Increased Body Mass Index and Hypertension: An Unbreakable Bond

Ioannis Vrettos, Panagiota Voukelatou, Evelina Pappa, Chrysoula Beletsioti, Angelos Papadopoulos, Dimitris Niakas


Background: Adherence with lifestyle recommendations is low among hypertensive patients. The main objective of this study was to assess the prevalence of diagnosed hypertension among the Greek urban population and to examine how lifestyle and sociodemographic characteristics differ between already known hypertensive and the rest of the population.

Methods: In this cross‑sectional survey, data were collected from 1,060 participants (mean age 47.1 ± 16.9 (mean ± 1standard deviation), 52.7% females). Sociodemographic characteristics, health risk factors, and medical history were involved. Body mass index (BMI) (kg/m2 ) was calculated, according to reported height and weight. Parametric tests and multiple logistic regression analysis were applied to identify whether socio‑demographic characteristics and health risk factors differed between known hypertensive and the rest of the population.

Results: Already known hypertensives were 179 (101 females‑78 males). The prevalence of known hypertension was 16.9% (18.1% in females and 15.6% in males). In multivariate analysis, known hypertensives were more likely to have advanced age (P < 0,001, OR = 1.101, 95%CI 1.081–1.121) and increased BMI (P < 0,001, OR = 1.138, 95%CI 1.085–1.194). Moreover, they had a higher probability of suffering from other cardiovascular diseases or sharing other risk factors for cardiovascular diseases.

Conclusions: Among Greek urban population, almost one to six adults knows to suffer from hypertension. In spite the recommendations, patients who were aware of their illness have increased BMI compared with the rest of the population.


Body mass index; cardiovascular diseases;hypertension; lifestyle; obesity; overweight

Full Text:



Chockalingam A, Campbell NR, Fodor JG. Worldwide epidemic

of hypertension. CJC 2006;22:553‑5.

Kearney PM, Whelton M, Reynolds K, Kearney PM, Whelton M,

Reynolds K, et al. Worldwide prevalence of hypertension:

A systematic review. J Hypertens 2004;22:11‑9.

Efstratopoulos AD, Voyaki SM, Baltas AA, Vratsistas FA,

Kirlas DE, Kontoyannis JT, et al. Prevalence, awareness, treatment

and control of hypertension in Hellas, Greece: The hypertension

study in general practice in Hellas (HYPERTENSHELL) national

study. Am J Hypertens 2006;19:53‑60.

Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A,

Böhm M, et al. 2013 ESH/ESC Guidelines for the

management of arterial hypertension: The task force for the

management of arterial hypertension of the European Society

of Hypertension (ESH) and of the European Society of

Cardiology (ESC). J Hypertens 2013;31:1281‑357.

Frisoli TM, Schmieder RE, Grodzicki T, Messerli FH. Beyond salt: Lifestyle modifications and blood pressure. Eur Heart J


Jones DW. Body weight and blood pressure. Effects of weight

reduction on hypertension. Am J Hypertens 1996;9:50s‑4s.

Harsha DW, Bray GA. Weight loss and blood pressure

control (Pro). Hypertension 2008;51:1420‑5.

Stevens VJ, Obarzanek E, Cook NR, Lee IM, Appel LJ,

Smith West D, et al. Trials for the Hypertension Prevention

Research Group. Long‑term weight loss and changes in blood

pressure: Results of the Trials of Hypertension Prevention, phase

II. Ann Intern Med 2001;134:1‑11.

Rahmouni K, Correia ML, Haynes WG, Mark AL.

Obesity‑associated hypertension: New insights into mechanisms.

Hypertension 2005;45:9‑14.

Sowers JR. Obesity as a cardiovascular risk factor. Am J Med

;115(Suppl 8A):37S‑41S.

Kim Y, Kong KA. Do Hypertensive individuals who are aware

of their disease follow lifestyle recommendations better than

those who are not aware? PLoS One 2015;10:e0136858.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA,

IzzoJLJr, et al. Seventh report of the joint national committee

on prevention, detection, evaluation, and treatment of high blood

pressure. Hypertension 2003;42:1206‑52.

Akbarpour S, Khalili D, Zeraati H, Mansournia MA,

Ramezankhani A, Fotouhi A. Healthy lifestyle behaviors and

control of hypertension among adult hypertensive patients. Sci

Rep 2018;8:8508.

Pitsavos C, Panagiotakos DB, Chrysohoou C, Stefanadis C.

Epidemiology of cardiovascular risk factors in Greece: Aims,

design and baseline characteristics of the ATTICA study. BMC

Public Health 2003;3:32.

Psaltopoulou T, Orfanos P, Naska A, Lenas D, Trichopoulos D,

Trichopoulou A. Prevalence, awareness, treatment and control of

hypertension in a general population sample of 26,913 adults in

the Greek EPIC study. Int J Epidemiol2004;33:1345‑52.

StergiouGS, Thomopoulou GC, Skeva II, Mountokalakis TD.

Prevalence, awareness, treatment, and control of hypertension in

Greece: The Didima study. Am J Hypertens 1999;12:959‑65.

Pitsavos C, Milias GA, Panagiotakos DB, Xenaki D,

Panagopoulos G, Stefanadis C. Prevalence of self‑reported

hypertension and its relation to dietary habits, in adults;

a nutrition and health survey in Greece. BMC Public


Jones DW, Miller ME, Wofford MR, Anderson DC Jr,

Cameron ME, Willoughby DL, et al. The effect of weight loss

intervention on antihypertensive medication requirements in the

hypertension optimal treatment (HOT) study. Am J Hypertens


Bays HE, Chapman RH, Grandy S; SHIELD Investigators’

Group. The relationship of body mass index to diabetes mellitus,

hypertension and dyslipidaemia: Comparison of data from two

national surveys. Int J Clin Pract 2007;61:737‑47.

Chen Y, Copeland WK, Vedanthan R, Grant E, Lee JE, Gu D,

et al. Association between body mass index and cardiovascular

disease mortality in east Asians and south Asians: Pooled

analysis of prospective data from the Asia Cohort Consortium.

BMJ 2013;347:f5446.

Leiter LA, Abbott D, Campbell NR, Mendelson R, Ogilvie RI,

Chockalingam A. Lifestyle modifications to prevent and control

hypertension. 2. Recommendations on obesity and weight loss.

Canadian hypertension society, Canadian coalition for high blood

pressure prevention and control, laboratory centre for disease

control at health Canada, heart and stroke foundation of Canada.

CMAJ 1999;160:S7‑12.

Banegas JR, Graciani A, de la Cruz‑TrocaJJ, León‑Muñoz LM,

Guallar‑Castillón P, Coca A, et al. Achievement of cardiometabolic

goals in aware hypertensive patients in Spain: A nationwide

population‑based study. Hypertension2012;60:898‑905.

Scheltens T, BeulensJW, VerschurenWM, Boer JM, Hoes AW,

Grobbee DE, et al. Awareness of hypertension: Will it bring

about a healthy lifestyle? J Hum Hypertens 2010;24:561‑7.

Hu H, Li G, Arao T. Prevalence rates of self‑care behaviors and

related factors in a rural hypertension population: A questionnaire

survey. Int J Hypertens 2013;2013:526949.

Gee ME, Bienek A, Campbell NR, Bancej CM, Robitaille C,

Kaczorowski J, et al. Prevalence of, and barriers to, preventive

lifestyle behaviors in hypertension (from a national survey of

Canadians with hypertension). Am J Cardiol2012;109:570‑5.

Ho AK, Bartels CM, Thorpe CT, Gandhi N, Smith MA,

Johnson HM. Achieving weight loss and hypertension control

among obese adults: A us multidisciplinary group practice

observational study. Am J Hypertens2016;29:984‑91.

Zhao G, Ford ES, Li C, Mokdad AH. Weight control behaviors

in overweight/obese U.S. adults with diagnosed hypertension and

diabetes. CardiovascDiabetol2009;8:13.

Palta M, Prineas RJ, Berman R, Hannan P. Comparison of

self‑reported and measured height and weight. Am J Epidemiol


Strauss RS. Comparison of measured and self‑reported weight

and height in a cross‑sectional sample of young adolescents. Int

J ObesRelatMetabDisord 1999;23:904‑8.

Larsson U, Karlsson J, Sullivan M. Impact of overweight and

obesity on health‑related quality of life‑‑a Swedish population

study. Int J ObesRelatMetabDisord 2002;26:417‑24.