While obesity with hypertension is the most widely recognised high-risk category, a recent study has shown that being underweight with elevated blood pressure or hypertension may also be a high-risk sub-group in Asian populations.The study done in Japan and published in Hypertension Research, an open-source journal in the Nature group of journals, showed the combination of being underweight and having elevated blood pressure or hypertension was associated with increased risk of major adverse cardiovascular events like heart attacks and strokes, particularly among women and among adults aged 40 and above. This is significant for India, where one in five men and women in the 15-49 age group is underweight (body mass index below 18.5).“Conventional prevention strategies for obesity with hypertension appropriately emphasise weight control and cardiometabolic risk reduction; however, the same approach may not be sufficient for underweight individuals with elevated BP or hypertension,” stated the study, suggesting the need for additional assessment for unintentional weight loss, malnutrition, low muscle mass, frailty, and underlying chronic disease for those who are underweight with hypertension.Potential management strategies may, therefore, include nutritional assessment and support, resistance exercise or muscle-strengthening interventions where appropriate, and individualised BP control that considers frailty, and symptoms like dizziness or fainting when rising from sitting or lying down.
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The association between being underweight and cardiovascular events and mortality has been observed in previous studies but significance of high blood pressure was not as well studied or understood. This is of particular significance in Asia where being underweight is relatively common and the distribution of BMI is different from Western populations. In India, the latest National Family Health Survey of 2023-24 showed about 20% of men and women above 15 years had elevated blood pressure or were taking medicine to control it.Understanding cardiovascular risk across the full range of BMI, rather than focusing exclusively on obesity, is expected to enhance understanding of risk stratification in hypertension. The study used the nationwise claims and health-check database of Japan for the period Jan 2005 to Oct 2023 and analysed 62.6 lakh adults without prior cardiovascular disease, chronic renal failure, dialysis, or antihypertensive medication use.