The pathophysiology of hypertension in patients with obesity.
The pathophysiology of hypertension in patients with obesity.
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DOI：
10.1038/nrendo.2014.44
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发表时间：
2014-06
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影响因子：
--
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中科院分区：
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--
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肥胖和高血压的组合与高发病率和死亡率相关，因为它导致心血管和肾脏疾病。肥胖与高血压相关的潜在机制包括饮食因素、代谢、内皮和血管功能障碍、神经内分泌失衡、钠潴留、肾小球高滤过、蛋白尿以及适应不良的免疫和炎症反应。内脏脂肪组织也变得对胰岛素和瘦素有抗性，并且是分子和激素（诸如脂联素、瘦素、Leptin、TNF和IL-6）的分泌改变的部位，其加剧肥胖相关的心血管疾病。越来越多的证据也表明，肠道微生物组对于调节这些机制很重要。尿酸和肠促胰岛素或二肽基肽酶4活性的改变进一步促进肥胖患者高血压的发展。肥胖相关性高血压的病理生理学与绝经前肥胖和2型糖尿病女性尤其相关，这些女性发生动脉硬化和内皮功能障碍的风险较高。在这篇综述中，我们讨论了肥胖和高血压之间的关系，特别强调了可能用于临床的潜在机制和治疗靶点。
The combination of obesity and hypertension is associated with high morbidity and mortality because it leads to cardiovascular and kidney disease. Potential mechanisms linking obesity to hypertension include dietary factors, metabolic, endothelial and vascular dysfunction, neuroendocrine imbalances, sodium retention, glomerular hyperfiltration, proteinuria, and maladaptive immune and inflammatory responses. Visceral adipose tissue also becomes resistant to insulin and leptin and is the site of altered secretion of molecules and hormones such as adiponectin, leptin, resistin, TNF and IL-6, which exacerbate obesity-associated cardiovascular disease. Accumulating evidence also suggests that the gut microbiome is important for modulating these mechanisms. Uric acid and altered incretin or dipeptidyl peptidase 4 activity further contribute to the development of hypertension in obesity. The pathophysiology of obesity-related hypertension is especially relevant to premenopausal women with obesity and type 2 diabetes mellitus who are at high risk of developing arterial stiffness and endothelial dysfunction. In this Review we discuss the relationship between obesity and hypertension with special emphasis on potential mechanisms and therapeutic targeting that might be used in a clinical setting.
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