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Body Mass and Hypertension in Women

TO THE EDITOR: Huang and colleagues' article on body weight, weight change, and risk for hypertension produced a convincing and unsurprising conclusion that both excess body mass and weight gain in adult women were associated with a linear increased risk for hypertension [1]. Two related issues that they did not discuss in the article would be interesting to address. First, in the United States, it has been estimated that 44% of African-American women meet criteria for obesity (body mass index 27 kg/m2), compared with 24% of white women [2]. The prevalence of hypertension among African-American women has also been found to be 1.5 times higher than the prevalence among white women [3]. It would be interesting to know whether Huang and colleagues performed a subgroup analysis specific to ethnicity; if so, did they find a similar or stronger correlation between body mass and blood pressure among African Americans? Second, two large prospective studies [4, 5] have reported that fluctuations in weight (weight cycling) among women who diet is associated with an increased total mortality compared with women who do not diet (relative risk, 1.45) [5]. We wonder whether Huang and colleagues examined this issue in their cohort with regard to relative risk for development of hypertension. Answers to both of these questions would be helpful for counseling our female patients about weight loss.