Individuals with greater skeletal muscle mass (SMM) may have higher blood pressure (BP) and left ventricular mass index (LVMI), regardless of adiposity, reveals a study.
“The findings suggest that increased muscularity may reflect unfavourable body remodelling, irrespective of adiposity,” the researchers said.
This cross-sectional, longitudinal cohort study used data from 492,498 UK Biobank participants with no history of stroke (mean age 56.5 years, 45 percent men, 94 percent White people).
The researchers measured muscle mass index (MMI) via bioimpedance analysis, lean mass index by dual-energy X-ray absorptiometry (DEXA), thigh MMI by MRI, fat mass index (FMI) by bioimpedance and DEXA, and LVMI by MRI. They also used multivariable regression to explore the association between muscle mass and BP and LVMI.
Cross-sectional analysis revealed higher values of all muscle mass metrics among people with hypertension. The increased metrics showed an independent association with elevated systolic and diastolic BP values after adjusting for age, sex, use of BP-lowering medications, and their interactions. [J Hypertens 2026;44:1594-1604]
Each 1-kg/m2 increase in muscle mass correlated with a systolic BP increase of 0.67 mm Hg (95 percent confidence interval [CI], 0.63‒0.71) for MMI, 0.82 mm Hg (95 percent CI, 0.68‒0.97) for lean mass index, and 4.7 mm Hg (95 percent CI, 4.3‒5.1) for thigh MMI.
In longitudinal cohort analyses, higher values of muscle mass changes independently correlated with greater systolic and diastolic BP after adjustments for age, sex, and FMI (for systolic BP per 1 kg/m2 increase). During follow-up of 4.3 years, MMI showed an independent association with a 2.2-mm Hg (95 percent CI, 1.9‒2.5) increase in systolic BP, consistent with the findings during longer follow-up and MMI assessment by DEXA and MRI (p<0.001 for all).
Higher values of muscle mass metrics and their follow-up changes also correlated independently with greater LVMI on cross-sectional and cohort analysis.
Cardiovascular events
“BP values are a well-established surrogate risk factor for cardiovascular events, even though body composition is not part of hypertension-related risk assessment at present,” the researchers said. “Some effects of SMM on cardiovascular mobility have already been explored using UK Biobank data.”
An earlier study found that limb muscle mass was associated with a higher incidence of cardiovascular disease in men (hazard ratio, 1.07, 95 percent CI, 1.06‒1.09), with a curvilinear association in women. [J Am Heart Assoc 2021;10:e019337]
“A detailed analysis of the effects of SMM on cardiovascular outcomes needs careful consideration of other risk factors, medications, and the timing of cardiovascular events, which were outside the scope of this work,” the researchers said.
The 2021 study showed J-shaped associations between SMM and overall mortality, which was different from the linear association between muscle mass, BP, and LVMI in the current study. This finding suggests that the overall health effects of muscle mass are “pleiotropic and can be both detrimental and protective,” according to the researchers.
“Further research is needed to establish whether the observed association is causal and to identify the optimal exercise modes for optimal BP and better health outcomes,” they said.