Kardiovaskuläre alterungsprozesse: Auswirkungen von änderungen des körpergewichts auf blutdruck und linksventrikuläre geometrie - Ergebnisse aus dem MONICA-Augsburg/KORA-projekt

Background: Abundant evidence shows that obesity is associated with structural and functional changes of the cardiovascular system. Consequently, the gain in weight which accompanies the ageing process in many individuals may contribute to the promotion of arterial hypertension and left ventricular hypertrophy. However, it remains unclear to which extent weight maintenance has beneficial effects on age-related cardiovascular remodeling. We evaluated the relation between weight changes and blood pressure as well as consecutive alterations of left ventricular geometry during ten years of follow-up. Methods: A total of 1005 individuals (aged 25-74 years) who originated from a gender- and age-stratified random sample of German residents of the Augsburg area were examined by standardized echocardiography at baseline in 1994/1995 (S3) and in 2004/2005 (F3). We calculated quartiles of absolute body weight changes (difference in kg between S3 and F3) within the subgroup of normotensive participants (n = 573). The concomitant 10-year changes in diastolic (DBP) and systolic blood pressure (SBP), left ventricular wall thickness (WT), and left ventricular mass (LVM) were assessed by quartile of weight change. Results: After 10 years of follow-up, individuals within the 1st quartile of body weight change presented with an average loss of body weight of -3.5 (SD 3.2) kg, whereas subjects in the 4th quartile presented with a mean increase of body weight by 10.2 (SD 4.0) kg. Changes in diastolic and systolic blood pressure associated with ageing by 10 years were significantly different between the two groups. Specifically, individuals within the 4 ^th quartile of weight change displayed higher increases in diastolic (+7.0 mmHg [95-% CI 5.6, 8.4] vs +2.0 mmHg [0.6, 3.4], p < 0.001) and systolic blood pressure (+14.2 mmHg [11.6, 16.7] vs +7.9 mmHg [5.4, 10.5], p = 0.001). Additionally, participants of the 4th quartile also presented with a higher increase in left ventricular wall thickness (+1.6 mm [1.2, 1.9] vs +1.0 mm [0.6, 1.4], p = 0.052) and left ventricular mass (+19.2 g [14.5, 23.8] vs +9.2 g [4.7, 13.8], p = 0.003), as compared to individuals within the 1 ^st quartile. Consequently, the risk for incident arterial hypertension (OR 2.4 [1.3-4.3], p = 0.004) and left ventricular hypertrophy (OR 3.4 [1.5-7.3], p = 0.002) was significantly higher for individuals from the 4 ^th quartile of weight change. Conclusions: In this prospective study, weight gain was associated with pronounced increases of the age-related diastolic and systolic blood pressure. Likewise, and probably as a result of the increase in afterload, left ventricular remodeling was also accelerated in these study participants. Of note, increases of left ventricular wall thickness and mass with ageing were also detected in subjects of the 1 ^st quartile who - on average - lost weight, but to a significantly lesser extent. Our findings indicate that weight gain accentuates left ventricular remodeling as it occurs during the ageing process.