Cohen Jordana B
Renal, Electrolyte and Hypertension Division, Hospital of the University of Pennsylvania, 3400 Spruce St., 1 Founders, Philadelphia, PA, 19104, USA.
Curr Cardiol Rep. 2017 Aug 24;19(10):98. doi: 10.1007/s11886-017-0912-4.
Several interrelated mechanisms promote the development of hypertension in obesity, often contributing to end organ damage including cardiovascular disease and chronic kidney disease.
The treatment of hypertension in obesity is complicated by a high prevalence of resistant hypertension, as well as unpredictable hemodynamic effects of many medications. Weight loss stabilizes neurohormonal activity and causes clinically significant reductions in blood pressure. While lifestyle interventions can improve blood pressure, they fail to consistently yield sustained weight loss and have not demonstrated long-term benefits. Bariatric surgery provides more permanent weight reduction, corresponding with dramatic declines in blood pressure and attenuation of long-term cardiovascular risk. Hypertension is closely linked to the prevalence, pathophysiology, and morbidity of obesity. There are multiple barriers to managing hypertension in obesity. Surgical weight loss offers the most promise in reducing blood pressure and decreasing end organ damage in this patient population.
多种相互关联的机制促进肥胖患者高血压的发生发展，常导致包括心血管疾病和慢性肾病在内的终末器官损害。
肥胖患者高血压的治疗因顽固性高血压的高患病率以及多种药物不可预测的血流动力学效应而变得复杂。体重减轻可稳定神经激素活性，并使血压出现具有临床意义的下降。虽然生活方式干预可改善血压，但它们未能持续实现体重的持续减轻，也未显示出长期益处。减重手术可实现更持久的体重减轻，同时血压显著下降，长期心血管风险降低。高血压与肥胖的患病率、病理生理学及发病率密切相关。肥胖患者高血压的管理存在多重障碍。手术减重对于降低该患者群体的血压及减少终末器官损害最具前景。
