['To quantify the relation between adiposity and blood pressure (BP) level in patients with symptomatic vascular disease and, thereby, assess whether the obesity paradox can be explained by a causal mechanism involving BP.', 'BP and markers of adiposity (i.e. weight, body mass index, waist circumference, waist-to-hip ratio, subcutaneous adipose tissue, and visceral adipose tissue) were recorded in 4556 men and women with symptomatic vascular disease enrolled in the Secondary Manifestations of Arterial Disease Study. Additionally, 185 patients underwent repeated measurements after 3.7 years follow-up.', 'Each 5 kg/m(2) body mass index was associated with +3.8 mmHg (95% confidence interval (CI) 3.0-4.6) SBP difference and +2.3 mmHg (95% CI 1.9-2.8 mmHg) DBP difference in both men and women. Measures of centralized adiposity compared with BMI were equally related with BP. In contrast, subcutaneous adipose tissue was only weakly related with DBP and not related with SBP and pulse pressure. Various methods of adjustment for BP-lowering medication use led to consistent results. Furthermore, 5 kg/m(2) body mass index change during follow-up was associated with +8.1/5.1 mmHg BP change.'] Does relation between adiposity and hypertension persist after onset of clinically manifest arterial disease?