The changes of BMI in prediction of 10-year-hypertension risk in United States population- a historical cohort study

BACKGROUND This is a historical cohort study, utilizing data from the US National Health and Nutrition Examination Survey (NHANES) 2007-2018 to predict 10-year- hypertension-risk based on body mass index (BMI) variations. METHOD Participants aged 40-79 without a hypertension diagnosis 10 years before the baseline interview were included. Subjects were categorized based on five major BMI variation patterns. Various statistical analyses, including Chi-square test, T test, univariate and multivariate logistic regression, and P-trend analysis, were employed to assess hypertension incidence among groups. Restricted cubic splines (RCS) were used to examine the age-hypertension correlation. RESULTS Among 13,287 participants, Stable-Norm (maintaining normal BMI) exhibited the lowest 10-year hypertension risk. Other patterns—Max-OW (maximum BMI in overweight), OB-nOB (obese to non-obese), nOB-OB (non-obese to obese), and Stable-OB (maintaining obese)—showed increasing risks. Hypertension risk correlated quasi-linearly with age. Subgroups analysis suggested certain specific BMI variation modes and absolute weight change groups demonstrated equivalent risks to stable normal/weight groups, while others presented higher risks. CONCLUSION Maintaining normal BMI had the lowest 10-year hypertension risk, and returning to normal BMI showed equivalent risk. Weight gain remained a significant hypertension risk factor in US adults, particularly with advancing age. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial This is not a clinical trail but a historical cohort study, utilizing data from the US National Health and Nutrition Examination Survey (NHANES), all data is avaliable online, without the need to recruit the population for questionnaires or medical examinations. ### Funding Statement None. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: None. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data of our article originated from the US National Health and Nutrition Examination Survey (NHANES).