Frezza Eldo E, Wei Cai, Wachtel Mitchell S
Center for Metabolic and Obesity Diseases, Department of Surgery and Pathology, Texas Tech University Health Sciences Center, Lubbock, USA.
J Clin Hypertens (Greenwich). 2009 May;11(5):284-8. doi: 10.1111/j.1751-7176.2009.00123.x.
Obesity is related to multiple comorbidities, including hypertension, diabetes, hypercholesterolemia, and sleep apnea. Comorbidities burden the health care system, such that in the United States, 6% to 8% of health care costs are related to obesity. Obesity-induced hypertension has multiple potential etiologic pathways, the most well established being increased renal sodium reabsorption with impaired pressure natriuresis via (1) activation of the renin-angiotensin system, (2) stimulation of the sympathetic nervous system, and (3) altered intrarenal physical forces. Weight loss is the best means to reduce obesity-related hypertension. For every 3 patients who lose 10 pounds of weight and maintain the weight loss for 4 years, 1 of them will eliminate the use of antihypertensive medication. Whereas nonsurgical therapy ineffectually treats extreme obesity, bariatric surgery yields durable weight loss, as well as resolution of some of the comorbidities associated with obesity, including hypertension. Increase in anti-inflammatory factors secreted by adipocytes may explain some of the improvement in blood pressure in the first 3 years post-procedure. Bariatric surgery safely and effectively improves and may improve or eliminate obesity-related hypertension. More data need to be collected to substantiate the same results over periods of time longer than 3 years.
肥胖与多种合并症相关，包括高血压、糖尿病、高胆固醇血症和睡眠呼吸暂停。合并症给医疗保健系统带来负担，在美国，6%至8%的医疗保健费用与肥胖有关。肥胖所致高血压有多种潜在病因途径，其中最明确的是通过以下方式导致肾钠重吸收增加，压力性利钠功能受损：(1) 激活肾素-血管紧张素系统；(2) 刺激交感神经系统；(3) 肾内物理力改变。体重减轻是降低肥胖相关高血压的最佳方法。每3名体重减轻10磅并维持体重减轻4年的患者中，就有1人将停用降压药物。非手术治疗对极端肥胖无效，而减肥手术可实现持久的体重减轻，还能解决一些与肥胖相关的合并症，包括高血压。脂肪细胞分泌的抗炎因子增加可能解释了术后头3年血压改善的部分原因。减肥手术安全有效地改善且可能改善或消除肥胖相关高血压。需要收集更多数据来证实超过3年时间的相同结果。
