The Concept of CMR

The relationship between obesity and hypertension

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Hypertension triggers an array of cardiovascular damage, such as left ventricular hypertrophy, atrial and ventricular arrhythmias, diastolic heart failure, systolic heart failure, and ischemic heart disease with or without congestive heart failure (6).  Hypertension also harms the central nervous system and kidneys. The presence of other risk factors (5)—such as insulin resistance and the metabolic syndrome (1)—increases hypertension’s harmful impact on target organs and CVD risk.

Obesity has many damaging effects on physiological processes (1, 7). Obesity and hypertension are linked, with obese patients having higher rates of hypertension than normal-weight individuals (8, 9). Interestingly, not every obese patient is hypertensive, indicating that obesity is a heterogeneous condition (10). Waist circumference has been reported as the strongest independent predictor of systolic BP and diastolic BP in normoglycemic Chinese (11). Furthermore, excess intra-abdominal fat has been found to be associated with hypertension in Japanese Americans (12). However, hypertension rates were rather high in both studies (56% and 25% respectively) (11, 12). Since  some antihypertensive medications may influence insulin sensitivity and the metabolic risk profile over time, it is important to study the relationship of abdominal obesity and blood pressure in population-based cohorts to avoid the influence of confounding factors (13).

Reference

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5. Wilson PW, D'Agostino RB, Levy D, et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97: 1837-47.

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7. Poirier P, Giles TD, Bray GA, et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 2006; 113: 898-918.

8. Chiang BN, Perlman LV and Epstein FH. Overweight and hypertension. A review. Circulation 1969; 39: 403-21.

9. Stamler R, Stamler J, Riedlinger WF, et al. Weight and blood pressure. Findings in hypertension screening of 1 million Americans. JAMA 1978; 240: 1607-10.

10. Poirier P and Després JP. Waist circumference, visceral obesity, and cardiovascular risk. J Cardiopulm Rehabil 2003; 23: 161-9.

11. Thomas GN, Critchley JA, Tomlinson B, et al. Obesity, independent of insulin resistance, is a major determinant of blood pressure in normoglycemic Hong Kong Chinese. Metabolism 2000; 49: 1523-8.

12. Hayashi T, Boyko EJ, Leonetti DL, et al. Visceral adiposity and the prevalence of hypertension in Japanese Americans. Circulation 2003; 108: 1718-23.

13. Baba T and Neugebauer S. The link between insulin resistance and hypertension. Effects of antihypertensive and antihyperlipidaemic drugs on insulin sensitivity. Drugs 1994; 47: 383-404.

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