Internal Medicine, University of Missouri, Columbia School of Medicine, One Hospital Drive, Columbia, MO 65212, USA.
Nat Rev Endocrinol. 2014 Jun;10(6):364-76. doi: 10.1038/nrendo.2014.44. Epub 2014 Apr 15.
The combination of obesity and hypertension is associated with high morbidity and mortality because it leads to cardiovascular and kidney disease. Potential mechanisms linking obesity to hypertension include dietary factors, metabolic, endothelial and vascular dysfunction, neuroendocrine imbalances, sodium retention, glomerular hyperfiltration, proteinuria, and maladaptive immune and inflammatory responses. Visceral adipose tissue also becomes resistant to insulin and leptin and is the site of altered secretion of molecules and hormones such as adiponectin, leptin, resistin, TNF and IL-6, which exacerbate obesity-associated cardiovascular disease. Accumulating evidence also suggests that the gut microbiome is important for modulating these mechanisms. Uric acid and altered incretin or dipeptidyl peptidase 4 activity further contribute to the development of hypertension in obesity. The pathophysiology of obesity-related hypertension is especially relevant to premenopausal women with obesity and type 2 diabetes mellitus who are at high risk of developing arterial stiffness and endothelial dysfunction. In this Review we discuss the relationship between obesity and hypertension with special emphasis on potential mechanisms and therapeutic targeting that might be used in a clinical setting.
肥胖和高血压的结合与高发病率和死亡率相关，因为它会导致心血管和肾脏疾病。将肥胖与高血压联系起来的潜在机制包括饮食因素、代谢、内皮和血管功能障碍、神经内分泌失衡、钠潴留、肾小球高滤过、蛋白尿以及适应性免疫和炎症反应。内脏脂肪组织也对胰岛素和瘦素产生抗性，并且是改变分子和激素分泌的部位，例如脂联素、瘦素、抵抗素、TNF 和 IL-6，这些会加剧与肥胖相关的心血管疾病。越来越多的证据还表明，肠道微生物组对于调节这些机制很重要。尿酸和改变的肠降血糖素或二肽基肽酶 4 活性进一步导致肥胖相关的高血压的发生。肥胖相关高血压的病理生理学与肥胖和 2 型糖尿病的绝经前女性特别相关，这些女性发生动脉僵硬和内皮功能障碍的风险很高。在这篇综述中，我们讨论了肥胖与高血压之间的关系，特别强调了可能在临床环境中使用的潜在机制和治疗靶点。
