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Description of Conditions
Essential Hypertension
➤ Obesity, particularly excess visceral adiposity, contributes to
essential hypertension through neurohormonal activation,
sodium retention, vascular dysfunction, and insulin resistance,
with a dose-dependent relationship evidenced by a 3 mm Hg
systolic increase per 10 kg of weight gain.
➤ Clinical Manifestations
• Hypertension often remains asymptomatic until complications
arise. Cardiovascular manifestations include left ventricular
hypertrophy, congestive heart failure, and accelerated
atherosclerosis. Renal manifestations may present as proteinuria,
chronic kidney disease, and hyperf iltration due to glomerular
hypertension. Neurological symptoms include headache, vision
changes, or cognitive impairment resulting f rom microvascular
damage. Additionally, metabolic comorbidities such as coexisting
dyslipidemia, T2DM, and obstructive sleep apnea synergize to
increase cardiovascular risk.
➤ Screening
• Blood pressure should be screened at every healthcare visit in
adults and annually in children aged three years and older with
obesity risk factors, using validated devices and proper technique,
including appropriate cuff size, correct patient positioning, and
multiple measurements on separate occasions. Auscultatory
methods should conf irm elevated readings.
• Home blood pressure monitoring combined with f requent
interactions with multidisciplinary team members using
standardized measurement and treatment protocols and
home measurement protocols is an important integrated tool
to improve rates of blood pressure control. Reliance on cuffless
devices, including smartwatches, for accurate blood pressure
measurements should be avoided until these devices demonstrate
greater precision and reliability.
Risk Factors
• Modifiable risk factors include obesity (which accounts for 65% to
78% of cases and is closely tied to visceral adiposity and metabolic
dysregulation), along with high sodium intake, low potassium
intake, excessive consumption of sugar-sweetened beverages,
physical inactivity, alcohol and tobacco use, psychological stress,
poor sleep quality, and certain medications such as nonsteroidal
anti-inflammatory drugs, decongestants, tricyclic antidepressants,
and corticosteroids. Nonmodifiable factors include older age, genetic
predisposition to obesity and hypertension, Black ethnicity (linked in
part to increased renin-angiotensin-aldosterone system sensitivity),
and sex, with men exhibiting higher prevalence and severity at
younger and middle ages, while women have higher rates in older
adulthood due to hormonal changes and vascular factors.
