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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.

In addition to insulin resistance, other mechanisms (eg, volume expansion and increased sympathetic nervous system activity) have also been implicated in the pathogenesis of obesity-related hypertension.³ Nevertheless, the purpose of our article . . . [Full Text of this Article]

Ihab Hajjar, MD, MS
Department of Internal Medicine
Palmetto Health Richland/University of South Carolina School of Medicine
Columbia

Raymond G. Hoffman, PhD
Division of Biostatistics

Theodore A. Kotchen, MD
Department of Medicine
Medical College of Wisconsin
Milwaukee

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Factors in the Increasing Prevalence of Hypertension
Joseph A. Hyder
JAMA. 2003;290(22):2940.
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