Aneja Ashish, El-Atat Fadi, McFarlane Samy I, Sowers James R
Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, New York 11203, USA.
Recent Prog Horm Res. 2004;59:169-205. doi: 10.1210/rp.59.1.169.
Obesity is a common problem in much of the western world today in that is linked directly with several disease processes, notably, hypertension. It is becoming clear that the adipocyte is not merely an inert organ for storage of energy but that it also secretes a host of factors that interact with each other and may result in elevated blood pressure. Of particular importance is the putative role of leptin in the causation of hypertension via an activation of the sympathetic nervous system and a direct effect on the kidneys, resulting in increased sodium reabsorption leading to hypertension. Obesity per se may have structural effects on the kidneys that may perpetuate hypertension, leading to an increased incidence of end-stage renal disease that results in further hypertension. Adipose tissue may elaborate angiotensin from its own local renin-angiotensin system. The distribution of body fat is considered important in the genesis of the obesity-hypertension syndrome, with a predominantly central distribution being particularly ominous. Weight loss is the cornerstone in the management of the obesity-hypertension syndrome. It may be achieved with diet, exercise, medications, and a combination of these measures. Anti-obesity medications that are currently undergoing clinical trials may play a promising role in the management of obesity and may also result in lowering of blood pressure. Antihypertensives are considered important components in the holistic approach to the management of this complex problem.
肥胖是当今西方世界大部分地区的一个常见问题，因为它与多种疾病进程直接相关，尤其是高血压。越来越明显的是，脂肪细胞不仅仅是一个储存能量的惰性器官，它还分泌大量相互作用的因子，可能导致血压升高。特别重要的是瘦素在高血压病因中的假定作用，它通过激活交感神经系统和对肾脏的直接作用，导致钠重吸收增加，进而引发高血压。肥胖本身可能对肾脏产生结构性影响，从而使高血压持续存在，导致终末期肾病的发病率增加，进而导致进一步的高血压。脂肪组织可能会从自身的局部肾素 - 血管紧张素系统中合成血管紧张素。身体脂肪的分布在肥胖 - 高血压综合征的发生中被认为很重要，以中心分布为主尤其危险重重。减肥是肥胖 - 高血压综合征管理的基石。可以通过饮食、运动、药物以及这些措施的组合来实现。目前正在进行临床试验的抗肥胖药物可能在肥胖管理中发挥有前景的作用，也可能导致血压降低。抗高血压药物被认为是整体管理这个复杂问题方法中的重要组成部分。
