Heartbeat: hypertension risk is higher when obesity onset occurs earlier in adult life

The risk of hypertension is higher in adults with an increased body mass index but there is little data on whether weight gain at a younger age is more detrimental than weight gain later in life. In order to address the impact of age of onset of overweight on the subsequent risk of hypertension, Li and colleagues compared 4742 subjects with newonset overweight to 4742 age and sexmatched normal weight controls in an ongoing communitybased prospective cohort in China with a mean followup interval of 5 years. After multivariable adjustment, they observed a stepwise increase in risk of hypertension in younger adults (particularly those less than age 40 years) with no significantly increased risk for those with onset of overweight at age 60 years or older (figure 1). In an editorial, Wong comments on the strengths of this study—large sample size, serial measurements, robustness of the data—but also points out the limitations—mostly men (68%), a single occupational class (a mining company), hypertension diagnosis based on a single measurement and lack of outcome data. Wong concludes that ‘These data suggest that prevention efforts aimed at the reduction or delay of overweight and obesity in younger individuals, may significantly impact the onset of hypertension in later life. Whether such an intervention significantly impacts the onset of cardiovascular disease and its related adverse outcomes requires future study.’ In studies based on costs and healthcare delivery in the USA, mitral transcatheter edgetoedge repair (TEER) appears to be costeffective for patients with heart failure with reduced ejection fraction (HFrEF) and severe secondary mitral regurgitation. In this issue of Heart, Cohen and colleagues examined whether mitral TEER in HFrEF patients with severe secondary MR would be costeffective in the NHS healthcare system. Overall, TEER reduced the rate of heart failure hospitalisations and improved survival (figure 2), but costs of TEER were higher than guidelinerecommended medical therapy (GRMT). Even so, the incremental costeffectiveness ratio was