Obesity-Related Hypertension: Epidemiology, Pathophysiology, and Clinical Management
Obesity-Related Hypertension: Epidemiology, Pathophysiology, and Clinical Management
复制标题
DOI：
10.1038/ajh.2010.172
复制
发表时间：
2010-11-01
影响因子：
3.2
通讯作者：
Kotchen, Theodore A.
中科院分区：
文献类型：
--
作者：
Kotchen, Theodore A.
肥胖症，包括儿童肥胖症的流行率在全世界范围内不断增加。体重增加与动脉压升高有关，据估计，成人高血压的60-70%可归因于肥胖。与胰岛素抵抗和血脂异常相关的中心体脂肪是比外周体脂肪更有效的血压升高决定因素。肥胖相关高血压可能是一种独特的高血压表型，具有独特的遗传决定因素。肥胖相关性高血压的机制包括胰岛素抵抗、钠潴留、交感神经系统活动增加、肾素-血管紧张素-醛固酮激活和血管功能改变。在超重的个体中，体重减轻会导致血压降低，然而，这种影响可能会在长期内减弱。越来越多的以社区为基础的项目（包括学校项目和工作场所项目）正在开发用于预防和治疗肥胖。肥胖高血压患者的评估和治疗应考虑总体心血管疾病（CVD）风险。没有令人信服的临床试验数据表明任何一类抗高血压药物上级其他药物，一般来说，肥胖高血压患者的药物治疗原则与非肥胖患者没有区别。未来的研究方向可能包括：（i）开发有效的，文化敏感的预防和治疗肥胖症的策略;（ii）临床试验，以确定最有效的药物治疗，以减少肥胖，高血压患者的心血管疾病;（iii）继续寻找肥胖，高血压表型的遗传决定因素。
The prevalence of obesity, including childhood obesity, is increasing worldwide. Weight gain is associated with increases in arterial pressure, and it has been estimated that 60-70% of hypertension in adults is attributable to adiposity. Centrally located body fat, associated with insulin resistance and dyslipidemia, is a more potent determinant of blood pressure elevation than peripheral body fat. Obesity-related hypertension may be a distinct hypertensive phenotype with distinct genetic determinants. Mechanisms of obesity-related hypertension include insulin resistance, sodium retention, increased sympathetic nervous system activity, activation of renin-angiotensin-aldosterone, and altered vascular function. In overweight individuals, weight loss results in a reduction of blood pressure, however, this effect may be attenuated in the long term. An increasing number of community-based programs (including school programs and worksite programs) are being developed for the prevention and treatment of obesity. Assessment and treatment of the obese hypertensive patient should address overall cardiovascular disease (CVD) risk. There are no compelling clinical trial data to indicate that any one class of antihypertensive agents is superior to others, and in general the principles of pharmacotherapy for obese hypertensive patients are not different from nonobese patients. Future research directions might include: (i) development of effective, culturally sensitive strategies for the prevention and treatment of obesity; (ii) clinical trials to identify the most effective drug therapies for reducing CVD in obese, hypertensive patients; (iii) continued search for the genetic determinants of the obese, hypertensive phenotype.