The interrelationships between hypertension and obesity, two common and major health hazards, are reviewed. Comparisons of simultaneous intra-arterial and cuff blood pressure measurements indicate in general that the association between blood pressure and body weight is real and independent of arm circumference. Hypertension is more common among the obese than among the nonobese and, conversely, a significant proportion of hypertensive persons in the population are overweight. Obese hypertensive subjects experience a greater risk of coronary heart disease than the nonobese, and mortality rates for obese hypertensive persons are higher than for those with obesity alone or hypertension alone. Weight reduction has been shown to lower blood pressure, and it may bring about a more favorable prognosis in obese hypertensive persons. Possible mechanisms that may be responsible for the frequent association between obesity and hypertension have been discussed. Irrespective of the underlying pathophysiologic mechanisms, the adverse metabolic and hemodynamic effects of obesity upon hypertension impose an extra burden and strain on the circulatory system and compromise its functional adequacy. Although it is not precisely known to what extent weight reduction alone may be effective in controlling or preventing the lesser degrees of hypertension, the control of obesity should be an intrinsic part of any therapeutic or preventive antihypertensive regimen.

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In an epidemiologic study of the total population of Tecumseh, Michigan, 98 deaths from coronary heart disease were observed between 1959 and 1965. Forty-five of the fatalities occurred within 1 hour of the onset of symptoms and were classified as sudden. The proportion of sudden deaths among men was nearly twice that among women, and the incidence increased progressively with age in both sexes.Hypertensive heart disease, coronary heart disease, or diabetes mellitus had been detected on prior examination in 62% of those who died suddenly. Physiologic abnormalities associated with a high risk of coronary heart disease were also found more frequently than in the total Tecumseh population.All but seven of the persons who died suddenly had abnormalities including arrhythmias and conduction defects which were detected in the standard 12-lead electrocardiogram.Although sudden deaths often seem to occur without warning, the victims are predisposed by conditions which are detectable long before the catastrophic event.by guest on May 16, 2015 http://circ.ahajournals.org/ Downloaded from syncope. Circulation 37: 429, 1968 25. WIGGERS CJ, WEGRIA R. PINERA B: The effect of myocardial ischemia on fibrillation threshold: The mechanism of spontaneous ventricular fibrillation following coronary occlusion. Amer

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