MECHANISMS IN OBESITY-RELATED HYPERTENSION - ROLE OF INSULIN AND CATECHOLAMINES
MECHANISMS IN OBESITY-RELATED HYPERTENSION - ROLE OF INSULIN AND CATECHOLAMINES
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DOI：
10.1093/ajh/1.1.84
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发表时间：
1988-01-01
影响因子：
3.2
通讯作者：
LANDSBERG, L
中科院分区：
文献类型：
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作者：
KRIEGER, DR;LANDSBERG, L
尽管肥胖和高血压的关联已得到广泛认可，但肥胖者血压升高的发病机制却知之甚少。最近的研究探讨了 1) 身体脂肪分布对血压的影响以及 2) 饮食摄入对交感神经系统 (SNS) 活动的影响，提出了一个合理的假设，即肥胖者的高血压与高胰岛素血症和 SNS 刺激有关。肥胖者的高血压与上半身的脂肪堆积有关。此类肥胖的特点还包括高胰岛素血症和胰岛素抵抗。此外，胰岛素是饮食摄入量与 SNS 活动之间关系的重要信号：胰岛素水平升高与 SNS 刺激相关。因此，肥胖引起的高胰岛素血症可能通过以下方式导致血压升高：1）胰岛素刺激肾钠重吸收的直接作用，2）对心脏、血管和肾脏的交感神经刺激。相反，热量限制后的 SNS 抑制和胰岛素减少可以解释热量限制对肥胖高血压受试者的降压作用。这里提出的假设强调了饮食在肥胖高血压受试者治疗中的重要作用。热量限制、减肥和运动在降低肥胖者血压方面的功效与胰岛素和交感神经系统活性的降低有关，可以被视为支持这一假设的证据。 Am J Hypertens 1:84-90, 1988
Although the association of obesity and hypertension is well recognized, the mechanisms involved in the pathogenesis of increased blood pressure in the obese are poorly understood. Recent studies addressing the impact of 1) body fat distribution on blood pressure and 2) dietary intake on sympathetic nervous system (SNS) activity suggest a plausible hypothesis that relates the hypertension of the obese to hyperinsulinemia and SNS stimulation. Hypertension in the obese is associated with fat accumulation in the upper body segments; this type of obesity is also characterized by hyperinsulinemia and insulin resistance.Insulin, moreover, is an important signal in the relationship between dietary intake and SNS activity: increased insulin levels are associated with SNS stimulation. The hyperinsulinemia of obesity may, therefore, increase blood pressure by 1) direct effects of insulin to stimulate renal sodium reabsorption, and 2) sympathetic stimulation of the heart, blood vessels, and kidney. Conversely, SNS suppression and diminished insulin following caloric restriction may explain the hypotensive effects of caloric restriction in obese hypertensive subjects.The hypothesis presented here emphasizes the important role of diet in the treatment of obese hypertensive subjects. The efficacy of caloric restriction, weight loss, and exercise in reducing blood pressure in the obese is linked to diminished insulin and SNS activity and may be viewed as evidence in favor of this hypothesis. Am J Hypertens 1:84-90, 1988