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TOP 10 TAKEAWAY MESSAGES:
Obesity and High Blood Pressure
1. The disease of obesity may promote an increase in blood pressure
and the disease of hypertension.
2. Hypertension is a major risk factor for CVD; CVD is the most
common cause of mortality among patients with obesity and
hypertension.
3. Patients with obesity and hypertension optimally undergo global
CVD risk reduction (e.g., healthful nutrition and physical activity,
smoking cessation, as well as optimal control of blood glucose,
blood pressure, and blood lipids).
4. In addition to food intake contributing to positive caloric balance,
dietary sodium can also increase blood pressure. Patients with
obesity may have increased salt sensitivity.
5. Obesity and "fat mass disease" can contribute to sleep apnea,
kidney and renal vessel compression, perivascular adipose tissue
(restricting blood vessel wall expansion) and increased cardiac
output — all of which can increase blood pressure.
6. Obesity promotes hyperleptinemia and hyperinsulinemia, both
of which act upon the central nervous system to increase blood
pressure.
7. Obesity increases the renin-angiotensin aldosterone system
(RAAS) activity in the kidney resulting in increased blood pressure.
8. Obesity increases adiposopathic cytokines which increase
endothelial dysfunction and increased arteriole vasoconstriction
resulting in increased blood pressure.
9. Obesity decreases the natriuretic effects of heart left ventricular
B-type natriuretic peptide (BNP) resulting in increased blood
pressure.
10. When accompanied by weight loss, many anti-obesity agents
decrease blood pressure; some anti-obesity agents may
initially increase blood pressure (i.e., sympathomimetics such
as phentermine) with possible longer-term reduction in blood
pressure (compared to baseline) after weight loss.
