Obesity, hypertension, and the heart

Hypertension occurs more commonly in obese than in lean persons at virtuall y every age. A variety of endocrine, genetic, and metabolic mechanisms have been linked to the development of obesity hypertension. These include insu lin resistance and hyperinsulinemia, increased serum aldosterone levels, sa lt sensitivity and expanded plasma volume in the presence of increased peri pheral vascular resistance, a genetic predisposition, and possibly increase d leptin levels. Pressure and volume overload are present in obese hyperten sives. This leads to a mixed eccentric-concentric form of left ventricular hypertrophy and increases the predisposition to congestive heart failure. W eight loss, even in modest decrements, is effective in reducing obesity-hyp ertension, possibly by ameliorating several of the proposed pathophysiologi c mechanisms. There are currently no specific recommendations concerning ph armacotherapy of obesity-hypertension because each drug group has pros and cons.