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The treatment of hypertension in obese patients

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Abstract

Hypertension causes a significant disease burden in all racial and ethnic groups and is directly attributable to excess weight in most cases. The relationship between increasing body mass index and hypertension prevalence has been recognized for decades. Epidemiologic studies clearly demonstrate the correlation between body weight and blood pressure in obese and lean populations. Most patients with hypertension are overweight or obese, and loss of excess weight lowers blood pressure. Although the epidemiologic relationship is clear, the understanding of mechanisms linking hypertension and weight gain is still evolving. Lifestyle modifications and specific pharmacologic agents address many of the known mechanisms; however, blood pressure remains difficult to control in obese hypertensive patients. This review highlights the association of obesity and hypertension, identifies potential mechanisms for this association, and describes nonpharmacologic and pharmacologic strategies that offer potential benefits for the obese patient with hypertension.

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References and Recommended Reading

  1. Ezzati M, Lopez AD, Rodgers A, et al.: Selected major risk factors and global and regional burden of disease. Lancet 2002, 360:1347–1360.

    Article  PubMed  Google Scholar 

  2. Chobanian AV, Bakris GL, Black HR, et al.: The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003, 289:2560–2572.

    Article  PubMed  CAS  Google Scholar 

  3. Ong KL, Cheung BM, Man YB, et al.: Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Hypertension 2007, 49:69–75.

    Article  PubMed  CAS  Google Scholar 

  4. National Institutes of Health, National Heart, Lung, and Blood Institutes: Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res 1998, 6(Suppl 2):51S–209S.

    Google Scholar 

  5. Poirier P, Giles TD, Bray GA, et al.: Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss. Circulation 2006, 113:898–918.

    Article  PubMed  Google Scholar 

  6. Ogden CL, Carroll MD, Curtin LR, et al.: Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006, 295:1549–1555.

    Article  PubMed  CAS  Google Scholar 

  7. Kannel WB, Brand N, Skinner JJ, et al.: The relation of adiposity to blood pressure and development of hypertension: the Framingham Study. Ann Intern Med 1967, 67:48–59.

    PubMed  CAS  Google Scholar 

  8. Garrison RJ, Kannel WB, Stokes JS, et al.: Incidence and precursors of hypertension in young adults: the Framingham Offspring Study. Prev Med 1987, 16:235–251.

    Article  PubMed  CAS  Google Scholar 

  9. Dyer AR, Elliott P: The INTERSALT study: relations of body mass index to blood pressure. INTERSALT Cooperative Research Group. J Hum Hypertens 1989, 3:299–308.

    PubMed  CAS  Google Scholar 

  10. Hall JE: The kidney, hypertension, and obesity. Hypertension 2003, 41:625–633.

    Article  PubMed  Google Scholar 

  11. Esler M, Straznicky N, Eikelis N, et al.: Mechanisms of sympathetic activation in obesity-related hypertension. Hypertension 2006, 48:787–796.

    Article  PubMed  CAS  Google Scholar 

  12. Alvarez GE, Beske SD, Ballard TP, Davy KP: Sympathetic neural activation in visceral obesity. Circulation 2002, 106:2533–2536.

    Article  PubMed  Google Scholar 

  13. Shibao C, Gamboa A, Diedrich A, et al.: Autonomic contribution to blood pressure and metabolism in obesity. Hypertension 2007, 49:27–33.

    Article  PubMed  CAS  Google Scholar 

  14. Kassab S, Kato T, Wilkins D, et al.: Renal denervation attenuated the sodium retention and hypertension associated with obesity. Hypertension 1995, 25:893–897.

    PubMed  CAS  Google Scholar 

  15. Wofford MR, Hall JE: Pathophysiology and treatment of obesity hypertension. Curr Pharm Des 2004, 10:3621–3637.

    Article  PubMed  CAS  Google Scholar 

  16. Rahmouni K, Correia MLG, Haynes WG, Mark AL: Obesity-associated hypertension: new insights into mechanisms. Hypertension 2004, 45:9–14.

    PubMed  Google Scholar 

  17. Engeli S, Böhnke J, Gorzelniak K, et al.: Weight loss and the renin-angiotensin-aldosterone system. Hypertension 2005, 45:356–362.

    Article  PubMed  CAS  Google Scholar 

  18. Massiéra F, Bloch-faure M, Ceiler D, et al.: Adipose angiotensinogen is involved in adipose tissue growth and blood pressure regulation. FASEB J 2001, 15:2727–2730.

    PubMed  Google Scholar 

  19. Boustany CM, Bharadway K, Daugherty A, et al.: Activation of the systemic and adipose renin-angiotensin system in rats with diet-induced obesity and hypertension. Am J Physiol 2004, 287:R943–R949.

    CAS  Google Scholar 

  20. Ehrhart-Bornstein M, Lamounier-Zepter V, Schraven A, et al.: Human adipocytes secrete mineralocorticoid releasing factors. Proc Natl Acad Sci U S A 2003, 100:14211–14216.

    Article  PubMed  CAS  Google Scholar 

  21. Calhoun DA, Nishizaka MK, Zaman MA, Harding SM: Aldosterone excretion among subjects with resistant hypertension and symptoms of sleep apnea. Chest 2004, 125:112–117.

    Article  PubMed  CAS  Google Scholar 

  22. de Paula RB, da Silva AA, Hall JE: Aldosterone antagonism attenuates obesity-induced hypertension and glomerular hyperfiltration. Hypertension 2004, 43:41–47.

    Article  PubMed  Google Scholar 

  23. Rahmouni K, Morgan DA, Morgan GM, et al.: Role of selective leptin resistance in diet-induced obesity hypertension. Diabetes 2005, 54:2012–2018.

    Article  PubMed  CAS  Google Scholar 

  24. Lichetenstein AL, Appel LJ, Brands M, et al.: Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 2006, 114:82–96.

    Article  Google Scholar 

  25. Whelton P, Appel LJ, Espeland MA, et al.: Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group. JAMA 1989, 279:839–846.

    Article  Google Scholar 

  26. The Trials of Hypertension Prevention Collaborative Research Group: The effects of nonpharmacologic interventions on blood pressure of persons with high normal levels. Results of the Trials of Hypertension Prevention, Phase I. JAMA 1992, 267:1213–1220.

    Article  Google Scholar 

  27. He J, Whelton PD, Appel LJ, et al.: Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension. Hypertension 2000, 35:544–549.

    PubMed  CAS  Google Scholar 

  28. Appel LJ, Brands MW, Daniels SR, et al.: Dietary approaches to prevent and treat hypertension: a scientific statement for the American Heart Association. Hypertension 2006, 47:296–308.

    Article  PubMed  CAS  Google Scholar 

  29. Lopes HF, Martin KL, Nashar K, et al.: DASH diet lowers blood pressure and lipid induced oxidative stress in obesity. Hypertension 2003, 41:422–430.

    Article  PubMed  CAS  Google Scholar 

  30. Blair SM, Goodyear NN, Gibbons LW, Copper KH: Physical fitness and incidence of hypertension in healthy normotensive men and women. JAMA 1984, 52:487–490.

    Article  Google Scholar 

  31. Paffenbarger RS Jr, Hyde RT, Wing AL, et al.: The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med 1993, 328:538–545.

    Article  PubMed  Google Scholar 

  32. Whelton SP, Chin A, Xin X, et al.: Effect of aerobic exercise on blood pressure; a metaanalysis of randomized, controlled trials. Ann Intern Med 2002, 136:493–503.

    PubMed  Google Scholar 

  33. Wolk R, Shamsuzzaman AS, Somers VK: Obesity, sleep apnea, and hypertension. Hypertension 2003, 42:1067–1074.

    Article  PubMed  CAS  Google Scholar 

  34. Weiss JW, Remsburg S, Garpestad E, et al.: Hemodynamic consequences of obstructive sleep apnea: state of the art review. Sleep 1996, 19:388–397.

    PubMed  CAS  Google Scholar 

  35. Nieto FJ, Young TB, Lind BK, et al.: Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study: Sleep Heart Health Study. JAMA 2000, 283:1829–1836.

    Article  PubMed  CAS  Google Scholar 

  36. Reisin E, Weir MR, Falkner B, et al.: for the Treatment in Obese Patients with Hypertension (TROPHY) Study Group: Lisinopril versus hydrochlorothiazide in obese hypertensive patients: a multicenter placebo-controlled trial. Hypertension 1997, 30:140–145.

    PubMed  CAS  Google Scholar 

  37. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group: Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the antihypertensive and lipid-lowering treatment to prevent heart attack trial. JAMA 2002, 288:2981–2997.

    Article  Google Scholar 

  38. Gress TW, Neito FJ, Shahar E, et al.: Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. Atherosclerosis Risk in Communities Study. N Engl J Med 2000, 342:905–912.

    Article  PubMed  CAS  Google Scholar 

  39. Julius S, Kjeldsen SE, Weber M, et al.: for the VALUE trial group: Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 2004, 363:2022–2031.

    Article  PubMed  CAS  Google Scholar 

  40. Lindholm LH, Ibsen H, Borch-Johnsen K, et al.: Risk of new-onset diabetes in the losartan intervention for endpoint reduction in hypertension study. J Hypertens 2002, 20:1879–1886.

    Article  PubMed  CAS  Google Scholar 

  41. Jordan J, Engeli S, Boye SW, et al.: Direct renin inhibition with aliskiren in obese patients with arterial hypertension. Hypertension 2007, 49:1047–1055.

    Article  PubMed  CAS  Google Scholar 

  42. Dahlöf B, Sever PS, Poulter NR, et al.: for the ASCOT Investigators: Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005, 366:895–906.

    Article  PubMed  Google Scholar 

  43. Wofford MR, Anderson DC, Brown CA, et al.: Antihy-pertensive effect of alpha-and beta-adrenergic blockade in obese and lean hypertensive subjects. Am J Hypertens 2001, 14:164–168.

    Article  Google Scholar 

  44. Fogari R, Derosa G, Zoppi A, et al.: Comparison of the effects of valsartan and felodipine on plasma leptin and insulin sensitivity in hypertensive obese patients. Hypertens Res 2005, 28:209–214.

    Article  PubMed  CAS  Google Scholar 

  45. Masuo K, Mikami H, Ogihara T, Tuck ML: Weight reduction and pharmacologic treatment in obese hypertensives. Am J Hypertens 2001, 14:530–538.

    Article  PubMed  CAS  Google Scholar 

  46. Snow V, Barry P, Fitterman N, et al.: for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians: Pharmacologic and surgical management of obesity in primary care: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2005, 142:525–541.

    PubMed  Google Scholar 

  47. Derosa G, Cicero AF, Murdolo G, et al.: Efficacy and safety comparative evaluation of orlistat and sibutramine treatment in hypertensive obese patients. Diabetes Obes Metab 2005, 7:47–55.

    Article  PubMed  CAS  Google Scholar 

  48. Scholze J, Grimm E, Herrmann D, et al.: Optimal treatment of obesity-related hypertension: the hypertension-obesity-sibutramine (HOS) study. Circulation 2007, 115:1991–1998.

    Article  PubMed  CAS  Google Scholar 

  49. Pi-Sunyer FX, Aronne LJ, Heshmati HM, et al.: for the RIO-North America Study Group: Effect of rimonabant, a cannabinoid-1 receptor blocker, on weight and cardio-metabolic risk factors in overweight or obese patients: RIO-North America: a randomized controlled trial. JAMA 2006, 295:761–775.

    Article  PubMed  CAS  Google Scholar 

  50. Scheen AJ, Finer N, Hollander P, et al.: for the RIO-Diabetes Study Group: Efficacy and tolerability of rimonabant in overweight or obese patients with type 2 diabetes: a randomised controlled study. Lancet 2006, 368:1660–1670.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Division of General Internal Medicine/Hypertension, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA

    Marion R. Wofford

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  1. Marion R. Wofford
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  2. Grant Smith
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  3. Deborah S. Minor
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Correspondence to Marion R. Wofford.

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Wofford, M.R., Smith, G. & Minor, D.S. The treatment of hypertension in obese patients. Current Science Inc 10, 143–150 (2008). https://doi.org/10.1007/s11906-008-0027-9

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