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To the Editor: In their analyses of National Health and Nutrition Examination Survey (NHANES) data and hypertension prevalence, Drs Hajjar and Kotchen¹ examined the possibility that the increase in age-adjusted hypertension prevalence between 1988-1991 (NHANES I) and 1999-2000 (NHANES III) could be related to the documented increase in body mass index (BMI). To do so, they used an analysis of covariance to adjust for age, sex, and race/ethnicity, and reported that BMI "contributed to 2%—more than half—of the 3.6% increase in hypertension prevalence."

This analytic approach may have resulted in a spuriously high attributable fraction of the change in prevalence because it did not account for the effects of insulin resistance and/or diabetes. Insulin resistance, an underdiagnosed condition, is associated with increased BMI.² And, like increased BMI, insulin resistance is an independent, established contributor to the development of hypertension.³ Consequently, the values for attributable fraction reported by Hajjar and Kotchen . . . [Full Text of this Article]

Joseph A. Hyder, BS
Medical Scientist Training Program
School of Medicine
University of California, San Diego

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