Pathways from obesity to hypertension: from the perspective of a vicious triangle

Abstract

Obesity and arterial hypertension are important public health problems. Both overweight and hypertension predispose to cardiovascular diseases, such as myocardial infarction, stroke and renal failure. Moreover, overweight clearly predisposes to hypertension, and thus to an increased prevalence of cardiovascular diseases. This in turn favors inactivity and further weight gain, leading to an exacerbation of cardiovascular disorders. Obesity, hypertension and cardiovascular diseases thus contribute to three corners of a vicious triangle. It is within this conceptual framework that this paper reviews the pathogenesis of obesityrelated hypertension, which is highly complex. Many factors act together to promote vasoconstriction and sodium retention. Leptin, free fatty acids and insulin, whose levels are increased in obesity, may act synergistically to stimulate sympathetic activity and vasoconstriction. In addition, obesity-induced insulin resistance and endothelial dysfunction may operate as amplifiers of the vasoconstrictor response. Finally, increased renal tubular reabsorption of sodium may also occur, caused by an increased renal sympathetic nerve activity, the direct effect of insulin, hyperactivity of the renin -angiotensin system and possibly by an alteration of intrarenal physical forces. All together, these factors will lead to sustained hypertension. Because the prevalence of obesity was steadily increasing in the last decades, leading to an increased prevalence of hypertension and cardiovascular disorders, obesity and hypertension will most likely become the health challenges of the twenty-first century.

Ectopic fat storage in heart, blood vessels and kidneys in the pathogenesis of cardiovascular diseases

“…It could be postulated that some of the cardiac changes result from the hypertension often observed in obesity. 15 However, the increase in blood pressure is often very mild and is thus unlikely to cause by itself important structural cardiac changes. Furthermore, decrements in systolic and diastolic functions have been documented in obese subjects even in the absence of hypertension.…”

“…27 Furthermore, the poorer exercise tolerance in obesity, due to the combination of cardiac dysfunction, increased whole-body metabolic demands and weight-induced osteo-articular problems, may further potentiate obesity, leading to a vicious cycle of inactivity, weight gain and heart failure. 15 Ectopic fat storage around blood vessels Nearly, all blood vessels in the body are surrounded by variable amounts of adventitial fat. Traditionally, perivascular fat has been assumed to serve as structural support for the vasculature.…”

Insulin's microvascular vasodilatory effects are inversely related to peripheral vascular resistance in overweight, but insulin‐sensitive subjects

“…CO may be increased in obesity as a result of sodium retention and increased circulating volume (5). Although PVR would be expected to decrease in obesity as a result of the increase in capillary cross-sectional area in adipose tissue, it may be inappropriately high because of, for example, hyperactivity of the sympathetic nervous system (SNS), renin-angiotensin system activation, and impaired vasodilator function (3). PVR is mainly determined by microvascular structure and function.…”

“…Obesity is an important risk factor for cardiovascular disease. One of the major sequelae of obesity is hypertension (3,4), but the pathophysiological pathways linking obesity to disturbed blood pressure homeostasis are incompletely understood.…”

Rosiglitazone Restores G-Protein Coupling, Recruitment, and Function of Renal Dopamine D 1A Receptor in Obese Zucker Rats

“…Obesity promotes insulin resistance, which can lead to development of type 2 diabetes and hypertension. 1,2 Hypertension in patients with insulin resistance is usually associated with increased sodium retention, 3,4 which is mainly owing to inability of the kidney to excrete sodium appropriately, leading to development of hypertension.…”