from normal-weight to overweight and obese patients (Kruskal–Wallis p < 0.001). Median LVMI values (IQR) were 92 g/m2 (80–105) in normal-weight, 101 g/m2 (88–115) in overweight, and 110 g/m2 (96–125) in obese patients. However, using guideline-recommended sex-specific LVMI cut-offs (higher or equal to 115 g/m2 in men and 95 g/m2 in women), the prevalence of left ventricular hypertrophy did not differ significantly across BMI strata (p=0.09). Higher BMI was independently associated with higher E/e’. In multivariable linear regression adjusted for age and sex, BMI was associated with E/e’ (β= 0.045 per kg/m2; p = 0.005). Elevated E/e’ (>13) was infrequent (2.2%, 2.6%, and 2.8% across increasing BMI categories) and showed a non-significant increase along the BMI continuum (p-trend = 0.50).Conclusions: In a hypertensive population with a high prevalence of structural remodelling, metabolic burden was associated with worsening diastolic function, supporting a functional two-hit framework.
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Rodolico et al. (2026) conducted a cross-sectional in Hypertension (n=1,820). Body mass index vs. Lower body mass index was evaluated on Left ventricular filling pressures (E/e') (β= 0.045 per kg/m2, p=0.005). Higher body mass index was independently associated with worse diastolic function, indicated by a higher E/e' ratio (β=0.045 per kg/m2; p=0.005).
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