Impact of the obesity epidemic on hypertension and renal disease
Impact of the obesity epidemic on hypertension and renal disease
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DOI：
10.1007/s11906-003-0084-z
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发表时间：
2003-10-01
影响因子：
5.6
通讯作者：
Liu, JK
中科院分区：
文献类型：
--
作者：
Hall, JE;Jones, DW;Liu, JK
体重过度增加是大多数原发性高血压患者血压升高的主要原因，也大大增加了肾脏疾病的风险。肥胖通过增加肾小管重吸收、损害压力性尿钠排泄、由于交感神经系统和肾素-血管紧张素系统的激活而引起体积膨胀以及通过肾脏的物理压缩（特别是当存在内脏肥胖时）来升高血压。肥胖症中交感神经系统激活的机制可能部分是由于高瘦素血症刺激下丘脑前阿黑皮素途径。长期肥胖，肾单位的功能可能会逐渐丧失，随着时间的推移，肾单位的功能会恶化，从而加重高血压。减轻体重是控制肥胖、高血压和肾脏疾病的第一步。对于肥胖患者的特殊考虑，除了充分控制血压外，还包括纠正代谢异常和保护肾脏免受进一步损伤。
Excess weight gain is a major cause of increased blood pressure in most patients with essential hypertension, and also greatly increases the risk for renal disease. Obesity raises blood pressure by increasing renal tubular reabsorption, impairing pressure natriuresis, causing volume expansion due to activation of the sympathetic nervous system and renin-angiotensin system, and by physical compression of the kidneys, especially when visceral obesity is present. The mechanisms of sympathetic nervous system activation in obesity may be due, in part, to hyperleptinemia that stimulates the hypothalamic pro-opiomelanocortin pathway. With prolonged obesity, there may be a gradual loss of nephron, function that worsens with time and exacerbates hypertension. Weight reduction is an essential first step in the management of obesity hypertension and renal disease. Special considerations for the obese patient, in addition to adequately controlling the blood pressure, include correction of the metabolic abnormalities and protection of the kidneys from further injury.