We appreciate the letter and additional data from Azevedo and Barros concerning our recent findings that a relationship between CRP concentration and risk of incident hypertension is attenuated after adjustment for BMI in young adults.1 There are several potential explanations for these results. For instance, the relationship between CRP concentration and hypertension could simply be confounded by obesity. However, as suggested by Azevedo and Barros, there are also several biologically plausible pathways that could account for a more direct link between obesity and inflammation leading to hypertension.2,3 Other data, predominately from older subjects, suggest an independent association between CRP concentration and hypertension.4 Thus, it is possible that the relationship among obesity, inflammation, and hypertension is modified by age or other factors that differ between the CARDIA cohort and other study populations. In the end, the data from CARDIA and from Azevedo and Barros make it clear that additional work is required to clarify both the independent and joint effects of obesity and inflammation on risk for hypertension because both conditions are potentially modifiable.
Lakoski SG, Herrington DM, Siscovick DM, Hulley SB. C-Reactive Protein Is an Intermediate Step Between Obesity and Hypertension—Reply. Arch Intern Med. 2006;166(14):1527. doi:10.1001/archinte.166.14.1527-a