Researchers in Saudi Arabia studied over 1,000 adults to understand what affects blood pressure the most. They discovered that combining measurements of body shape, cholesterol, and blood sugar with lifestyle habits like exercise and sleep gives a much better picture of blood pressure health than just looking at lifestyle alone. The biggest surprise? Where you carry weight around your middle is one of the strongest predictors of high blood pressure. This research suggests doctors should pay attention to both what people do (exercise, sleep, diet) and their body measurements to better predict and prevent high blood pressure.

The Quick Take

  • What they studied: Whether combining body measurements (like waist size and cholesterol) with lifestyle habits (like exercise and sleep) is better at predicting high blood pressure than just looking at lifestyle habits alone.
  • Who participated: 1,041 adults living in Saudi Arabia. The study looked at a mix of people with different lifestyles and health conditions.
  • Key finding: When researchers combined body measurements with lifestyle information, they could predict blood pressure much better. For every point higher on this combined score, people had lower blood pressure and were 27% less likely to have high blood pressure. However, lifestyle habits alone didn’t predict blood pressure as well.
  • What it means for you: If you’re concerned about blood pressure, doctors may need to look at more than just your daily habits—they should also check your waist size, cholesterol, and blood sugar. This combined approach might help catch high blood pressure risk earlier. However, this study was done in Saudi Arabia, so results may differ in other populations.

The Research Details

This was a cross-sectional study, which means researchers looked at a large group of people at one point in time rather than following them over years. They asked 1,041 Saudi adults questions about their lifestyle (how much they exercise, how well they sleep, their stress levels, and what they eat) and also measured their body size, cholesterol levels, and blood sugar. They then looked at which of these factors were most connected to high blood pressure.

The researchers created two different ‘scores’ to compare. The first score (called BioBeh) included both lifestyle information and body measurements like waist circumference, cholesterol, and blood sugar. The second score (called Beh) included only lifestyle information. They then used statistical methods to see which score was better at predicting who had high blood pressure.

This approach is useful because it lets researchers quickly see patterns in a large group of people, though it can’t prove that one thing directly causes another.

Understanding what predicts high blood pressure is important because high blood pressure affects millions of people and can lead to serious health problems like heart disease and stroke. Most previous research focused on either lifestyle factors or body measurements separately. This study is valuable because it combines both approaches to see if doctors get a clearer picture when they look at everything together. This is especially important in Saudi Arabia, where high blood pressure is very common, and where research on this topic has been limited.

This study has several strengths: it included over 1,000 people, which is a solid sample size; it measured multiple factors rather than just one; and it used proper statistical methods to control for other factors that might affect blood pressure. However, because it’s a cross-sectional study, it shows relationships between factors but can’t prove that one causes the other. The study was done in Saudi Arabia, so the results may not apply equally to people in other countries with different genetics and lifestyles. Additionally, the study relied on people’s reports of their own behavior, which can sometimes be inaccurate.

What the Results Show

The main finding was striking: when researchers used the combined score that included both body measurements and lifestyle factors, they found strong connections to blood pressure. For every 1-point increase on this combined score, people’s systolic blood pressure (the top number) dropped by about 1.68 mmHg, and their diastolic blood pressure (the bottom number) dropped by about 1.67 mmHg. More importantly, people with higher combined scores were 27% less likely to have high blood pressure.

In contrast, when researchers looked at the lifestyle-only score, they found no meaningful connection to blood pressure. This was surprising and suggests that lifestyle factors alone—without considering body measurements—don’t tell the full story about blood pressure risk.

Waist circumference (how big around your middle is) turned out to be the single strongest predictor. People with smaller waists had significantly lower blood pressure readings and much lower rates of high blood pressure. For every unit decrease in waist circumference, systolic blood pressure dropped by 3.80 mmHg and diastolic dropped by 3.31 mmHg. People with smaller waists were 43% less likely to have high blood pressure.

Other factors that mattered included cholesterol levels, fasting blood sugar, smoking status, sleep quality, physical activity, stress levels, and diet quality. However, waist circumference was the most powerful single factor.

The study also looked at whether these scores predicted ’elevated blood pressure’ (higher than normal but not yet high blood pressure). Interestingly, the combined score didn’t predict elevated blood pressure as well as it predicted full high blood pressure. This suggests the combined score is particularly useful for identifying people at risk for actual high blood pressure rather than just slightly elevated readings. The individual components of the score (cholesterol, blood sugar, smoking, sleep, exercise, stress, and diet) all contributed to the overall picture, but waist circumference was by far the most important.

Previous research has shown that both lifestyle factors and body measurements affect blood pressure, but most studies looked at these separately. This research adds to our understanding by showing that combining these measurements gives a much clearer picture than looking at them alone. The finding that waist circumference is so important aligns with other research showing that where you carry weight (around your middle) is more concerning for heart health than total weight alone. The study’s focus on the Middle East is important because most blood pressure research has been done in Western countries, and this shows that these patterns hold true in different populations.

This study has several important limitations to keep in mind. First, because it only looked at people at one point in time, we can’t know if the factors measured actually cause high blood pressure or if high blood pressure causes changes in these factors. Second, the study was done only in Saudi Arabia, so the results may not apply to people in other countries with different genetics, climates, and lifestyles. Third, the study relied on people reporting their own behavior (exercise, sleep, diet, stress), which people often remember or report inaccurately. Fourth, the study didn’t include information about medications people were taking, which could affect blood pressure. Finally, the study measured blood pressure only once, whereas blood pressure naturally varies throughout the day, so a single measurement might not be completely accurate.

The Bottom Line

Based on this research, if you’re concerned about blood pressure, it’s worth having your doctor check not just your lifestyle habits but also your waist circumference, cholesterol, and blood sugar levels. This combined information gives a better picture of your blood pressure risk. The research suggests that paying special attention to waist circumference may be particularly important. However, these findings are most directly applicable to people in Saudi Arabia and similar populations, and more research is needed to confirm whether these patterns hold true worldwide. This research should not replace personalized medical advice from your doctor.

This research is most relevant to adults in the Middle East, particularly Saudi Arabia, who are concerned about blood pressure or have family history of high blood pressure. It’s also useful for healthcare providers who want to better identify people at risk for high blood pressure. People with high blood pressure or elevated blood pressure should definitely pay attention to these findings. However, the results may be less directly applicable to people in other parts of the world with different genetic backgrounds and lifestyles. Anyone taking blood pressure medication should continue following their doctor’s advice rather than making changes based solely on this research.

If you make changes based on these findings—such as reducing waist circumference through diet and exercise, improving sleep, or managing stress—you might expect to see changes in blood pressure within 2-4 weeks, though more significant improvements typically take 2-3 months of consistent effort. However, this timeline is based on general knowledge about blood pressure, not specifically from this study.

Want to Apply This Research?

  • Track waist circumference weekly (measure at the level of your belly button), along with weekly blood pressure readings if you have a home monitor. Record these alongside lifestyle factors like average sleep hours per night, exercise minutes per week, and perceived stress level (1-10 scale).
  • Use the app to set a goal for waist circumference reduction (even 1-2 inches can matter) and track progress weekly. Combine this with tracking sleep quality, daily exercise minutes, and stress management activities. The app could send reminders to measure waist circumference weekly and log these measurements alongside blood pressure readings.
  • Create a dashboard that shows trends in waist circumference, blood pressure, and lifestyle factors over 8-12 weeks. Set up alerts if waist circumference increases or blood pressure rises, and celebrate milestones when waist circumference decreases. Include reminders to get cholesterol and blood sugar checked periodically, as these are key components of the combined score.

This research is observational and shows associations, not direct cause-and-effect relationships. These findings are based on a study of Saudi Arabian adults and may not apply equally to all populations. This information is for educational purposes only and should not replace personalized medical advice from your healthcare provider. If you have high blood pressure or are concerned about your blood pressure, please consult with your doctor before making significant lifestyle changes or stopping any medications. Always work with your healthcare team to develop a personalized blood pressure management plan.