BACKGROUND: Greater adiposity is associated with higher blood pressure. Substantial uncertainty remains, however, about which measures of adiposity most strongly predict blood pressure and whether these associations differ materially between populations. METHODS: We examined cross-sectional data on 500 000 adults recruited from 10 diverse localities across China during 2004-08. Multiple linear regression was used to estimate the effects on systolic blood pressure (SBP) of general adiposity [e.g. body mass index (BMI), body fat percentage, height-adjusted weight] vs central adiposity [e.g. waist circumference (WC), hip circumference (HC), waist-hip ratio (WHR)], before and after adjustment for each other. The main analyses excluded those reported taking any antihypertensive medication, and were adjusted for age, region and education. RESULTS: The overall mean [standard deviation (SD)] BMI was 23.6 (3.3) kg/m(2) and mean WC was 80.0 (9.5) cm. The differences in SBP (men/women, mmHg) per 1SD higher general adiposity (height-adjusted weight: 6.6/5.6; BMI: 5.5/4.9; body fat percentage: 5.5/5.0) were greater than for central adiposity (WC: 5.0/4.3; HC: 4.8/4.1; WHR: 3.7/3.2), with a 10 kg/m(2) greater BMI being associated on average with 16 (men/women: 17/14) mmHg higher SBP. The associations of blood pressure with measures of general adiposity were not materially altered by adjusting for WC and HC, but those for central adiposity were significantly attenuated after adjusting for BMI (WC: 1.1/0.7; HC: 0.3/-0.2; WHR: 0.6/0.6). CONCLUSION: In adult Chinese, blood pressure is more strongly associated with general adiposity than with central adiposity, and the associations with BMI were about 50% stronger than those observed in Western populations.

Original publication




Journal article


Int J Epidemiol

Publication Date





1305 - 1319


Adiposity, Chinese, blood pressure, cross-sectional studies, epidemiology, Adiposity, Adult, Aged, Asian Continental Ancestry Group, Blood Pressure, Blood Pressure Determination, Body Mass Index, China, Cross-Sectional Studies, Female, Humans, Linear Models, Male, Middle Aged, Risk Factors, Waist Circumference, Waist-Hip Ratio