Higher skeletal muscle mass is associated with higher blood pressure and left ventricular mass

Q: What are the key findings of this study?

Higher skeletal muscle mass index was independently associated with a 0.67 mmHg increase in systolic blood pressure per 1 kg/m2 increase in cross-sectional analysis.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: General population without prior stroke (n=492498). Intervention: Higher skeletal muscle mass vs. Lower skeletal muscle mass. Primary outcome: Systolic blood pressure (SBP) (0.67 mmHg increase per 1 kg/m2 higher muscle mass index, 95% CI 0.63-0.71, p=<0.001).

Q: What does this research mean for the field?

Higher skeletal muscle mass index is independently associated with increased blood pressure and higher left ventricular mass over time, independent of adiposity. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine the cross-sectional and longitudinal associations between skeletal muscle mass, blood pressure, and left ventricular mass index.

Eduard Shantsila; Alena Shantsila; Matthew Sperrin; Zhuangzhi Gao; Yalin Zheng; Ian B. Wilkinson; Paul Leeson; Iain Buchan; G Y H Lip

doi:10.1097/hjh.0000000000004375

June 10, 2026Journal of Hypertension

Higher skeletal muscle mass is associated with higher blood pressure and left ventricular mass

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Key result

Higher skeletal muscle mass index linked to ~0.7 mmHg higher SBP per unit increase.

0.67 mmHg increase per 1 kg/m2 higher muscle mass index
95% CI 0.63-0.71
P<0.001
n=492,498

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Why the study?

Skeletal muscles comprise approximately 40% of body mass, but the effects of skeletal muscle mass on blood pressure and the heart remain unclear.

Is higher skeletal muscle mass associated with higher blood pressure and left ventricular mass index in adults?

Key Points

To determine the cross-sectional and longitudinal associations between skeletal muscle mass, blood pressure, and left ventricular mass index.
Analyzed cross-sectional and longitudinal cohort data from 492 498 UK Biobank participants without a history of stroke [mean (SD) age 56.5 (8.1) years, 45% men, 94% white].
Assessed muscle mass index via bioimpedance analysis, lean mass index via DEXA, thigh muscle mass index via MRI, and left ventricular mass index via MRI.
Used multivariable regression adjusting for age, sex, blood pressure-lowering medication use, and fat mass index across follow-up intervals ranging from 2.9 to 11.5 years.
In cross-sectional multivariable analysis, each 1 kg/m2 higher muscle mass was independently associated with higher SBP by 0.67 (95% CI 0.63–0.71) mmHg for MMI, 0.82 (95% CI 0.68–0.97) mmHg for lean mass index, and 4.7 (95% CI 4.3–5.1) mmHg for thigh MMI (P < 0.001 for all).
In longitudinal cohort analyses, an increase of 1 kg/m2 in MMI during a 4.3-year follow-up was independently associated with a 2.2 (95% CI 1.9–2.5) mmHg increase in SBP, with consistent findings across extended follow-ups and DEXA or MRI assessments (P < 0.001 for all).
Higher muscle mass metrics and their longitudinal changes were independently associated with higher left ventricular mass index and higher DBP on both cross-sectional and cohort analyses.

Study Design

Type

Cohort (n=492,498)

Multicenter

Yes

Structured PICO

Is higher skeletal muscle mass associated with higher blood pressure and left ventricular mass index in adults?

P

Population

492,498 adults from the UK Biobank aged 40-70 without a history of stroke, with a mean age of 56.5 years and 55% female, followed for up to 11.5 years.

E

Exposure

Higher skeletal muscle mass (assessed via bioimpedance analysis, DEXA, and MRI as muscle mass index, lean mass index, and thigh muscle mass index).

C

Comparator

Lower skeletal muscle mass (observational exposure gradient).

O

Outcome

Systolic and diastolic blood pressure, and left ventricular mass index (LVMI).surrogate

Main Result

Mean Difference: 0.67 (95% CI 0.63–0.71)

p-value: p=<0.001

Higher skeletal muscle mass is independently associated with elevated blood pressure and increased left ventricular mass index, independent of body adiposity.

Limitations

Selective population (94% white ethnic background, 40-69 years old) with a low 5.5% response rate limits generalizability.
Cannot establish causal effect due to observational design.
Did not directly measure skeletal muscle mass, only estimated it.
Did not consider effects of diet, physical activity types, or changes in comorbidities/medications during follow-up.
Unable to establish causal association.
Cross-sectional analyses excluded individuals of advanced age for DBP values.
Did not evaluate the association between SMM-related blood pressure changes and hard cardiovascular outcomes.

Implication

Does not support changing BP management by muscle mass; leaves open whether muscularity independently drives hypertension or LV remodeling.

Abstract

BACKGROUND AND AIMS: Skeletal muscles make up about 40% of the body mass, but the effects of skeletal muscle mass (SMM) on blood pressure (BP) and the heart remain unclear and were explored in this study. METHODS: The study used cross-sectional and longitudinal cohort designs with data from 492 498 UK Biobank (ID 54078) participants without a history of stroke [mean (SD) age 56.5 (8.1) years, 45% men, 94% white]. Muscle mass index (MMI) was measured by bioimpedance analysis, lean mass index by DEXA, and thigh MMI by MRI, fat mass index (FMI) by bioimpedance and DEXA, left ventricular mass index (LVMI) by MRI. Multivariable regression was used to relate muscle mass, BP, and LVMI. RESULTS: On cross-sectional analysis, people with hypertension have higher values of all muscle mass metrics, which were independently associated with higher SBP and DBP after adjustment for age, sex, use of BP-lowering drugs and their interactions. Each 1 kg/m2 higher muscle mass was associated with higher SBP by 0.67 [95% confidence interval (CI) 0.63-0.71] mmHg for MMI, 0.82 (95% CI 0.68-0.97) mmHg for lean mass index and 4.7 (95% CI 4.3-5.1) mmHg for thigh MMI. On longitudinal cohort analyses, higher values of muscle mass changes were independently associated with higher SBP and DBP after adjustment for age, sex and FMI (for SBP per 1 kg/m2 increase) MMI during first follow-up of 4.3 years was independently associated with 2.2 (95% CI 1.9-2.5) mmHg increase in SBP, with consistent findings during longer follow-ups and MMI assessment by DEXA and MRI (P < 0.001 for all). Similarly, higher values of muscle mass metrics and their follow-up changes were independently associated with higher LVMI on cross-sectional and cohort analysis. CONCLUSION: Higher SMM is associated with higher BP and LVMI, independently of adiposity. Further research is needed to establish whether the observed association is causal and to identify the optimal exercise modes for optimal BP and better health outcomes.

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Cite This Study

Shantsila et al. (2026) conducted a cohort in General population without prior stroke (n=492,498). Higher skeletal muscle mass vs. Lower skeletal muscle mass was evaluated on Systolic blood pressure (SBP) (0.67 mmHg increase per 1 kg/m2 higher muscle mass index, 95% CI 0.63-0.71, p=<0.001). Higher skeletal muscle mass index was independently associated with a 0.67 mmHg increase in systolic blood pressure per 1 kg/m2 increase in cross-sectional analysis.

synapsesocial.com/papers/6a2ba34a8101cf8926f01fd1 https://doi.org/10.1097/hjh.0000000000004375

Topics

Hypertension management

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Higher skeletal muscle mass is associated with higher blood pressure and left ventricular mass

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Higher skeletal muscle mass is associated with higher blood pressure and left ventricular mass

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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Topics

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