Treatment of hypertension in obese patients

Czech version

Authors: M. Souček
Published in: Kardiol Rev Int Med 2011, 13(1): 9-13
Category: From Hypertension to Heart Failure

Overview

Obesity and hypertension are two major cardiovascular risk factors that frequently occur together and increasingly influence the health of the population at large. The mutual relationship of the two is very well known, the actual cause of this relationship is not entirely clear. An increasing amount of evidence shows that an important role in the aetiology of hypertension in obese patients is played by increased activity in the sympathicus and activity in the renin-angiotensin-aldosterone system. The basic type of obesity on which we should focus in practice is obesity of the visceral type. Treatment of hypertension should start with treatment for obesity and an effort to reduce body mass and bring about a change in the patient’s lifestyle. In favourable cases it is possible, if not necessary, to support regimen procedures through the prescription of drugs from the so-called anti-obesic group. Unfortunately, these are currently few. A further option is bariatric surgery. We currently have little information at our disposal on the pharmacological treatment of hypertension in obese individuals and chiefly on its long-term effects. We therefore base the application of antihypertensive medication on general recommendations for the treatment of high blood pressure and the prevention of cardiovascular disease with regard to the known pathophysiological relationship between blood pressure and obesity.

Keywords:
hypertension – obesity – visceral fat – metabolic syndrome

Sources

1. Kelly T, Yang W, Chen CS et al. Global burden of obesity in 2005 and projections to 2030. Int J Obes 2008; 32: 1431–1437.

2. Eckel RH. Obesity and heart disease: a statement for healthcare professionals from the Nutrition Committee, American Heart Association. Hypertension 2000; 35: 1270–1277.

3. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA 2003; 290: 199–206.

4. Must A, Spadano J, Coakley EH et al. The disease burden associated with overweight and obesity. JAMA 1999; 282: 1523–1529.

5. Jozífová M, Cífková R, Škodová Z et al. Léčba a kontrola hypertenze v České republice v období 1997/1998–2006/2009. Intern Med pro Prax 2010; 12: 212–217.

6. Kunešová M, Čechová M, Laika M. Zpráva o projektu Životní styl a obezita. Kvantitativní výzkum STEM/MARK pro MZ ČR a Českou obezitologickou společnost, 2006. www.obesitas.cz/download/dospeli_web.ppt.

7. Sharma AM, Grassi G. Obesity and hypertension: cause or consequence? J Hypertens 2001; 19: 2125–2126.

8. Allemann Y, Hutter D, Aeschbacher BC et al. Increased central body fat deposition precedes a significant rise in resting blood pressure in male. Offspring of essential hypertensive parents: a 5 year follow-up study. J Hypertens 2001; 19: 2143–2148.

9. Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension in women. JAMA 2009; 302: 401–411.

10. Hayashi T, Boyko EJ, Leonetti DL et al. Visceral adiposity is an independent predictor of incident hypertension in Japanese Americans. Ann Intern Med 2004; 140: 992–1000.

11. Mancia G, Bombelli M, Facchetti R et al. Long-term risk of diabetes, hypertension and left ventricular hypertrophy associated with the metabolic syndrome in a general population. J Hypertens 2008; 26: 1602–1611.

12. Julius S, Valentini M, Palatini P. Overweight and hypertension. A 2-way street? Hypertension 2000; 35: 807–813.

13. Garrison RJ, Kannel WB, Stokes J 3rd et al. Incidence and precursors of hypertension in young adults: the Framingham Offspring Study. Prev Med 1987; 16: 235–251.

14. Masuo K, Kawaguchi H, Mikami H et al. Serum uric acid and plasma norepinephrine concentrations subsequent weight gain and blood pressure elevation. Hypertension 2003; 42: 474–480.

15. Svačina Š, Owen K. Syndrom inzulínové rezistence. Praha: Triton 2003.

16. Doll S, Paccaud F, Bovet P et al. Body mass index, abdominal adiposity and blood pressure: consistency of their association across developing and develop countries. Int J Obes Relat Metab Disord 2002; 26: 48–57.

17. Kanai H, Matsuzawa Y, Kotani K et al. Close correlation of intra-abdominal fat accumulation to hypertension in obese women. Hypertension 1990; 16: 484–490.

18. Unger R. The physiology of cellular liporegulation. Annu Rev Physiol 2003; 65: 333–347.

19. Lambert E, Straznicky N, Schlaich M et al. Differing pattern of sympathoexcitation in normal-weight and obesity-related hypertension. Hypertension 2007; 50: 862–868.

20. Straznicky NE, Eikelis N, Lambert EA et al. Mediators of sympathetic activation in metabolic syndrome obesity. Curr Hypertens Rep 2008; 10: 440–447.

21. Tank J, Heusser K, Dietrich A et al. Influences of gender on the interaction between sympathetic nerve traffic and central adiposity. J Clin Endocrinol Metab 2008; 93: 4974–4978.

22. Schillaci G, Pirro M, Vaudo G et al. Prognostic value of the metabolic syndrome in essential hypertension. J Am Coll Cardiol 2004; 43: 1817–1822.

23. Stevens VJ, Obarzanek E, Cook NR et al. Long-term weight loss and changes in blood pressure: results of the Trials of Hypertension Prevention, phase II. Ann Intern Med 2001; 134: 1–11.

24. National Heart, Lung, and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults – The Evidence Report. Obes Res 1998; 6: S51–S209.

25. Neter JE, Stam BE, Kok FJ et al. Influence of weight reduction on blood pressure. A meta-analysis of randomized controlled trials. Hypertension 2003; 42: 878–884.

26. Masuo K, Mikami H, Ogihara T et al. Differences in mechanisms between weight loss-sensitive and resistant blood pressure reduction in obese subjects. Hypertens Res 2001; 24: 371–376.

27. Alvarez GE, Beske SD, Ballard TP et al. Sympathetic neural activation in visceral obesity. Circulation 2002; 106: 2533–2536.

28. Sjöström CD, Peltonen M, Wedel H et al. Differentiated long-term effects of intentional weight loss on diabetes and hypertension. Hypertension 2000; 36: 20–25.

29. Kuller LH, Simkin-Silverman LR, Wing RR et al. Women´s healthy lifestyle project. A randomized clinical trial: results at 54 months. Circulation 2001; 103: 32–37.

30. Blair SN, Goodyear NN, Gibbons LW et al. Physical fitness and incidence of hypertension in healthy normotensive men and women. JAMA 1984; 252: 487–490.

31. Svačinová H. Pohybová léčba u pacientů s metabolickým syndromem. Vnitř Lék 2007; 53: 540–544.

32. Hagberg JM, Park JJ, Brown MD. The role of exercise training in the treatment of hypertension: an update. Sports Med 2000; 30: 193–206.

33. Graudal NA, Galløe AM, Garred P. Effects of sodium restriction on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride: a meta-analysis. JAMA 1998; 279: 1383–1391.

34. Andersson OK, Fagerberg B, Hedner T. Importance of dietary salt in the hemodynamic adjustment to weight reduction in obese hypertensive men. Hypertension 1984; 6: 814–819.

35. Trials of Hypertension Prevention Collaborative Research Group. Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The Trials of Hypertension Prevention, Phase II. Arch Intern Med 1997; 157: 657–667.

36. Tuck ML, Sowers J, Dornfeld L et al. The effect of weight reduction on blood pressure, plasma rennin activity and plasma aldosterone levels in obese patients. N Engl J Med 1981; 304: 930–933.

37. Dengel DR, Galecki AT, Hagberg JM et al. The independent and combined effects of weight loss and aerobic exercise on blood pressure and oral glucose tolerance in older men. Am J Hypertens 1998; 11: 1405–1412.

38. Miller ER 3rd, Erlinger TP, Young DR. Results of the Diet, Exercise, and Weight Loss Intervention Trial (DEW-IT). Hypertension 2002; 40: 612–618.

39. Anderssen S, Holme I, Urdal P et al. Diet and exercise intervention have favourable effects on blood pressure in mild hypertensives: the Oslo diet and Exercise study (ODES). Blood Pressure 1995; 4: 343–349.

40. Reid CM, Dart AM, Dewar EM et al. Interactions between the effects of exercise and weight loss on risk factors, cardiovascular haemodynamics and left ventricular structure in overweight subjects. J Hypertens 1994; 12: 291–301.

41. Straznicky NE, Lambert EA, Nestel PJ et al. Sympathetic neural adaptation to hypocaloric diet with or without exercise training in obese metabolic syndrome subjects. Daibetes 2010; 59: 71–79.

42. Trombetta IC, Batalha LT, Rondon MU et al. Weight loss improves neurovascular and muscle metabaroflex control in obesity. Am J Physiol Heart Circ Physiol 2003; 285: H974–H982.

43. Svačina Š. Prevence diabetu. Praha: Galén 2003.

44. Sharma AM, Golay A. Effect of orlistat-induced weight loss on blood pressure and heart rate in obese patients with hypertension. J Hypertens 2002; 20: 1873–1878.

45. Siebenhofer A, Horvath K, Jeitler K et al. Long-term effects of weight-reducing drugs in hypertensive patients. Cochrane Database Syst Rev 2009: CD007654.

46. Torgenson JS, Boldrin MN, Hauptman J et al. Xenical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 2004; 27: 155–161.

47. Dixon JB, O´Brien PE, Playfair J et al. Adjustable gastric banding and conventional therapy for type 2 diabetes. A randomized controlled trial. JAMA 2008; 299: 316–323.

48. Sjöström L, Lindroos AK, Peltonen M et al. Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk faktors 10 years after bariatric surgery. N Engl J Med 2004; 351: 2683–2693.

49. Widimský J jr, Cífková R, Špinar J a kol. Doporučení diagnostických a léčebných postupů u arteriální hypertenze – verze 2007. Doporučení České společnosti pro hypertenzi. Vnitř Lék 2008; 54: 101–118.

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

51. Grassi G, Seravalle G, Dell‘Oro R et al. CROSS Study. Comparative effects of candesartan and hydrochlorothiazide on blood pressure, insulin sensitivity, and sympathetic drive in obese hypertensive individuals: results of the CROSS study. J Hypertens 2003; 21: 1761–1769.