Joint statement of the European Association for the Study of Obesity and the European Society of Hypertension

Abstract

Obese patients are prone to arterial hypertension, require more antihypertensive medications, and have an increased risk of treatment-resistant arterial hypertension. Obesity-induced neurohumoral activation appears to be involved. The association between obesity and hypertension shows large inter-individual variability, likely through genetic mechanisms. Obesity affects overall cardiovascular and metabolic risk; yet, the relationship between obesity and cardiovascular risk is complex and not sufficiently addressed in clinical guidelines. The epidemiological observation that obesity may be protective in patients with established cardiovascular disease is difficult to translate into clinical experience and practice. Weight loss is often recommended as a means to lower blood pressure. However, current hypertension guidelines do not provide evidence-based guidance on how to institute weight loss. In fact, weight loss influences on blood pressure may be overestimated. Nevertheless, weight loss through bariatric surgery appears to decrease cardiovascular risk in severely obese patients. Eventually, most obese hypertensive patients will require antihypertensive medications. Data from large-scale studies with hard clinical endpoints on antihypertensive medications specifically addressing obese patients are lacking and the morbidity from the growing population of severely obese patients is poorly recognized or addressed. Because of their broad spectrum of beneficial effects, renin-angiotensin system inhibitors are considered to be the most appropriate drugs for antihypertensive treatment of obese patients. Most obese hypertensive patients require two or more antihypertensive drugs. Finally, how to combine weight loss strategies and antihypertensive treatment to achieve an optimal clinical outcome is unresolved.

Prehypertension, Hypertension and Associated Cardiovascular Risk Factors among Adult Congolese Urban Dwellers: Results of the Vitaraa Study

“…Most participants with prehypertension displayed at least two additional cardiovascular risk factors and had indices of obesity that were intermediate between subjects with normal blood pressure and those with definite hypertension. The association of prehypertension or hypertension and overweight/obesity concurs with the literature [20]- [26] and is known to major the risk of atherosclerosis [27] [28]. Overweight/obesity is characterized by sympathetic overload responsible for elevated systemic vascular resistance [29] [30] and expanded extracellular volume through which cardiac output and blood pressure can be increased [31] [32].…”

Successful Weight Reduction Improves Left Ventricular Diastolic Function and Physical Performance in Severe Obesity

“…In addition, successful weight reduction in the severe obese goes along with several positive pleiotropic effects, such as reduction in blood pressure and heart rate, improved insulin/glucose metabolism, improved blood lipids, as well as ameliorated adipokines, corroborating previous findings on the beneficial effects of weight reduction on cardiovascular morbidity. [27][28][29][30] Since obesity is associated with cardiovascular risk factors such as hypertension and diabetes, as well as with cardiac structural changes such as CAD, obesity might be found as an indirect predictor for LVDD. Indeed, it has been recently reported that exercise and weight loss may improve exercise capacity due to a general improvement of MetS parameters but independently of cardiac function in obese subjects with the MetS.…”

2013 Esh/Esc Guidelines for the Management of Arterial Hypertension

“…По данным исследования мероприятий по поддер-жанию здоровья при диабете (AHEAD), при уже развившемся сахарном диабете 2 типа преднаме-ренное снижение массы тела не уменьшало частоту сердечно-сосудистых событий, поэтому общий контроль факторов риска, вероятно, более значим, чем само по себе снижение массы тела. Снижению массы тела могут способствовать препараты для лечения ожирения, такие как орлистат, и, в боль-шей степени, -бариатрическая хирургия, которая снижает сердечно-сосудистый риск у больных с тяжелым (морбидным) ожирением [368]. Более подробную информацию можно получить в послед-нем документе, разработанном ESH и Европейской ассоциацией по изучению ожирения [368].…”