Sharma Arya M, Engeli Stefan
Michael G. deGroote Medical School, McMaster University, Hamilton, Ontario, Canada.
J Cardiometab Syndr. 2006 Winter;1(1):29-35. doi: 10.1111/j.0197-3118.2006.05422.x.
The mounting epidemic of overweight and obesity has made understanding the relationship between excess weight and associated comorbidities more urgent. Obesity is one of the strongest predictors of the development of hypertension and is an independent risk factor for cardiovascular disease, renal disease, and diabetes mellitus. The concomitant presence of obesity and hypertension, as commonly occurs in the cardiometabolic syndrome, magnifies the risk for cardiovascular and renal disease. The term "obesity-hypertension" thus serves to underscore the link between these two deleterious conditions and to emphasize the imperative for clinical intervention. Adipose tissue is now known to produce hormones and cytokines that promote inflammation, lipid accumulation, and insulin resistance. In addition, adipose tissue contains all the components of the renin-angiotensin system (RAS), which is upregulated in the presence of obesity. Evidence implicates activation of the systemic and adipose tissue RAS, as well as the sympathetic nervous system, as key obesity-related mechanisms of hypertension and other components of the cardiometabolic syndrome. RAS blockade therefore becomes a potential therapeutic strategy in patients with obesity-related hypertension and in persons with the cardiometabolic syndrome. Clinical trials of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers conducted in predominantly overweight/obese populations have demonstrated significant reductions in cardiovascular and renal disease risk among a range of at-risk patients. RAS blockade also is associated with a reduced risk of new-onset diabetes compared with other classes of antihypertensive therapy. Randomized, controlled trials conducted specifically in patients with obesity and hypertension are needed to determine the optimal therapeutic approach for these patients.
超重和肥胖的流行日益加剧，使得了解超重与相关合并症之间的关系变得更加紧迫。肥胖是高血压发生的最强预测因素之一，也是心血管疾病、肾脏疾病和糖尿病的独立危险因素。肥胖和高血压同时存在，常见于心脏代谢综合征中，会增加心血管和肾脏疾病的风险。“肥胖-高血压”这一术语因此强调了这两种有害状况之间的联系，并突出了临床干预的必要性。现在已知脂肪组织会产生促进炎症、脂质积累和胰岛素抵抗的激素和细胞因子。此外，脂肪组织含有肾素-血管紧张素系统（RAS）的所有成分，在肥胖情况下该系统会上调。有证据表明，全身和脂肪组织RAS以及交感神经系统的激活是与肥胖相关的高血压及心脏代谢综合征其他成分的关键机制。因此，RAS阻断成为肥胖相关高血压患者和心脏代谢综合征患者的一种潜在治疗策略。在主要为超重/肥胖人群中进行的血管紧张素转换酶抑制剂和血管紧张素II受体阻滞剂的临床试验表明，一系列高危患者的心血管和肾脏疾病风险显著降低。与其他类别的抗高血压治疗相比，RAS阻断还与新发糖尿病风险降低有关。需要专门针对肥胖和高血压患者进行随机对照试验，以确定这些患者的最佳治疗方法。
