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December 10, 2003

Factors in the Increasing Prevalence of Hypertension—ReplyFactors in the Increasing Prevalence of Hypertension—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(22):2940. doi:10.1001/jama.290.22.2940-a

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.