HYPERTENSION WITH HEALTHY OBESITY IS FAVORABLE IN CIRCADIAN RHYTHM OF BLOOD PRESSURE AND HEART RATE COMPARED WITH PATHOLOGIC OBESITY: KOREAN REGISTRY OF TARGET ORGAN DAMAGES IN HYPERTENSION (KORHR)

초록

Objective: Metabolically healthy obesity is more advantageous in cardiovascular outcomes than pathologic obesity. This study was to evaluate blood pressure (BP) and heart rate (HR) using 24-hour ambulatory BP monitoring and to compare various types of obesity and non-obesity hypertensives. Design and method: The Korean Registry of Target Organ Damages in Hypertension (KorHR), established in March 2013 was a nationwide prospective observation study including 16 tertiary care hospitals. A total of 1654 hypertensive subjects aged more than 30 years old without a history of obvious cardiovascular disease were divided into 4 groups according to body mass index (BMI) and waist circumference (WC). (table) Office BP and 24-hour ambulatory BP with HR were measured with other laboratory data. Results: A total of 1096 subjects [mean age = 51.4±11.9 years, including 699 (63.8%) male and 524 (47.8%) naïve hypertensives] BMI and WC data were available. There were no significant differences in lipid profile, hs-CRP, and HbA1C levels among various obesity groups (group 1, 2, and 3). However, the 24-hour mean SBP was significantly lower in group 3 compared with other groups. (138.7±15.0 vs. 137.8±12.7 vs. 133.1±17.6∗ vs. 136.5±14.0, ∗p=0.016 vs. other groups) Early morning HR was significantly lower in group 3 (71.1±11.4 vs. 66.2±12.2∗ vs. 66.2±11.8∗ vs. 69.6±11.9 bpm, ∗p=0.026 vs. group 1) and dipper pattern showed a strong tendency of more prevalent in group 3 and 4 with intermediate significance. The results were consistent in both naïve population and patients with anti-hypertensive medications. Conclusions: Healthy obesity hypertensives showed more favorable circadian rhythm in BP and HR than pathologic obesity regardless of metabolic profiles and history of anti-hypertensive medication. This would be a mechanism of advantageous cardiovascular outcomes in healthy obesity hypertensives.