Burden of Obesity-Related Hypertension in a Hospital-Based Pakistani Cohort: Insights from the PREVENT-CARD Registry

Objectives: This study aimed to assess the burden of obesity-related hypertension and its associated demographic and metabolic risk factors in adults attending preventive cardiology clinics in Pakistan, using World Health Organization (WHO) criteria for Asian populations. Methodology: A cross-sectional analysis was conducted using data from the PREVENT-CARD registry, including 2,309 adults evaluated at the preventive cardiology outpatient clinic and affiliated chest pain units of the National Institute of Cardiovascular Diseases (NICVD), Karachi. Obesity was defined using WHO Asian BMI criteria (BMI ≥25 kg/m²), while central obesity was classified using waist circumference thresholds (≥80 cm for females and ≥90 cm for males). Hypertension was determined based on European Society of Cardiology (ESC) criteria for previously diagnosed or newly diagnosed hypertension. Participants were categorized into four phenotypes: normal, obesity without hypertension, non-obesity-related hypertension, and obesity-related hypertension. Multivariable logistic regression was performed to identify independent correlates of obesity-related hypertension. Results: Obesity-related hypertension was observed in 54.6% (n=1,261) of participants, while 14.4% had hypertension without obesity and 15.9% were obese but normotensive. Advancing age, central obesity, diabetes mellitus, and elevated low-density lipoprotein (LDL) cholesterol were independently associated with obesity-related hypertension. Central obesity demonstrated the strongest association, conferring more than fivefold higher odds of obesity-related hypertension. Conclusion: Obesity-related hypertension is highly prevalent in this clinic-based Pakistani cohort and is strongly associated with central adiposity, metabolic dysregulation, and advancing age. These findings underscore the need for early identification and targeted management of obesity-driven cardiometabolic risk to reduce the growing burden of cardiovascular disease in South Asian populations.