Mechanisms of Obesity-Associated Cardiovascular and Renal Disease

Hall, John E.; Crook, Errol D.; Jones, Daniel W.; Wofford, Marion R.; Dubbert, Patricia M.

doi:10.1097/00000441-200209000-00003

Cited by 330 publications

(334 citation statements)

References 68 publications

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“…Epidemiological studies have demonstrated the importance of measuring blood pressure during childhood and adolescence, 7,18 since the increase in the blood pressure levels of youths translates into a greater chance of having high blood pressure in adulthood, producing an increased risk of cardiovascular diseases. 19 In the present study, we performed three blood pressure measurements during one visit to the schools.…”

Section: Discussionmentioning

confidence: 99%

“…Presence of abdominal fat has been demonstrated as a strong risk factor for obesity and cardiovascular risk. 7 Low level of physical activity has also been detected as a risk factor for the development of cardiovascular diseases. 8 Several Brazilian studies have demonstrated the presence of high blood pressure levels in children and adolescents.…”

Section: Introductionmentioning

confidence: 99%

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Fatores associados a níveis pressóricos elevados em escolares de uma cidade de porte médio do sul do Brasil

Costanzi¹,

Halpern²,

Rech³

et al. 2009

J. Pediatr. (Rio J.)

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fatores associados a níveis pressóricos elevados em escolares de uma cidade de porte médio do sul do Brasil

Costanzi¹,

Halpern²,

Rech³

et al. 2009

J. Pediatr. (Rio J.)

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“…22 Physical compression of both kidneys seems to generate from accumulation of adipose tissue around the organs emphasizing the crucial function of visceral obesity in the development of renal disease. 28 Deposition of extracellular matrix throughout the renal medulla is greatly expanded and the tissue surrounding the ducts of Bellini at the vascular pole tends to prolapse. Increased numbers of interstitial cells and an increase in material rich in lipids and proteoglycans compresses the renal parenchyma toward the pole of the kidney resulting in the formation of round-shaped, enlarged kidneys in obese subjects.…”

Section: Structural Changes In the Kidneymentioning

confidence: 99%

Mechanisms of obesity-induced hypertension

et al. 2010

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The relationship between obesity and hypertension is well established both in children and adults. The mechanisms through which obesity directly causes hypertension are still an area of research. Activation of the sympathetic nervous system has been considered to have an important function in the pathogenesis of obesity-related hypertension. The arterial-pressure control mechanism of diuresis and natriuresis, according to the principle of infinite feedback gain, seems to be shifted toward higher blood-pressure levels in obese individuals. During the early phases of obesity, primary sodium retention exists as a result of increase in renal tubular reabsorption. Extracellular-fluid volume is expanded and the kidney-fluid apparatus is resetted to a hypertensive level, consistent with a model of hypertension because of volume overload. Plasma renin activity, angiotensinogen, angiotensin II and aldosterone values display significant increase during obesity. Insulin resistance and inflammation may promote an altered profile of vascular function and consequently hypertension. Leptin and other neuropeptides are possible links between obesity and the development of hypertension. Obesity should be considered as a chronic medical condition, which is likely to require long-term treatment. Understanding of the mechanisms associated with obesity-related hypertension is essential for successful treatment strategies. Hypertension Research (2010) 33, 386-393; doi:10.1038/hr.2010.9Keywords: leptin; obesity; pressure natriuresis; rennin-angiotensin-aldosterone system; sympathetic nervous system INTRODUCTION Obesity is a common disorder that develops from the interaction between the genotype and the environment and involves social, behavioral, cultural, physiological, metabolic and genetic factors. A large number of studies have shown that obesity has an important negative impact on health in a population, leading to the recommendation for general practitioners to have an important function in the management of this condition and of its associated comorbidities such as hypertension, hyperlipidemia and hyperinsulinemia/insulin resistance. The relationship between obesity and hypertension is well established both in adults and children. 1,2 Obese individuals exhibit higher levels of office as well as ambulatory blood pressure (BP) from childhood to old age. Obese subjects display higher BP levels than non-obese individuals even in the normotensive range. The combination of obesity, hypertension and other cardiovascular risk factors significantly increases the probability of adverse cardiovascular outcomes, and raises considerations for aggressive treatment strategies. 3 The mechanisms through which obesity directly causes hypertension are still an area of research. Human and animal studies have elucidated the function of adipose tissue derivatives (adipokines and cytokines), neurohumoral pathways, metabolic functions and modulation of pressor/depressor mechanisms. Although obesity-related hypertension may be the result of a combinatio...

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“…CO may be increased in obesity as a result of sodium retention and increased circulating volume (5). Although PVR would be expected to decrease in obesity as a result of the increase in capillary cross-sectional area in adipose tissue, it may be inappropriately high because of, for example, hyperactivity of the sympathetic nervous system (SNS), renin-angiotensin system activation, and impaired vasodilator function (3).…”

Section: Introductionmentioning

confidence: 99%

Insulin's microvascular vasodilatory effects are inversely related to peripheral vascular resistance in overweight, but insulin‐sensitive subjects

Hornstra

Serné

Eringa

et al. 2013

Obesity

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Objective: The mechanisms underlying obesity-related hypertension are incompletely understood. Microvascular dysfunction might play a role by increasing peripheral vascular resistance (PVR). Metabolic and microvascular effects of insulin are impaired in obesity, but how these impairments contribute to disturbed blood pressure homeostasis is unclear. Specifically, it is unknown whether local microvascular vasoactive effects of insulin play a role in determining systemic vascular resistance. The aim of this study was to investigate the association between PVR and local microvascular effects of insulin. Design and Methods: Thirty-seven healthy, overweight subjects (age 25-55 years, BMI 25-30 kg/m 2 ) were cross-sectionally studied. Local insulin-mediated vasodilation was measured using skin laser Doppler fluxmetry combined with transcutaneous iontophoresis of insulin. For comparison, local vasodilatory effects of acetylcholine and sodium nitroprusside were measured. PVR was calculated from mean arterial pressure and cardiac output, assessed by pulse-dye densitometry. Results: PVR was inversely correlated with insulin-mediated vasodilation (r ¼ À0.50; P < 0.01). This finding was maintained after adjustment for age, sex, blood pressure, and smoking. PVR was not associated with local microvascular effects of acetylcholine. Conclusions: Our study in overweight subjects suggests that insulin's role in the microvasculature may contribute to blood pressure control.

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Mechanisms of Obesity-Associated Cardiovascular and Renal Disease

Cited by 330 publications

References 68 publications

Fatores associados a níveis pressóricos elevados em escolares de uma cidade de porte médio do sul do Brasil

Fatores associados a níveis pressóricos elevados em escolares de uma cidade de porte médio do sul do Brasil

Mechanisms of obesity-induced hypertension

Insulin's microvascular vasodilatory effects are inversely related to peripheral vascular resistance in overweight, but insulin‐sensitive subjects

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