Lakoski et al1 recently reported on data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study regarding the association between C-reactive protein (CRP) concentration and incidence of hypertension. The association reported in crude analysis was no longer significant after adjusting for body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters). In fact, we believe that it was an expected finding because CRP concentration likely reflects obesity. Recent new insights into the relation between obesity and inflammatory activation show that obese individuals have larger adipocytes and consequently a larger amount of macrophages present.2 Within a representative sample of Portuguese adults, in subjects with a CRP concentration of 1 mg/dL or less and no hypertension at baseline (n = 476) high-sensitivity CRP was associated with increasing BMI, both in men (Spearman correlation, 0.34; P<.001) and women (Spearman correlation, 0.34; P<.001), and the association was even stronger with fat mass (assessed by bioimpedance), particularly among women (Spearman correlation, 0.48 [P = .004] in men and 0.70 [P<.001] in women). In this sample, after a median 4.4 years’ follow-up, the incidence of hypertension was also significantly associated with CRP levels and attenuated and nonsignificant after adjusting for BMI, as in the CARDIA Study (Table 1). When cross-classifying subjects according to CRP concentration and BMI, as shown in Table 2, increasing CRP concentration was still associated with incident hypertension in overweight and obese individuals, but this may result from residual confounding by obesity within each broad class of BMI and CRP categories. It would be most interesting to assess these associations with longitudinal data beginning in childhood, in which case one would be able to appreciate the temporal sequence between obesity, inflammatory activation, and incident hypertension.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
The Rational Clinical Examination EDUCATION GUIDESAbdominal Aortic Aneurysm
All results at
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.