Shaper A G
Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London, UK.
Ciba Found Symp. 1996;201:90-103; discussion 103-7, 188-93.
The strong and consistent relationship observed between body weight and blood pressure develops early in life, and overweight/obesity in adult life is a good predictor of hypertension. Weight reduction leads to a decrease in blood pressure and prevention of weight increase lowers the incidence of hypertension, but obesity is not necessarily the direct cause of raised blood pressure. Obesity is not established as an independent risk factor for stroke beyond its association with other risk factors. Obesity is a relatively weak risk factor for coronary heart disease (CHD) but it is closely associated with almost all other coronary risk factors. Thus, becoming obese on a Western high fat diet, with development of excess central fat, promotes atherogenesis through a wide range of biochemical and hormonal parameters, including insulin sensitivity. The obesity-CHD relationship is further confused by the weight loss associated with smoking and smoking-related disease, and is confounded by risk factors that accompany the development and maintenance of obesity. Weight loss in middle-aged populations does not apparently lower CHD incidence, possibly because of lack of specificity in methods of weight reduction. Irrespective of the mechanisms involved, early prevention of atherogenic weight gain in young adulthood is an important public health goal towards the control of hypertension and CHD.
体重与血压之间观察到的紧密且一致的关系在生命早期就已形成，成年期的超重/肥胖是高血压的良好预测指标。体重减轻会导致血压下降，预防体重增加可降低高血压的发病率，但肥胖不一定是血压升高的直接原因。除了与其他危险因素相关联外，肥胖尚未被确立为中风的独立危险因素。肥胖是冠心病（CHD）的相对较弱的危险因素，但它与几乎所有其他冠心病危险因素密切相关。因此，在西方高脂肪饮食下变得肥胖，并伴有过多的中心性脂肪堆积，会通过包括胰岛素敏感性在内的一系列生化和激素参数促进动脉粥样硬化的发生。肥胖与冠心病的关系因与吸烟及吸烟相关疾病有关的体重减轻而进一步复杂化，并且还受到伴随肥胖发生和维持的危险因素的混淆。中年人群体重减轻显然不会降低冠心病发病率，这可能是由于减肥方法缺乏特异性所致。无论涉及何种机制，在成年早期尽早预防致动脉粥样硬化的体重增加都是控制高血压和冠心病的一项重要公共卫生目标。
