Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia.
Department of Cardiology, Royal Perth Hospital, Perth, Australia.
Curr Hypertens Rep. 2017 Oct 28;19(12):99. doi: 10.1007/s11906-017-0795-1.
Obesity-related hypertension is commonly characterized by increased sympathetic nerve activity and is therefore acknowledged as a predominantly neurogenic form of hypertension. The sustained sympatho-excitation not only contributes to the rise in blood pressure but also elicits a vicious cycle which facilitates further weight gain and progression of associated co-morbidities. While weight loss and exercise remain at the forefront of therapy for obesity and obesity-related hypertension, the difficulties in achieving and maintaining long-term weight loss with lifestyle measures and the variable blood pressure response to weight loss often necessitate prescription of antihypertensive drug therapy. Remarkably, there are no specific recommendations for pharmacologic treatment for obese patients with arterial hypertension in any of the current guidelines and general principles of antihypertensive treatment are applied. The use of β-blockers and diuretics is commonly discouraged as first- or second-line therapy due to their unfavorable metabolic effects. This review explores evolving therapeutic strategies which based on their interference with pathophysiologic mechanism relevant in the context of obesity may guide optimized treatment of obesity-related hypertension.
肥胖相关性高血压通常以交感神经活动增加为特征，因此被认为是一种主要的神经原性高血压形式。持续的交感兴奋不仅导致血压升高，而且还引发了一个恶性循环，促进了体重进一步增加和相关合并症的进展。虽然减肥和运动仍然是肥胖和肥胖相关性高血压治疗的首要方法，但通过生活方式措施实现和维持长期减肥的困难以及对减肥的血压反应的变化，往往需要开处降压药物治疗。值得注意的是，目前的任何指南中都没有针对肥胖合并动脉高血压患者的药物治疗的具体建议，而是应用了一般的降压治疗原则。由于β受体阻滞剂和利尿剂具有不利的代谢作用，通常不鼓励将其作为一线或二线治疗药物。本综述探讨了基于与肥胖相关的病理生理机制的干预的新的治疗策略，这些策略可能指导肥胖相关性高血压的优化治疗。
