Associations of waist circumference and BMI with the trajectory of cardiometabolic multimorbidity in hypertensive patients: A multi-state model.

Background and Aims: The burden of cardiometabolic multimorbidity (CMM) in hypertensive patients is substantial, and obesity may play an important role in progression of CMM. We aim to explore associations of obesity with the transition patterns from hypertension to first cardiometabolic disease (FCMD), CMM, and death.
Methods and Results: 21 286 hypertensive patients over 40 were enrolled in Yinzhou Health Information System from 2010 to 2015, followed until June 30, 2022. CMM was defined as the coexistence of stroke, diabetes, and coronary heart disease. Two indices of obesity including body mass index (BMI) and waist circumference (WC) were assessed at baseline. We used multi-state models to evaluate associations of BMI and WC between risk of CMM trajectories in hypertensive patients. During a median follow-up of 8.06 years, 13 289 hypertensive patients developed CMD, 6401 further developed CMM, and 1648 died. WC in every 1 cm increase was positively associated with risk of transitions from hypertension to FCMD (HR = 1.01, 95 % CI: 1.00-1.01) and from FCMD to CMM (HR = 1.01, 95 % CI: 1.01-1.02). Underweight participants had a 17 % elevated risk of transition from FCMD to CMM, while overweight participants had a 5 % elevated risk of transition from hypertension to FCMD. U-shape curves were observed for the association of WC with transitions from FCMD or CMM to death.
Conclusions: Underweight and abnormal WC were associated with an increased risk of CMM and death in hypertensive patients. Our findings emphasize the role of healthy body shape in hypertensive management.
Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare.
(Copyright © 2025 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)