Abstract
Background: The relationship between obesity and hypertension has been established in both adults and children. The combination of obesity, hypertension and other cardiovascular risk factors significantly increases the likelihood of adverse cardiovascular effects and raises concerns about aggressive treatment strategies.
Objective: Despite the impressive elements which indicate an important role for excessive weight gain in increasing blood pressure, not all obese patients are hypertensive. A subgroup of obese people may not develop hypertension. Furthermore, masked hypertension occurs more common among obese patients, and body fat distribution has a major role in the development of hypertension.
Method: We conducted a research of the relevant literature regarding obesity-induced hypertension and possible treatment strategies.
Results: Successful weight loss is correlated with blood pressure reduction and requires a multidisciplinary approach that includes personalized dietary interventions combined with regular exercise and cognitive behavioral therapy.
Conclusion: Pharmacological therapy may be considered as part of a comprehensive obesity management strategy. More research and new treatment therapies are required in this field.
Keywords: Obesity, hypertension, antiobesity drugs, obesity-induced hypertension, treatment, weight loss.
Graphical Abstract
[2]
Kelly T, Yang W, Chen CS, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes 2008; 32(9): 1431-7.
[3]
Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet (London, England) 2014; 384(9945): 766-81.
[4]
Yumuk V, Tsigos C, Fried M, et al. European guidelines for obesity management in adults. Obes Facts 2015; 8(6): 402-24.
[7]
Klop B, Elte JW, Cabezas MC. Dyslipidemia in obesity: Mechanisms and potential targets. Nutrients 2013; 5(4): 1218-40.
[8]
Kotsis V, Tsioufis K, Antza C, et al. Obesity and cardiovascular risk: A call for action from the European Society of Hypertension Working Group of Obesity, Diabetes and the High-risk Patient and European Association for the Study of Obesity: Part B: Obesity-induced cardiovascular disease, early prevention strategies and future research directions. J Hypertens 2018; 36(7): 1441-55.
[9]
Kotsis V, Stabouli S, Bouldin M, Low A, Toumanidis S, Zakopoulos N. Impact of obesity on 24-hour ambulatory blood pressure and hypertension. Hypertension 2005; 45(4): 602-7.
[10]
Stabouli S, Kotsis V, Papamichael C, Constantopoulos A, Zakopoulos N. Adolescent obesity is associated with high ambulatory blood pressure and increased carotid intimal-medial thickness. J Pediatr 2005; 147(5): 651-6.
[11]
Wofford MR, Anderson DC Jr, Brown CA, Jones DW, Miller ME, Hall JE. Antihypertensive effect of alpha- and beta-adrenergic blockade in obese and lean hypertensive subjects. Am J Hypertens 2001; 14(7 Pt 1): 694-8.
[12]
Hall JE, Brands MW, Hildebrandt DA, Kuo J, Fitzgerald S. Role of sympathetic nervous system and neuropeptides in obesity hypertension. Braz J Med Biol Res 2000; 33(6): 605-18.
[13]
Coatmellec-Taglioni G, Ribiere C. Factors that influence the risk of hypertension in obese individuals. Curr Opin Nephrol Hypertens 2003; 12(3): 305-8.
[14]
Rocchini AP, Yang JQ, Gokee A. Hypertension and insulin resistance are not directly related in obese dogs. Hypertension 2004; 43(5): 1011-6.
[15]
Narkiewicz K, van de Borne PJ, Cooley RL, Dyken ME, Somers VK. Sympathetic activity in obese subjects with and without obstructive sleep apnea. Circulation 1998; 98(8): 772-6.
[16]
Hall JE, Louis K. Dahl Memorial Lecture. Renal and cardiovascular mechanisms of hypertension in obesity. Hypertension 1994; 23(3): 381-94.
[17]
Jones DW, Kim JS, Andrew ME, Kim SJ, Hong YP. Body mass index and blood pressure in Korean men and women: The Korean National Blood Pressure Survey. J Hypertens 1994; 12(12): 1433-7.
[19]
Droyvold WB, Midthjell K, Nilsen TI, Holmen J. Change in body mass index and its impact on blood pressure: A prospective population study. Int J Obes 2005; 29(6): 650-5.
[20]
Stevens VJ, Obarzanek E, Cook NR, et al. Long-term weight loss and changes in blood pressure: Results of the trials of hypertension prevention, phase II. Ann Intern Med 2001; 134(1): 1-11.
[21]
Jones DW, Miller ME, Wofford MR, et al. The effect of weight loss intervention on antihypertensive medication requirements in the hypertension Optimal Treatment (HOT) study. Am J Hypertens 1999; 12(12 Pt 1-2): 1175-80.
[22]
Hall JE, Crook ED, Jones DW, Wofford MR, Dubbert PM. Mechanisms of obesity-associated cardiovascular and renal disease. Am J Med Sci 2002; 324(3): 127-37.
[23]
Tchernof A, Despres JP. Pathophysiology of human visceral obesity: An update. Physiol Rev 2013; 93(1): 359-404.
[24]
Echouffo-Tcheugui JB, Short MI, Xanthakis V, et al. Natural history of obesity sub-phenotypes: Dynamic changes over two decades and prognosis in The Framingham Heart study. J Clin Endocrinol Metab 2019; 104(3): 738-52.
[25]
Bell JA, Hamer M, Sabia S, Singh-Manoux A, Batty GD, Kivimaki M. The natural course of healthy obesity over 20 years. J Am Coll Cardiol 2015; 65(1): 101-2.
[26]
Stefan N, Haring HU, Schulze MB. Metabolically healthy obesity: The low-hanging fruit in obesity treatment? Lancet Diabetes Endocrinol 2018; 6(3): 249-58.
[27]
Kramer CK, Zinman B, Retnakaran R. Are metabolically healthy overweight and obesity benign conditions?: A systematic review and meta-analysis. Ann Intern Med 2013; 159(11): 758-69.
[28]
Ozkan S, Ata N, Yavuz B. Increased masked hypertension prevalence in patients with obesity. Clin Exp Hypertens 2018; 40(8): 780-3.
[29]
Kenny IE, Saeed S, Gerdts E, Midtbo H, Halland H, Lonnebakken MT. Masked hypertension in obesity: Potential predictors and arterial damage. Blood Press Monit 2017; 22(1): 12-7.
[30]
Colantonio LD, Anstey DE, Carson AP, et al. Metabolic syndrome and masked hypertension among African Americans: The Jackson Heart Study. J Clin Hypertens 2017; 19(6): 592-600.
[31]
Cuspidi C, Facchetti R, Bombelli M, et al. Risk of new-onset metabolic syndrome associated with white-coat and masked hypertension: Data from a general population. J Hypertens 2018; 36(9): 1833-9.
[32]
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet 2017; 390(10113): 2627-42.
[33]
Wang P, Abdin E, Sambasivam R, Chong SA, Vaingankar JA, Subramaniam M. Smoking and Socio-demographic correlates of BMI. BMC Public Health 2016; 16: 500.
[34]
Nelson RG, Sievers ML, Knowler WC, et al. Low incidence of fatal coronary heart disease in Pima Indians despite high prevalence of non-insulin-dependent diabetes. Circulation 1990; 81(3): 987-95.
[35]
Calhoun DA, Oparil S. Racial differences in the pathogenesis of hypertension. Am J Med Sci 1995; 310(Suppl. 1): S86-90.
[36]
Saad MF, Knowler WC, Pettitt DJ, Nelson RG, Mott DM, Bennett PH. Insulin and hypertension. Relationship to obesity and glucose intolerance in Pima Indians. Diabetes 1990; 39(11): 1430-5.
[37]
Cheung EL, Bell CS, Samuel JP, Poffenbarger T, Redwine KM, Samuels JA. Race and obesity in adolescent hypertension. Pediatrics 2017; 139(5): pii: . e20161433
[38]
Seo DC, Choe S, Torabi MR. Is waist circumference >/=102/88cm better than body mass index >/=30 to predict hypertension and diabetes development regardless of gender, age group, and race/ethnicity? Meta-analysis. Prev Med 2017; 97: 100-8.
[39]
Young DR, Fischer H, Arterburn D, et al. Associations of overweight/obesity and socioeconomic status with hypertension prevalence across racial and ethnic groups. J Clin Hypertens (Greenwich) 2018; 20(3): 532-40.
[40]
Aroor AR, McKarns S, Demarco VG, Jia G, Sowers JR. Maladaptive immune and inflammatory pathways lead to cardiovascular insulin resistance. Metabolism 2013; 62(11): 1543-52.
[41]
Howard BV, Cowan LD, Go O, Welty TK, Robbins DC, Lee ET. Adverse effects of diabetes on multiple cardiovascular disease risk factors in women. The Strong Heart Study. Diabetes Care 1998; 21(8): 1258-65.
[42]
Huxley R, Barzi F, Woodward M. Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. BMJ 2006; 332(7533): 73-8.
[43]
Huang Z, Willett WC, Manson JE, et al. Body weight, weight change, and risk for hypertension in women. Ann Intern Med 1998; 128(2): 81-8.
[44]
Engeli S, Bohnke J, Gorzelniak K, et al. Weight loss and the renin-angiotensin-aldosterone system. Hypertension 2005; 45(3): 356-62.
[45]
Burke GL, Bertoni AG, Shea S, et al. The impact of obesity on cardiovascular disease risk factors and subclinical vascular disease: The Multi-Ethnic Study of Atherosclerosis. Arch Intern Med 2008; 168(9): 928-35.
[46]
Brunner EJ, Shipley MJ, Ahmadi-Abhari S, et al. Adiposity, obesity, and arterial aging: longitudinal study of aortic stiffness in the Whitehall II cohort. Hypertension 2015; 66(2): 294-300.
[47]
Wohlfahrt P, Somers VK, Cifkova R, et al. Relationship between measures of central and general adiposity with aortic stiffness in the general population. Atherosclerosis 2014; 235(2): 625-31.
[48]
Boillot A, Zoungas S, Mitchell P, et al. Obesity and the microvasculature: A systematic review and meta-analysis. PLoS One 2013; 8(2)e52708
[49]
Antza C, Doundoulakis I, Akrivos E, et al. Early vascular aging risk assessment from ambulatory blood pressure monitoring: The early vascular aging ambulatory score. Am J Hypertens 2018; 31(11): 1197-204.
[50]
Hsu CY, McCulloch CE, Iribarren C, Darbinian J, Go AS. Body mass index and risk for end-stage renal disease. Ann Intern Med 2006; 144(1): 21-8.
[51]
Sikorska D, Grzymislawska M, Roszak M, Gulbicka P, Korybalska K, Witowski J. Simple obesity and renal function. J Physiol Pharmacol 2017; 68(2): 175-80.
[52]
Chagnac A, Weinstein T, Herman M, Hirsh J, Gafter U, Ori Y. The effects of weight loss on renal function in patients with severe obesity. J Am Soc Nephrol 2003; 14(6): 1480-6.
[53]
Johnson BL, Blackhurst DW, Latham BB, et al. Bariatric surgery is associated with a reduction in major macrovascular and microvascular complications in moderately to severely obese patients with type 2 diabetes mellitus. J Am Coll Surg 2013; 216(4): 545-56. discussion 56-8.
[54]
Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis. BMC Public Health 2009; 9: 88.
[55]
Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med 2002; 347(5): 305-13.
[56]
Cuspidi C, Rescaldani M, Sala C, Grassi G. Left-ventricular hypertrophy and obesity: A systematic review and meta-analysis of echocardiographic studies. J Hypertens 2014; 32(1): 16-25.
[57]
Williams B, Mancia G, Spiering W, et al. 2018 Practice Guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology: ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens 2018; 36(12): 2284-309.
[58]
Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur J Prev Cardiol 2016; 23(11): Np1-np96.
[59]
Neter JE, Stam BE, Kok FJ, Grobbee DE, Geleijnse JM. Influence of weight reduction on blood pressure: A meta-analysis of randomized controlled trials. Hypertension 2003; 42(5): 878-84.
[60]
Dernini S, Berry EM. Mediterranean diet: From a healthy diet to a sustainable dietary pattern. Front Nutr 2015; 2: 15.
[61]
Estruch R, Ros E, Salas-Salvado J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; 368(14): 1279-90.
[62]
Larsen TM, Dalskov SM, van Baak M, et al. Diets with high or low protein content and glycemic index for weight-loss maintenance. N Engl J Med 2010; 363(22): 2102-13.
[63]
Ayyad C, Andersen T. Long-term efficacy of dietary treatment of obesity: A systematic review of studies published between 1931 and 1999. Obes Rev 2000; 1(2): 113-9.
[64]
Kay SJ, Fiatarone Singh MA. The influence of physical activity on abdominal fat: A systematic review of the literature. Obes Rev 2006; 7(2): 183-200.
[65]
Lee S, Kuk JL, Davidson LE, et al. Exercise without weight loss is an effective strategy for obesity reduction in obese individuals with and without Type 2 diabetes. J Appl Physiol 2005; 99(3): 1220-5.
[66]
Ross R, Janssen I, Dawson J, et al. Exercise-induced reduction in obesity and insulin resistance in women: A randomized controlled trial. Obes Res 2004; 12(5): 789-98.
[67]
Willis LH, Slentz CA, Bateman LA, et al. Effects of aerobic and/or resistance training on body mass and fat mass in overweight or obese adults. J Appl Physiol 2012; 113(12): 1831-7.
[68]
Geliebter A, Ochner CN, Dambkowski CL, Hashim SA. Obesity-related hormones and metabolic risk factors: A randomized trial of diet plus either strength or aerobic training versus diet alone in overweight participants. J Diabetes Obes 2014; 1(1): 1-7.
[69]
Poirier P, Despres JP. Exercise in weight management of obesity. Cardiol Clin 2001; 19(3): 459-70.
[70]
Chirinos JA, Gurubhagavatula I, Teff K, et al. CPAP, weight loss, or both for obstructive sleep apnea. N Engl J Med 2014; 370(24): 2265-75.
[71]
Billes SK, Sinnayah P, Cowley MA. Naltrexone/bupropion for obesity: An investigational combination pharmacotherapy for weight loss. Pharmacol Res 2014; 84: 1-11.
[72]
Bray GA. Medical treatment of obesity: The past, the present and the future. Best Pract Res Clin Gastroenterol 2014; 28(4): 665-84.
[73]
Halpern B, Mancini MC. Safety assessment of combination therapies in the treatment of obesity: Focus on naltrexone/bupropion extended release and phentermine-topiramate extended release. Expert Opin Drug Saf 2017; 16(1): 27-39.
[74]
Wadden TA, Foreyt JP, Foster GD, et al. Weight loss with naltrexone SR/bupropion SR combination therapy as an adjunct to behavior modification: The COR-BMOD trial. Obesity 2011; 19(1): 110-20.
[75]
Greenway FL, Dunayevich E, Tollefson G, et al. Comparison of combined bupropion and naltrexone therapy for obesity with monotherapy and placebo. J Clin Endocrinol Metab 2009; 94(12): 4898-906.
[76]
Greenway FL, Fujioka K, Plodkowski RA, et al. Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): A multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2010; 376(9741): 595-605.
[77]
Allison DB, Gadde KM, Garvey WT, et al. Controlled-release phentermine/topiramate in severely obese adults: A randomized controlled trial (EQUIP). Obesity 2012; 20(2): 330-42.
[78]
Gadde KM, Allison DB, Ryan DH, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): A randomised, placebo-controlled, phase 3 trial. Lancet 2011; 377(9774): 1341-52.
[79]
Garvey WT, Ryan DH, Look M, et al. Two-year sustained weight loss and metabolic benefits with controlled-release phentermine/topiramate in obese and overweight adults (SEQUEL): A randomized, placebo-controlled, phase 3 extension study. Am J Clin Nutr 2012; 95(2): 297-308.
[80]
Jordan J, Astrup A, Engeli S, Narkiewicz K, Day WW, Finer N. Cardiovascular effects of phentermine and topiramate: A new drug combination for the treatment of obesity. J Hypertens 2014; 32(6): 1178-88.
[81]
Brashier DB, Sharma AK, Dahiya N, Singh SK, Khadka A. Lorcaserin: A novel antiobesity drug. J Pharmacol Pharmacother 2014; 5(2): 175-8.
[82]
Pucci A, Finer N. New medications for treatment of obesity: Metabolic and cardiovascular effects. Can J Cardiol 2015; 31(2): 142-52.
[83]
Fidler MC, Sanchez M, Raether B, et al. A one-year randomized trial of lorcaserin for weight loss in obese and overweight adults: The BLOSSOM trial. J Clin Endocrinol Metab 2011; 96(10): 3067-77.
[84]
O’Neil PM, Smith SR, Weissman NJ, et al. Randomized placebo-controlled clinical trial of lorcaserin for weight loss in type 2 diabetes mellitus: The BLOOM-DM study. Obesity 2012; 20(7): 1426-36.
[85]
Thrasher J. Pharmacologic management of type 2 diabetes mellitus: available therapies. Am J Med 2017; 130(6s): S4-s17.
[86]
Karagiannis T, Liakos A. Efficacy and safety of once-weekly glucagon-like peptide 1 receptor agonists for the management of type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Diabetes Obes Metab 2015; 17(11): 1065-74.
[87]
Varanasi A, Patel P, Makdissi A, Dhindsa S, Chaudhuri A, Dandona P. Clinical use of liraglutide in type 2 diabetes and its effects on cardiovascular risk factors. Endocr Pract 2012; 18(2): 140-5.
[88]
Vilsboll T, Zdravkovic M, Le-Thi T, et al. Liraglutide, a long-acting human glucagon-like peptide-1 analog, given as monotherapy significantly improves glycemic control and lowers body weight without risk of hypoglycemia in patients with type 2 diabetes. Diabetes Care 2007; 30(6): 1608-10.
[89]
Zinman B, Gerich J, Buse JB, et al. Efficacy and safety of the human glucagon-like peptide-1 analog liraglutide in combination with metformin and thiazolidinedione in patients with type 2 diabetes (LEAD-4 Met+TZD). Diabetes Care 2009; 32(7): 1224-30.
[90]
Wang B, Zhong J, Lin H, et al. Blood pressure-lowering effects of GLP-1 receptor agonists exenatide and liraglutide: A meta-analysis of clinical trials. Diabetes Obes Metab 2013; 15(8): 737-49.
[91]
Sun F, Wu S, Guo S, et al. Impact of GLP-1 receptor agonists on blood pressure, heart rate and hypertension among patients with type 2 diabetes: A systematic review and network meta-analysis. Diabetes Res Clin Pract 2015; 110(1): 26-37.
[92]
Katout M, Zhu H, Rutsky J, et al. Effect of GLP-1 mimetics on blood pressure and relationship to weight loss and glycemia lowering: Results of a systematic meta-analysis and meta-regression. Am J Hypertens 2014; 27(1): 130-9.
[93]
O’Neil PM, Birkenfeld AL, McGowan B, et al. Efficacy and safety of semaglutide compared with liraglutide and placebo for weight loss in patients with obesity: A randomised, double-blind, placebo and active controlled, dose-ranging, phase 2 trial. Lancet 2018; 392(10148): 637-49.
[94]
Kotsis V, Jordan J, Micic D, et al. Obesity and cardiovascular risk: A call for action from the European Society of Hypertension Working Group of Obesity, Diabetes and the High-risk Patient and European Association for the Study of Obesity: Part A: Mechanisms of obesity induced hypertension, diabetes and dyslipidemia and practice guidelines for treatment. J Hypertens 2018; 36(7): 1427-40.
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