Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: In response to Mr Hyder, we suggested
that the population-based increase in BMI from 1988 to 2000 may have contributed
to the increased prevalence of hypertension during that time. A strong positive
relationship between BMI and blood pressure is well documented in numerous
population-based and clinical studies.1,2 Hyder
is concerned that this association may be "spuriously high" because it does
not account for the possibility that obesity-related insulin resistance may
contribute to hypertension. However, the mechanisms by which increasing BMI
may lead to elevations of arterial pressure are not clear.3 Furthermore,
because of the strong association between obesity and insulin resistance,4 adjusting for insulin resistance would result in
overadjustment for the relationship between obesity and hypertension.
Hajjar I, Hoffman RG, Kotchen TA. Factors in the Increasing Prevalence of Hypertension—ReplyFactors in the Increasing Prevalence of Hypertension—Reply. JAMA. 2003;290(22):2940. doi:10.1001/jama.290.22.2940-a