Waist Circumference Change is Associated with Blood Pressure Change Independent of BMI Change

OBJECTIVE: This study aimed to understand how an increase in abdominal adiposity relative to overall adiposity is associated with blood pressure (BP) change. METHODS: A sex‐stratified mixed linear model was used to examine the association (95% CI) between annual changes in waist circumference (WC) and systolic blood pressure and diastolic blood pressure, estimated from two to eight repeated measures across the 1993‐2015 China Health and Nutrition Survey, among 5,742 men and 5,972 women (18‐66 years) with no history of antihypertension medication use. RESULTS: The association between annual WC change and BP change remained statistically significant but was attenuated after controlling for annual BMI change, regardless of baseline abdominal obesity or overweight status. Each 10‐cm annual WC gain in men and women was associated with a 0.98‐mm Hg (95% CI: 0.61‐1.35) and a 0.97‐mm Hg (95% CI: 0.62‐1.32) annual increase in systolic blood pressure and a 1.13‐mm Hg (95% CI: 0.87‐1.38) and a 0.74‐mm Hg (95% CI: 0.51‐0.97) annual increase in diastolic blood pressure, respectively, independent of annual BMI change. CONCLUSIONS: WC gain may elevate BP even in the absence of BMI gain. BP management that addresses only BMI gain could overlook individuals at risk of elevated BP who have increased WC but not BMI.