A two-decade population-based study on the effect of hypertension in the general population with obesity in the United States

Gwyneth Kon, Yip Han Chin, Jieyu Lim, Cheng Han Ng, Shankar Kannan, Bryan Chong, Chaoxing Lin, Kai En Chan, Vickram Vijay Anand, Ethan Cheng Zhe Lee, Shaun Loong, Zhen Yu Wong, Chin Meng Khoo, Mark Muthiah, Roger Foo, Georgios K Dimitriadis, Gemma Figtree, Yibin Wang, Mark Chan, Nicholas WS Chew*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


Objective: With rising prevalence of hypertension and obesity, the effect of hypertension in obesity remains an important global issue. The prognosis of the US general population with obesity based on hypertension control was examined. Methods: This study examined participants from the National Health and Nutrition Examination Survey between 1999 and 2018. Individuals with obesity were stratified into no hypertension, controlled hypertension, and uncontrolled hypertension. The study outcome was all-cause mortality. Cox regression of all-cause mortality was adjusted for age, sex, ethnicity, diabetes, and previous myocardial infarction. Results: Of 16,386 individuals with obesity, 53.1% had no hypertension, 24.7% had controlled hypertension, and 22.2% had uncontrolled hypertension. All-cause mortality was significantly higher in uncontrolled hypertension (17.1%), followed by controlled hypertension (14.8%) and no hypertension (4.0%). Uncontrolled hypertension had the highest mortality risk (hazard ratio [HR] 1.34, 95% CI: 1.13-1.59, p = 0.001), followed by controlled hypertension (HR 1.21, 95% CI: 1.10-1.34, p < 0.001), compared with no hypertension after adjustment. The excess mortality trend was more pronounced in females, those with diabetes, and those older than age 65 years. Conclusions: The incremental mortality risk in controlled and uncontrolled hypertension, compared with the normotensive counterparts, irrespective of sex, age, and diabetes status, urges health care providers to optimize hypertension control and advocate weight loss to achieve better outcomes in obesity.

Original languageEnglish
Pages (from-to)832-840
Number of pages9
Issue number3
Early online date7 Feb 2023
Publication statusPublished - Mar 2023


  • Obesity
  • hypertension
  • Diabetes mellitus type II


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