ESC Congress 2026 Abstract · Oct 26, 2026

Cumulative adiposity and blood pressure trajectory in the UK biobank cohort

By Mcgowan G, Brennan SO, Wood D et al.

Background: Sex-specific blood pressure (BP) trajectories and drivers of worsening trajectories remain inadequately characterised. Emerging evidence indicates accelerated BP increases in females earlier in adulthood. Excess adiposity is a key modifiable driver of blood pressure (BP), yet its life-course relation to cumulative BP exposure is incompletely defined. Purpose: This study aims to characterise BP trajectories in males and females, and to identify potential drivers of worsening trajectories. Body mass index (BMI) and associated summary metrics were the exposures explored due to rising prevalence of obesity in both sexes. Methods: UK Biobank participants with ≥3 temporal BP measurements and no history of cardiovascular disease (CVD) were sampled. Linear mixed-effects models examined sex-specific BP trajectories, with age used as the underlying time scale, adjusted for ethnicity, deprivation, smoking, and time-varying antihypertensive dose. Linear regression examined the association between cumulative area under the curve (AUC) metrics derived from these models for both BMI and BP. Results: The analytic sample comprised of 144,223 adults. A total of 2.6 million blood-pressure readings were captured over a median follow-up period of 15.7 years. Midlife BP trajectories showed an early-adult rise, mid-life plateau and late decline, with higher values at each stage in males. Higher cumulative BMI (BMI-AUC) and greater peak BMI were associated with larger BP AUC and higher peak BP. Per 100 kg/m²·year higher BMI-AUC, SBP-AUC was +53.7 and DBP-AUC +41.1 mmHg·years (both p<0.001). Associations between BMI AUC and BP AUC were weaker in males than females (sex interaction term: β = –0.065 for SBP and –0.037 for DBP; both p < 0.001). Conclusion: Cumulative BP exposure is a strong driver of CVD in both sexes. BMI patterns shape BP trajectories, with cumulative BMI exposure increasing cumulative exposure to BP. This highlights the importance of adiposity and BP control in both sexes, particularly during midlife. Results support calls for early identification and treatment of elevated BP, given the anticipated rise across the lifespan and associated increase in cumulative exposure.Systolic & Diastolic BP ModelsBP & BMI Regression Analyses

doi.org/10.1093/eurheartj/ehag785.3005Open accessPopulations