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Introduction <p>Hypertension is a major public health concern. Although metabolic obesity phenotypes are key risk factors for cardiovascular disease, the association between their dynamic changes and hypertension incidence remains unclear.</p> Methods <p>Based on the Guizhou Population Health Cohort Study (GPHCS), after excluding participants with hypertension at baseline or incomplete data, a total of 3399 subjects were included in the final analysis. Participants were classified into four phenotypes based on body mass index (BMI) and metabolic status: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy obesity (MHO), and metabolically unhealthy obesity (MUO). Cox proportional hazards models were applied to assess the associations between 16 phenotype transition patterns and the risk of hypertension, with robustness confirmed through multiple sensitivity analyses.</p> Results <p>Over a median follow-up of 6.42 years, 826 incident cases of hypertension were identified. After multivariable adjustment, compared with MHNW, baseline MHO (HR = 1.26, 95% CI: 1.02–1.55) and MUO (HR = 1.50, 95% CI: 1.22–1.82) were positively associated with hypertension risk, whereas MUNW was not (HR = 1.10, 95% CI: 0.91–1.33). Dynamic analysis showed that 48.75% of participants underwent phenotypic transitions during follow-up. The two most prominent changes were that 37.38% of individuals with MUNW transitioned to MHNW and 31.21% of those with MHO transitioned to MUO. Transitions from any baseline phenotype to MHNW were not associated with a statistically significant increase in hypertension risk (all <i>P</i> &gt; 0.05). All other phenotypic transitions were positively associated. Even participants who remained MHO experienced increased hypertension risk (HR = 2.30, 95% CI: 1.45–3.64).</p> Conclusion <p>Within the study population, MHO is an unstable state athat tended to progress to MUO, which carries the highest risk of hypertension. In contrast, the MUNW phenotype exhibits high reversibility and can revert to the MHNW phenotype. Future our studies require confirm whether early lifestyle interventions targeting metabolic health can effectively reduce the risk of hypertension.</p>

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Metabolic obesity phenotypic stability, dynamic transformation and risk of hypertension: a 10-year prospective cohort study in southwest China

  • 期刊论文

  • 发表日期：

    2026年6月29日

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  • Si Li,
  • Jixing Lei,
  • Lihua Yin,
  • Xiaoxue Li,
  • Fuyan Zhang,
  • Yun Han,
  • Ziyun Wang,
  • Tao Liu

摘要

Introduction

Hypertension is a major public health concern. Although metabolic obesity phenotypes are key risk factors for cardiovascular disease, the association between their dynamic changes and hypertension incidence remains unclear.

Methods

Based on the Guizhou Population Health Cohort Study (GPHCS), after excluding participants with hypertension at baseline or incomplete data, a total of 3399 subjects were included in the final analysis. Participants were classified into four phenotypes based on body mass index (BMI) and metabolic status: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy obesity (MHO), and metabolically unhealthy obesity (MUO). Cox proportional hazards models were applied to assess the associations between 16 phenotype transition patterns and the risk of hypertension, with robustness confirmed through multiple sensitivity analyses.

Results

Over a median follow-up of 6.42 years, 826 incident cases of hypertension were identified. After multivariable adjustment, compared with MHNW, baseline MHO (HR = 1.26, 95% CI: 1.02–1.55) and MUO (HR = 1.50, 95% CI: 1.22–1.82) were positively associated with hypertension risk, whereas MUNW was not (HR = 1.10, 95% CI: 0.91–1.33). Dynamic analysis showed that 48.75% of participants underwent phenotypic transitions during follow-up. The two most prominent changes were that 37.38% of individuals with MUNW transitioned to MHNW and 31.21% of those with MHO transitioned to MUO. Transitions from any baseline phenotype to MHNW were not associated with a statistically significant increase in hypertension risk (all P > 0.05). All other phenotypic transitions were positively associated. Even participants who remained MHO experienced increased hypertension risk (HR = 2.30, 95% CI: 1.45–3.64).

Conclusion

Within the study population, MHO is an unstable state athat tended to progress to MUO, which carries the highest risk of hypertension. In contrast, the MUNW phenotype exhibits high reversibility and can revert to the MHNW phenotype. Future our studies require confirm whether early lifestyle interventions targeting metabolic health can effectively reduce the risk of hypertension.