Cumulative adiposity and blood pressure trajectory in the UK biobank cohort

Q: What are the key findings of this study?

Higher cumulative BMI increased cumulative SBP by +53.7 and DBP by +41.1 mmHg·years per 100 kg/m²·year BMI-AUC (both p<0.001), with stronger associations in females.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Blood pressure trajectories in adults free of cardiovascular disease (n=144223). Intervention: Cumulative body mass index (BMI-AUC) and peak BMI vs. Lower cumulative BMI (continuous per 100 kg/m²·year increase). Primary outcome: Cumulative blood pressure area under the curve (SBP-AUC and DBP-AUC) (+53.7 mmHg·years for SBP-AUC and +41.1 mmHg·years for DBP-AUC per 100 kg/m²·year higher BMI-AUC, p=<0.001).

Q: What does this research mean for the field?

Cumulative adiposity exposure significantly increases cumulative blood pressure exposure over the life course, with a stronger association observed in females than in males. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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

To characterize sex-specific blood pressure trajectories across adulthood and determine how cumulative exposure to excess body mass index shapes long-term blood pressure patterns.

G Mcgowan; S O Brennan; D Wood; C Jennings; J Jones; A Tinworth; J W McEvoy

doi:10.1093/eurheartj/ehag785.3005

October 1, 2026European Heart JournalOpen Access

Cumulative adiposity and blood pressure trajectory in the UK biobank cohort

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Key result

Higher cumulative BMI links to ~54 mmHg·years higher cumulative SBP per 100-unit increase, especially in females.

+53.7 mmHg·years for SBP-AUC and +41.1 mmHg·years for DBP-AUC per 100 kg/m²·year higher BMI-AUC
P<0.001
n=144,223

Why the study?

Sex-specific blood pressure trajectories, their drivers, and the life-course relationship between excess adiposity and cumulative blood pressure exposure remain incompletely defined.

Does higher cumulative BMI exposure increase cumulative blood pressure exposure and worsen blood pressure trajectories in adults without baseline cardiovascular disease?

Key Points

To characterize sex-specific blood pressure trajectories across adulthood and determine how cumulative exposure to excess body mass index shapes long-term blood pressure patterns.
Analyzed 144,223 UK Biobank adults without baseline cardiovascular disease who had at least 3 blood pressure readings across a median follow-up of 15.7 years (2.6 million total measurements).
Applied linear mixed-effects models adjusted for ethnicity, deprivation, smoking, and time-varying antihypertensive treatment to calculate area-under-the-curve (AUC) metrics for body mass index and blood pressure.
Per 100 kg/m²·year higher cumulative body mass index (BMI-AUC), systolic blood pressure exposure increased by +53.7 mmHg·years and diastolic exposure by +41.1 mmHg·years (both p < 0.001).
Associations between BMI-AUC and blood pressure AUC were weaker in males than females (interaction term: β = -0.065 for systolic and β = -0.037 for diastolic; both p < 0.001).
Blood pressure trajectories followed an early-adult rise, a midlife plateau, and a late-life decline, with males exhibiting higher values at every phase.

Study Design

Type

Cohort (n=144,223)

Multicenter

Yes

Structured PICO

Does higher cumulative BMI exposure increase cumulative blood pressure exposure and worsen blood pressure trajectories in adults without baseline cardiovascular disease?

P

Population

144,223 UK Biobank adults with ≥3 blood pressure measurements and no history of cardiovascular disease, followed for a median of 15.7 years.

E

Exposure

Cumulative body mass index (BMI-AUC) and peak BMI exposure

O

Outcome

Sex-specific blood pressure trajectories, cumulative blood pressure area under the curve (SBP-AUC and DBP-AUC), and peak blood pressure over a median follow-up of 15.7 yearssurrogate

Main Result

Effect estimate: +53.7 mmHg·years for SBP-AUC and +41.1 mmHg·years for DBP-AUC per 100 kg/m²·year higher BMI-AUC

p-value: p=<0.001

Cumulative adiposity exposure significantly drives higher life-course cumulative blood pressure exposure, particularly in females, underscoring the need for early weight and blood pressure management in midlife.

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Implication

Cumulative BMI exposure tracks with BP burden; hypothesis-generating for interventions and requires prospective trials before practice change.

Abstract

Background Sex-specific blood pressure (BP) trajectories and drivers of worsening trajectories remain inadequately characterised. Emerging evidence indicates accelerated BP increases in females earlier in adulthood. Excess adiposity is a key modifiable driver of blood pressure (BP), yet its life-course relation to cumulative BP exposure is incompletely defined. Purpose This study aims to characterise BP trajectories in males and females, and to identify potential drivers of worsening trajectories. Body mass index (BMI) and associated summary metrics were the exposures explored due to rising prevalence of obesity in both sexes. Methods UK Biobank participants with ≥3 temporal BP measurements and no history of cardiovascular disease (CVD) were sampled. Linear mixed-effects models examined sex-specific BP trajectories, with age used as the underlying time scale, adjusted for ethnicity, deprivation, smoking, and time-varying antihypertensive dose. Linear regression examined the association between cumulative area under the curve (AUC) metrics derived from these models for both BMI and BP. Results The analytic sample comprised of 144,223 adults. A total of 2.6 million blood-pressure readings were captured over a median follow-up period of 15.7 years. Midlife BP trajectories showed an early-adult rise, mid-life plateau and late decline, with higher values at each stage in males. Higher cumulative BMI (BMI-AUC) and greater peak BMI were associated with larger BP AUC and higher peak BP. Per 100 kg/m²·year higher BMI-AUC, SBP-AUC was +53.7 and DBP-AUC +41.1 mmHg·years (both p<0.001). Associations between BMI AUC and BP AUC were weaker in males than females (sex interaction term: β = –0.065 for SBP and –0.037 for DBP; both p < 0.001). Conclusion Cumulative BP exposure is a strong driver of CVD in both sexes. BMI patterns shape BP trajectories, with cumulative BMI exposure increasing cumulative exposure to BP. This highlights the importance of adiposity and BP control in both sexes, particularly during midlife. Results support calls for early identification and treatment of elevated BP, given the anticipated rise across the lifespan and associated increase in cumulative exposure.Systolic & Diastolic BP ModelsBP & BMI Regression Analyses

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Cite This Study

Mcgowan et al. (2026) conducted a cohort in Blood pressure trajectories in adults free of cardiovascular disease (n=144,223). Cumulative body mass index (BMI-AUC) and peak BMI vs. Lower cumulative BMI (continuous per 100 kg/m²·year increase) was evaluated on Cumulative blood pressure area under the curve (SBP-AUC and DBP-AUC) (+53.7 mmHg·years for SBP-AUC and +41.1 mmHg·years for DBP-AUC per 100 kg/m²·year higher BMI-AUC, p=<0.001). Higher cumulative BMI increased cumulative SBP by +53.7 and DBP by +41.1 mmHg·years per 100 kg/m²·year BMI-AUC (both p<0.001), with stronger associations in females.

synapsesocial.com/papers/6ae13ce6043bfbd6353326af https://doi.org/10.1093/eurheartj/ehag785.3005

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Cumulative adiposity and blood pressure trajectory in the UK biobank cohort

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Cumulative adiposity and blood pressure trajectory in the UK biobank cohort

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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