Hypertension in Obesity and the Impact of Weight Loss

Abstract

Purpose of Review Several interrelated mechanisms play a role in the development of hypertension in obesity, often contributing to end organ damage including cardiovascular disease and chronic kidney disease. Recent Findings The treatment of hypertension in obesity is complicated by a high prevalence of resistant hypertension, as well as unpredictable hemodynamic effects of many medications. Weight loss stabilizes neurohormonal activity and causes clinically significant reductions in blood pressure. While lifestyle interventions can improve blood pressure, they fail to consistently yield sustained weight loss and have not demonstrated long-term benefits. Weight loss surgery provides more permanent weight reduction, corresponding with dramatic declines in blood pressure and attenuation of long-term cardiovascular risk. Summary Hypertension is closely linked to the prevalence, pathophysiology, and morbidity of obesity. There are multiple barriers to managing hypertension in obesity. Surgical weight loss offers the most promise in reducing blood pressure and decreasing end organ damage in this patient population.

Relationship of Body Adiposity with Platelet Function in Obese and Non-obese Individuals

“…In the current study, the blood pressure of obese subjects was significantly higher compared to the non-obese, which is in alignment with the earlier study by Cohen et al [17]. The study conducted by Cohen et al concluded that several interrelated mechanisms promote the development of hypertension in obesity, often contributing to end-organ damage, including cardiovascular disease.…”

Sleep duration and 24‐hour ambulatory blood pressure in adults not on antihypertensive medications

“…We also stratified and assessed for effect modification of the association between sleep duration and each of the outcomes by OSA (only available in PISA) and obesity (BMI ≥30 kg/m 2 vs. <30 kg/m 2 ). 23,25–28 …”

“…We also stratified and assessed for effect modification of the association between sleep duration and each of the outcomes by OSA (only available in PISA) and obesity (BMI ≥30 vs <30 kg/m 2 ). 23,[25][26][27][28] 3 | RE SULTS There was no clinically significant difference in age (Table 1; mean 52, SD 7 vs 52, SD 7 years, P = 0.581), sex (88% vs 84% male, P = 0.470), race (19% vs 23% black, P = 0.768), BMI (mean 31, SD 4 vs 30, SD 4 kg/m 2 , P = 0.038), or alcohol use (77% vs 81%, P = 0.567) among subjects with shorter sleep duration (less than 7 hours) compared to subjects with longer sleep duration (at least 7 hours). There were similar rates of tobacco use (19% vs 25%, P = 0.448), moderate-severe OSA (71% vs 72%, P = 0.811), diabetes mellitus (10% vs 3%, P = 0.091), coronary artery disease (1% vs 1%, P = 0.921), and congestive heart failure (1% vs 0%, P = 0.364) among participants with shorter sleep duration compared to those with longer sleep duration.…”

Association between metabolic surgery and cardiovascular outcome in patients with hypertension: A nationwide matched cohort study

“…Hypertension, together with high body mass index (BMI), is a leading cause of mortality and disability [3]. A combination of the two may also be associated with resistant hypertension and increased risk for organ damage [9]. Compared to T2DM, the effect of metabolic surgery on hypertension is less well studied.…”