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ABSTRACT BACKGROUND Relationship between BMI and all-cause mortality in patients with hypertension remains controversial. This study aimed to evaluate the time-varying association between

BMI in patients with hypertension and all-cause mortality. METHODS This population-based cohort study included 212,394 Chinese adults with hypertension from 2007 to 2015 and was followed up

until death, loss-to-follow-up, or December 31, 2018. According to the World Health Organization criteria for Asians, BMI was categorized into five groups: underweight (BMI < 18.5 kg/m2),

normal weight (18.5–22.9 kg/m2), overweight (23–24.9 kg/m2), class I obesity (25–29.9 kg/m2) and class II obesity (BMI ≥ 30 kg/m2). Cox model was used to estimate the time-varying

association of BMI on the risk of mortality by including the interaction term between BMI and time using restricted cubic spline. RESULTS Compared with normal weight, underweight and class

II obesity were associated with higher mortality (Hazard ratio [HRs] at 1 and 10 years of follow-up: 1.51 [95% CI: 1.39–1.65], and 1.27 (1.15–1.41) for underweight, respectively; 1.08

(0.96–1.21), and 1.16 (1.03–1.30) for class II obesity, respectively). However, overweight and class I obesity were associated with lower mortality, although the protective effects gradually

attenuated over time (HRs at 1 and 10 years of follow-up: 0.85 (0.81–0.90), and 0.96 (0.91–1.02) for overweight, respectively; 0.80 (0.76–0.84), and 1.04 (0.99–1.10) for class I obesity,

respectively). CONCLUSIONS We found increased mortality among hypertensive patients with underweight and class II obesity while decreased mortality with overweight and class I obesity was

observed during the first 5 years of follow-up. Management efforts for hypertension may target controlling body weight in a reasonable range for patients, and probably more attention should

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our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS BLOOD PRESSURE CATEGORIES DEFINED BY THE 2017 ACC/AHA GUIDELINE AND ALL-CAUSE MORTALITY: A NATIONAL COHORT STUDY IN

CHINA AND META-ANALYSIS Article 15 February 2021 IMPACT OF UNDERWEIGHT ON 3-YEAR ALL-CAUSE MORTALITY IN PATIENTS WITH ACUTE SEVERE HYPERTENSION: A RETROSPECTIVE COHORT STUDY Article Open

access 21 March 2022 THE RELATIONSHIP BETWEEN THE TRIGLYCERIDE-GLUCOSE (TYG) INDEX AND ALL-CAUSE MORTALITY IN ICU PATIENTS WITH PRIMARY HYPERTENSION: A RETROSPECTIVE STUDY Article Open

access 09 April 2025 DATA AVAILABILITY The datasets generated and analyzed in the study are not publicly available but are available from the corresponding authors on reasonable request.

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Obesity. Endocrinol Metab Clin North Am. 2016;45:677–88. Article  PubMed  PubMed Central  Google Scholar  Download references ACKNOWLEDGEMENTS The authors would like to thank the research

participants and the staff of the Minhang District community in Shanghai, China for their contributions to the research. FUNDING This study was supported by Shanghai Municipal Nature Science

Foundation (19ZR1445900), Nature Science Foundation of Minhang district, Shanghai, China (2020MHZ043), the National Nature Science Foundation of China (NO: 11871164 and No 82073570),

Minhang district key disciplines in public health (MGWXK01) and Health Consortium Foundation of Fudan University and Minhang District Health Committee (NO: 2019FM02). AUTHOR INFORMATION

Author notes * These authors contributed equally: Jingjing Zhu, Xiaohua Liu. AUTHORS AND AFFILIATIONS * Department of Biostatistics, School of Public Health, Fudan University, Shanghai, PR

China Jingjing Zhu, Chen Huang, Yongfu Yu & Guoyou Qin * Shanghai Minhang Center for Disease Control and Prevention, 965 Zhong Yi Road, Shanghai, 201101, PR China Xiaohua Liu, Jinling

Zhang, Jun Li, Linli Chen & Huilin Xu * Minhang District Branch of School of Public Health, Fudan University, Shanghai, PR China Xiaohua Liu & Huilin Xu * Department of Clinical

Medicine-Department of Clinical Epidemiology, Aarhus University, Aarhus N, 8200, Denmark Jiong Li * Key Lab of Health Technology Assessment, National Health Commission of the People’s

Republic of China, Fudan University, Shanghai, 200032, PR China Guoyou Qin Authors * Jingjing Zhu View author publications You can also search for this author inPubMed Google Scholar *

Xiaohua Liu View author publications You can also search for this author inPubMed Google Scholar * Jinling Zhang View author publications You can also search for this author inPubMed Google

Scholar * Jun Li View author publications You can also search for this author inPubMed Google Scholar * Linli Chen View author publications You can also search for this author inPubMed 

Google Scholar * Chen Huang View author publications You can also search for this author inPubMed Google Scholar * Jiong Li View author publications You can also search for this author

inPubMed Google Scholar * Yongfu Yu View author publications You can also search for this author inPubMed Google Scholar * Huilin Xu View author publications You can also search for this

author inPubMed Google Scholar * Guoyou Qin View author publications You can also search for this author inPubMed Google Scholar CONTRIBUTIONS YFY, HLX, and GYQ had full access to all of the

data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. YFY, HLX, and GYQ conceived the idea, JJZ and HLX conducted data extraction

and statistical analyses. JJZ wrote the first draft of the manuscript. JLZ, JL, and LLC involved in data acquisition and check. YFY, HLX, and GYQ contributed to data interpretation. All

authors revised the manuscript for important intellectual content. All authors read and approved the final manuscript. CORRESPONDING AUTHORS Correspondence to Yongfu Yu, Huilin Xu or Guoyou

Qin. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no competing interests ETHICS APPROVAL AND CONSENT TO PARTICIPATE The study was approved by the Institutional Review Board of

center for disease control and prevention in Minhang District, Shanghai (NO: EC-P-2019-009). Informed consent from participants involved in the study was waived due to the fact that

anonymized data compiled from electronic medical records was applied in the study. ADDITIONAL INFORMATION PUBLISHER’S NOTE Springer Nature remains neutral with regard to jurisdictional

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J., Liu, X., Zhang, J. _et al._ Time-varying association between body mass index and all-cause mortality in patients with hypertension. _Int J Obes_ 46, 316–324 (2022).

https://doi.org/10.1038/s41366-021-00994-0 Download citation * Received: 04 May 2021 * Revised: 21 September 2021 * Accepted: 11 October 2021 * Published: 25 October 2021 * Issue Date:

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