Trends in Central Obesity Prevalence Among Adults With Hypertension in the United States, 2001–2023

Central obesity drives hypertension progression, but long-term trend data in hypertensive populations are lacking. This study using National Health and Nutrition Examination Survey (NHANES) data (2001-2023), 28,666 adult hypertensive participants were included. Central obesity was defined as waist circumference ≥102 cm (men) or ≥88 cm (women). Central obesity was further categorized into three severity grades: Grade I (men 102-110 cm, women 88-95 cm), Grade II (men 110-120 cm, women 95-105 cm), and Grade III (men ≥120 cm, women ≥105 cm). Age-standardized prevalence trends were analyzed with Joinpoint software. Overall central obesity prevalence increased significantly from 59.2% (2001-2004) to 69.7% (2021-2023, p < 0.001). Females (72.2%-80.5%) had higher rates than males (49.2%-61.3%). Severe (Grade III) obesity rose most prominently (20.1%-30.9%, p < 0.001). The 20-44 age group showed the largest absolute increase (50.5%-66.1%) and contributed 46.5% to the overall rise. In conclusion, central obesity, particularly severe forms, increased steadily among US hypertensive adults. Younger adults contributed most, highlighting the need for targeted interventions to reduce cardiovascular burden.