Dustan H P
Veterans Administration Hospital, Alabama.
Diabetes Care. 1991 Jun;14(6):488-504. doi: 10.2337/diacare.14.6.488.
There is a close association of obesity with hypertension through mechanisms not now understood. Hypertension occurs frequently in industrialized societies where weight gain with advancing years is a common feature and is rare in primitive societies where weight and age are negatively correlated. Hemodynamically, obesity is characterized by an expanded blood volume and increased cardiac output. Hypertension results if/when systemic vascular resistance fails to decrease as cardiac output increases. When calorie restriction leads to weight loss, both blood volume and cardiac output decrease; when the blood pressure falls, this is because peripheral resistance is unchanged. Weight-loss programs are helpful for the obese hypertensive because when hypertension is mild, blood pressure often (but not always) normalizes. Also, weight loss has been shown to decrease antihypertensive drug requirements. Interest in obesity-associated hypertension focuses on hyperinsulinemia/insulin resistance as causative factors. Although the evidence is tempting, it is far from conclusive and it seems likely that the mechanism of this type of hypertension is as multifactorial as those of other types.
肥胖与高血压之间存在紧密联系，但其机制目前尚不清楚。高血压在工业化社会中很常见，在这些社会中，随着年龄增长体重增加是一个普遍特征；而在原始社会中则很少见，在原始社会中体重与年龄呈负相关。从血液动力学角度来看，肥胖的特征是血容量增加和心输出量增加。如果心输出量增加时全身血管阻力未能降低，就会导致高血压。当热量限制导致体重减轻时，血容量和心输出量都会减少；血压下降是因为外周阻力没有变化。减肥计划对肥胖型高血压患者有帮助，因为当高血压较轻时，血压通常（但并非总是）会恢复正常。此外，已证明体重减轻可减少抗高血压药物的需求。对肥胖相关高血压的研究重点在于高胰岛素血症/胰岛素抵抗作为致病因素。尽管证据很有吸引力，但远非确凿无疑，而且这种类型高血压的机制似乎与其他类型一样是多因素的。
