A major longitudinal study confirms what experts have long suspected: High blood pressure is key to the increased risk of fatal heart attack and stroke in overweight and obese people.

In the study, French researchers tracked the health of more than 240,000 people for an average of 14 years.

"We observed that cardiovascular risk is not clearly increased unless hypertension is present in these overweight and obese subjects," Dr. Athanase Benetos, of the Medical School of Nancy, said in a prepared statement. "In our population, the presence of hypertension was the most important factor that led to increased cardiovascular disease mortality among overweight subjects."

The researchers also found that:

• Overweight men and women who had high blood pressure faced double the risk for fatal heart attack or stroke of overweight people with normal blood pressure.
• Overweight women who had high blood pressure and diabetes were at more than four times the risk of cardiovascular death and overweight men with high blood pressure had triple the risk, compared to women and men with normal weight and normal blood pressure.
• Overweight people with diabetes and normal blood pressure weren't at increased risk of cardiovascular death. Overweight men with high cholesterol were at a slightly increased risk of cardiovascular death, but that was not the case for women.

The best way to reduce the risk of cardiovascular death in overweight and obese people with high blood pressure is treatment that targets both blood pressure and weight, Benetos said.

The study was published in a recent issue of Hypertension.

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