Obesity and weight reduction in hypertension
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
- Section Editors
- George L Bakris, MD
George L Bakris, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Professor of Medicine
- The University of Chicago
- F Xavier Pi-Sunyer, MD, MPH
F Xavier Pi-Sunyer, MD, MPH
- Section Editor — Obesity
- Professor of Medicine
- Columbia University College of Physicians and Surgeons
Weight gain raises blood pressure . In addition to the risk of hypertension, obesity further enhances total cardiovascular risk and all-cause mortality . (See "Obesity in adults: Health consequences".)
The importance of these associations was illustrated in a review from the Framingham Heart Study, in which participants were prospectively followed for up to 44 years . It was estimated that excess body weight (including overweight and obesity) accounted for approximately 26 percent of cases of hypertension in men and 28 percent in women and for approximately 23 percent of cases of coronary heart disease in men and 15 percent in women.
Similar findings were noted in a report from the Nurses' Health Study . The BMI at age 18 years and at midlife were positively associated with the occurrence of hypertension (figure 1). Weight gain was also associated with increased risk; the relative risks of hypertension in women who gained 5.0 to 9.9 kg and ≥25.0 kg were 1.7 and 5.2, respectively (figure 2).
PATHOGENESIS OF HYPERTENSION
The rise in blood pressure seen with obesity is initially associated with an elevation in cardiac output and a relatively normal systemic vascular resistance (SVR) . However, normotensive obese patients have the same cardiac output but an SVR that is below that in lean normotensives. Thus, the hemodynamic difference between hypertensive and normotensive obese subjects is an elevation in SVR in hypertensives, findings similar to those in lean subjects . In addition, obese individuals may have increased activation of the renin-angiotensin aldosterone system .
These hemodynamic alterations plus abnormalities in lipid and glucose metabolism appear to be related to fat distribution as well as to total body weight . In particular, the risk is greatest in those patients with abdominal (also called upper body or central) obesity, which is a major component of the metabolic syndrome .
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