Interaction between body mass index and blood pressure on the risk of vascular stiffness : A community-based cross-sectional study and implications for nursing

This study aimed to analyze associations between body mass index (BMI) and vascular measurements (pulse wave velocity [PWV] and ankle-brachial index [ABI]) and whether blood pressure (BP) was involved in the relationship. This cross-sectional study was conducted. A total of 1,894 middle-aged and older adults who underwent routine health screening at a community medical center in the Zhangjiang community in Shanghai, China, were included. Participants were divided into three groups based on BMI: normal weight, overweight, and obese. Multivariate linear regression models and smooth curve fittings were used to evaluate the associations between BMI and indices of arterial function. Mediation analysis examined whether blood pressure variables mediate the association between BMI and vascular function variables. Multiple linear regression analysis showed that BMI to be significantly and negatively associated with baPWV (β = −0.06 [–0.10, −0.03])and ABI (β = −0.004 [–0.005, −0.003]), respectively. The interaction test results of systolic blood pressure (SBP) in the relationship between BMI and baPWV were significant (P for interaction = 0.01). After adjusting for age and sex, mediation analyses showed that BMI and baPWV were correlated (β = 0.090, P < 0.001) and mediated by SBP (β = 0.533, P < 0.001) and diastolic blood pressure (DBP) (β = 0.338, P < 0.001). A negative association was found between BMI and ABI (β = −0.135, P < 0.001), which appeared to be partially mediated by SBP (β = 0.124, P < 0.001) and DBP (β = 0.053, P < 0.001). After subgroup analysis based on blood pressure levels, the most mediating effects between subgroups were insignificant. Our findings showed conflicting results regarding the associations between BMI and non-invasive vascular measurements of arterial stiffness and atherosclerosis. BP may have a biological interaction in the relationship between BMI and baPWV. Managing blood pressure and weight through comprehensive clinical care is crucial for preventing damage or blockage of vessels in middle-aged and older adults.