CE: Bhavana; HJH/201507; Total nos of Pages: 7; HJH 201507 Two-year change in BMI and subsequent risk of hypertension among men and women in a Taiwan community Pei-Chun Chen a , Fung-Chang Sung a,b,c , Ta-Chen Su d , Kuo-Liong Chien c,d , Hsiu-Ching Hsu d and Yuan-Teh Lee d,e Objective To examine the relationship between short-term changes in BMI and the development of hypertension in a cohort of ethnic Chinese men and women. Methods BMI changes between the baseline survey in 1990–1991 and examinations in 1992–1993 were evaluated for 713 men and 853 women aged 35 years or above, free from hypertension, stroke, coronary heart disease and diabetes at the baseline. The incident hypertension and associated risks were assessed in follow- up visits in 2000. Results Both men and women in the highest BMI change quartile had the highest adjusted mean blood pressures at the initial follow-up period. The differences in blood pressure between the extreme quartiles of BMI changes remained significant at the end of follow-up period in men but were notably reduced in women. The risk of incident hypertension increased as the BMI change quartile increased in men (multivariate-adjusted hazard ratio and 95% confidence interval for the highest quartile versus the lowest quartile: 1.81, 1.22–2.68, respectively, P for trend U 0.002). However, in women, the BMI gain effect on hypertension was not significant unless menopausal status was included in the adjustment (hazard ratio and 95% confidence interval: 1.46, 1.04 – 2.06, respectively). Stratified analyses showed that the BMI change effect was significant only in women in the premenopause or transition to menopause during their BMI change period. Conclusion The 2-year substantial BMI gain is associated with a persistent risk for developing hypertension in men. The risk for women is influenced by their menopause status. J Hypertens 27:000–000 Q 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins. Journal of Hypertension 2009, 27:000–000 Keywords: changes in BMI, cohort studies, hypertension, sex, Taiwan Abbreviations: CCC, cohort study, the Chin-Shan Community Cardiovascular Cohort Study; CI, confidence interval; P1, BMI change period; P2, follow-up period a Institute of Environmental Health, China Medical University College of Public Health, Taichung, b Institute of Environmental Health, c Institute of Preventive Medicine, National Taiwan University College of Public Health, Taipei, d Department of Internal Medicine, National Taiwan University Hospital, Taipei and e Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan Correspondence to Professor Yuan-Teh Lee, MD, PhD, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung Shan South Road, Taipei 100, Taiwan Tel: +886 2 2356 2830; fax: +886 2 2395 9922; e-mail: ytlee@ntu.edu.tw Received 12 September 2008 Revised 10 December 2008 Accepted 26 February 2009 Introduction Hypertension has been a persistent public health chal- lenge because of its high prevalence rate in the middle- aged and elderly populations [1]. Obesity is a well known risk factor for hypertension. Weight loss is a critical lifestyle modification for overweight people to control hypertension [1 – 3]. Studies have shown that weight gain increases the risk for high blood pressure (BP) in popu- lation settings. However, these studies measured the effect of weight changes after a long study period [4–9] and concurrently evaluated changes in weight and BP during the same period [5,7 – 9]. The body weight may fluctuate during a long lag period. The development of hypertension may actually reflect the exposure in earlier years. Whether a short-term weight gain has a persistent adverse effect on BP during subsequent years in general populations has not been well documented. Evidence has shown sex and ethnic differences in cardiovascular risks and levels of risk factors [10,11]. African–American women are over 1.5 times more likely than white women and African–American men to be overweight [11]. The Chinese population is in general characterized with a lower BMI but higher BP compared with whites [10]. Colin Bell et al. [12] also reported that the association between BMI and hypertension is stron- ger for Chinese people than for non-Hispanic white people. The effect of weight change on hypertension incidence has not been reported using prospective study for the ethnic Chinese population. In the Chin-Shan Community Cardiovascular (CCC) Cohort Study, a study population homogeneous in Chinese ethnicity and culture was monitored for over 15 years and repeatedly examined approximately every other year. This longitudinal follow-up study provides a unique opportunity to observe short-term BMI changes and the effect on BP in successive years. The present study reports on the BMI change effect on the hyper- tension development 7 years after the initial 2-year Original article 1 0263-6352 ß 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI:10.1097/HJH.0b013e32832af6d4