Body composition and blood pressure: Haemodynamic links in young men and women

Q: What are the key findings of this study?

Fat-free mass is the primary correlate of systolic blood pressure in young men via cardiac output, whereas fat mass drives systolic and diastolic blood pressure in women via vascular resistance and stiffness.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Healthy young adults free of cardiovascular disease (n=427). Intervention: Body composition parameters (fat mass and fat-free mass). Primary outcome: Systolic and diastolic blood pressure (SBP and DBP) and mediating haemodynamic mechanisms (B = 0.359 mmHg/kg (FFM-SBP in men); B = 0.440 mmHg/kg (FM-SBP in women), p=<0.001).

Q: What does this research mean for the field?

The haemodynamic links between body composition and blood pressure are sex-specific, with fat-free mass influencing systolic blood pressure primarily through cardiac output in young men, whereas fat mass influences blood pressure primarily through vascular mechanisms in young women and diastolic pressure in young men. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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

To examine sex-specific haemodynamic mechanisms linking body composition parameters to systolic and diastolic blood pressure in young, healthy adults.

Domonkos Cseh; Jessica E. Middlemiss; Shikai Yu; Gisele J. Bentley; Abbie R Williams; Yasmin Yasmin; Barry J. McDonnell; Christopher J. A. Pugh; Ian B. Wilkinson; Carmel M. McEniery

doi:10.1113/ep093982

November 11, 2026Experimental PhysiologyOpen Access

Body composition and blood pressure: Haemodynamic links in young men and women

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Key result

Fat-free mass correlates with SBP in young men, whereas fat mass drives BP in women.

B = 0.359 mmHg/kg (FFM-SBP in men); B = 0.440 mmHg/kg (FM-SBP in women)
P<0.001
n=427

Why the study?

The sex-specific haemodynamic links between body composition parameters and systolic and diastolic blood pressure in young adults free of cardiovascular disease and not receiving cardiovascular medications required exploration.

Key Points

To examine sex-specific haemodynamic mechanisms linking body composition parameters to systolic and diastolic blood pressure in young, healthy adults.
Cross-sectional analysis of 235 men and 192 women aged 18–40 years without cardiovascular disease or cardiovascular medications from the AWE study.
Assessed body composition via bioelectrical impedance, resting blood pressure via oscillometry, cardiac output via inert gas rebreathing, and arterial stiffness via carotid–femoral pulse wave velocity.
Used age-adjusted multivariable linear regression and single- as well as multiple-mediator models with bootstrap resampling to evaluate haemodynamic pathways.
Body mass index showed significant positive associations with systolic blood pressure (B = 1.06 mmHg per kg/m² in men; B = 0.97 mmHg per kg/m² in women; P < 0.001 for both) and diastolic blood pressure (B = 1.15 mmHg per kg/m² in men; B = 0.94 mmHg per kg/m² in women; P < 0.001 for both).
In men, fat-free mass was the primary independent correlate of systolic blood pressure (P < 0.001), driven positively by cardiac output and partially offset by peripheral vascular resistance, whereas fat mass correlated independently with diastolic blood pressure (P < 0.001).
In women, fat mass was the primary independent determinant of both systolic and diastolic blood pressure (P < 0.001 for both), mediated primarily by peripheral vascular resistance and pulse wave velocity.

Study Design

Type

Cross-Sectional (n=427)

Structured PICO

P

Population

427 young adults (235 men, 192 women; aged 18-40 years) free of cardiovascular disease and not taking cardiovascular medications evaluated in a cross-sectional study.

O

Outcome

Supine systolic blood pressure (SBP) and diastolic blood pressure (DBP) and their underlying haemodynamic pathways, including cardiac output (CO), stroke volume (SV), heart rate (HR), peripheral vascular resistance (PVR), and carotid–femoral (aortic) pulse wave velocity (PWV).surrogate

Main Result

Effect estimate: B = 0.359 mmHg/kg (FFM-SBP in men); B = 0.440 mmHg/kg (FM-SBP in women)

p-value: p=<0.001

In young adults free of cardiovascular disease, blood pressure is linked to body composition via sex-specific haemodynamic pathways: fat-free mass drives systolic blood pressure in men primarily through cardiac output, whereas fat mass drives both systolic and diastolic blood pressure in women (and diastolic blood pressure in men) predominantly via vascular resistance and aortic stiffness.

Limitations

Cross-sectional nature of the study limits inference regarding causality
Results did not provide information on fat mass distribution (peripheral vs central)
Hydration status was not standardized before bioelectrical impedance analysis
Absence of physical activity data limited ability to account for its potential confounding effects
Majority of participants were of White ethnic origin, limiting generalizability
Parallel mediator models included candidate mediators that are not entirely independent
No formal adjustment for multiple testing was applied
Cross-sectional analysis design
In men, a significant direct positive FFM–SBP association remained that was not explained by the haemodynamic mechanisms assessed in the study

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Implication

Sex-specific body composition-BP associations may inform tailored risk assessment in young adults; hypothesis-generating and leaves open causal effects on outcomes.

Abstract

The aim of this study was to explore the sex‐specific haemodynamic links between body composition parameters and systolic and diastolic blood pressure (SBP and DBP, respectively) in adults free of cardiovascular disease and not receiving cardiovascular medications. Body mass index (BMI), fat mass (FM), fat‐free mass (FFM), SBP and DBP, cardiac output (CO), peripheral vascular resistance (PVR) and aortic pulse wave velocity (PWV) were determined in 235 men and 192 women aged 18–40 years. Multivariable linear regression and single‐ as well as multiple‐mediator models were used to assess haemodynamic mechanisms underlying the associations between body composition and blood pressure. BMI showed positive associations with SBP and DBP in both sexes ( P < 0.001 for all). In men, FFM was the main body composition correlate of SBP ( P < 0.001), with the positive association driven in part by CO and partially offset by opposing effects through PVR. FM was the dominant body composition correlate of DBP in men and both SBP and DBP in women ( P < 0.001 for all), with the positive associations mediated by PVR and PWV in both sexes, and additionally by heart rate in the FM–DBP association in men. Changes in FFM may affect SBP predominantly through CO in young men. Changes in FM may affect DBP in young men and both SBP and DBP in young women, predominantly through vascular mechanisms. These findings provide important insights into sex differences in the physiology of adiposity‐related BP changes in young adults and may help inform sex‐specific strategies for the management of adiposity‐related hypertension.

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Cite This Study

Cseh et al. (2026) conducted a cross-sectional in Healthy young adults free of cardiovascular disease (n=427). Body composition parameters (fat mass and fat-free mass) was evaluated on Systolic and diastolic blood pressure (SBP and DBP) and mediating haemodynamic mechanisms (B = 0.359 mmHg/kg (FFM-SBP in men); B = 0.440 mmHg/kg (FM-SBP in women), p=<0.001). Fat-free mass is the primary correlate of systolic blood pressure in young men via cardiac output, whereas fat mass drives systolic and diastolic blood pressure in women via vascular resistance and stiffness.

synapsesocial.com/papers/6af5cd33a40bbe8669e89c67 https://doi.org/10.1113/ep093982

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Body composition and blood pressure: Haemodynamic links in young men and women

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Body composition and blood pressure: Haemodynamic links in young men and women

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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