Department of Internal Medicine, Division of Endocrinology and Metabolism, University of Iowa Hospitals & Clinics, Iowa City, IA, USA.
Departamento de Medicina Clínica, Universidade Federal Fluminense, Niterói, Brazil.
J Hum Hypertens. 2022 Sep;36(9):785-793. doi: 10.1038/s41371-021-00644-y. Epub 2022 Jan 10.
The prevalence of obesity has increased two to three times from 1975 to 2015. Large-scale epidemiological and longitudinal prospective studies link obesity with hypertension. Research suggests that excessive weight gain, particularly when associated with visceral adiposity, may account for as much as 65% to 75% of the risk of incident hypertension. Also, exercise and bariatric/metabolic surgery significantly lowers blood pressure, whereas weight gain increases blood pressure, thus establishing a firm link between these two factors. The mechanisms underpinning obesity-related hypertension are complex and multifaceted, and include, but are not limited to, renin-angiotensin-aldosterone system/sympathetic nervous system overactivation, overstimulation of adipokines, insulin resistance, immune dysfunction, structural/functional renal, cardiac, and adipocyte changes. Though weight loss is the mainstay of treatment for obesity-related hypertension, it is often not a feasible long-term solution. Therefore, it is recommended that aggressive treatment with multiple antihypertensive medications combined with diet and exercise be used to lower blood pressure and prevent complications. The research regarding the mechanisms and treatment of obesity-related hypertension has moved at a blistering pace over the past ten years. Therefore, the purpose of this expert review is two-fold: to discuss the pathophysiological mechanisms underlying obesity-related hypertension, and to revisit pharmacotherapies that have been shown to be efficacious in patients with obesity-related hypertension.
肥胖症的患病率在 1975 年至 2015 年期间增加了两到三倍。大规模的流行病学和纵向前瞻性研究将肥胖与高血压联系起来。研究表明，体重过度增加，特别是与内脏脂肪过多相关时，可能占高血压新发病例风险的 65%至 75%。此外，运动和减肥/代谢手术显著降低血压，而体重增加会升高血压，从而在这两个因素之间建立了牢固的联系。肥胖相关高血压的机制复杂且多方面，包括但不限于肾素-血管紧张素-醛固酮系统/交感神经系统过度激活、脂肪因子过度刺激、胰岛素抵抗、免疫功能障碍、结构性/功能性肾、心脏和脂肪细胞变化。尽管减肥是肥胖相关高血压治疗的主要方法，但它通常不是可行的长期解决方案。因此，建议使用多种降压药物联合饮食和运动来积极降低血压并预防并发症。过去十年中，肥胖相关高血压的机制和治疗研究进展迅速。因此，本次专家综述的目的有两个：讨论肥胖相关高血压的病理生理机制，并重新审视在肥胖相关高血压患者中已证明有效的药物治疗方法。
