Obesity Paradox in Hypertension

Esler, Murray; Lambert, Gavin W.; Schlaich, Markus P.; Dixon, John; Sari, Carolina Ika; Lambert, Elisabeth

doi:10.1161/hypertensionaha.117.09790

Cited by 56 publications

(29 citation statements)

References 127 publications

(190 reference statements)

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“…Reasons for this are unclear, but reinforce that there may be sex differences in blood pressure regulation and pharmacological interventions that warrant more research. These results are consistent with the “obesity paradox” which suggests that obesity is associated with decreased morbidity and mortality [ 12 , 35 , 36 ]. Given that hypertension is one of the most important risk factors for premature CVD [ 37 ], the superior antihypertensive effect of medications in obesity may play a protective role in risk reduction.…”

Section: Discussionsupporting

confidence: 87%

The Association between Antihypertensive Medication Use and Blood Pressure Is Influenced by Obesity

et al. 2018

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Introduction One in three US adults is living with obesity or hypertension, and more than 75% of hypertensive individuals are using antihypertensive medications. Therefore, it is important to examine blood pressure (BP) differences in populations that are using these medications with differing obesity status. Aim We examined whether BP attained when using various antihypertensive medications varies amongst different body mass index (BMI) categories and whether antihypertensive medication use is associated with differences in other metabolic risk factors, independent of BMI. Methods Adults with hypertension from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014 were used (n=15,285). Linear regression analyses were used to examine the main effects and interaction between antihypertensive use and BMI. Results In general, users of antihypertensive medications had lower BP than those not taking BP medications (NoBPMed) (P < 0.05), whereby in women, the differences in systolic BP between angiotensin-converting-enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) users and NoBPMed were greater in those with obesity (ACE inhibitors: −14 ± 1 mmHg; ARB: −16 ± 1 mmHg) compared to normal weight individuals (ACE inhibitors: −9 ± 1 mmHg; ARB: −11 ± 1 mmHg) (P < 0.05). Diastolic BP differences between women ARB users and NoBPMed were also greatest in obesity (−5 ± 1 mmHg) (P < 0.05) whilst there were no differences in normal weight individuals (−1 ± 1 mmHg) (P>0.05). Furthermore, glucose levels and waist circumference in women were higher in those using ACE inhibitors compared to diuretics (P < 0.05). Conclusion ACE inhibitors and ARBs may be associated with more beneficial BP profiles in women with obesity, with no obesity-related BP differences for antihypertensive medication in men. However, there could be potential cardiometabolic effects for some antihypertensive medications that should be explored further.

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Section: Discussionsupporting

confidence: 87%

The Association between Antihypertensive Medication Use and Blood Pressure Is Influenced by Obesity

et al. 2018

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“…The changes in autonomic tone related to MS may also be more pronounced in women than in men 52–55 . Of note, the alterations in autonomic tone in subjects who are overweight, a characteristic feature of MS, show remarkable disparity 56 . Overweight subjects may have normal cardiac sympathetic activity and neuronal noradrenaline uptake, while afferent renal sympathetic activity may still be increased 56 .…”

Section: Discussionmentioning

confidence: 99%

“…Of note, the alterations in autonomic tone in subjects who are overweight, a characteristic feature of MS, show remarkable disparity 56 . Overweight subjects may have normal cardiac sympathetic activity and neuronal noradrenaline uptake, while afferent renal sympathetic activity may still be increased 56 . Decreased parasympathetic activity is also a putative cause for an imbalance in autonomic function 57,58 .…”

Section: Discussionmentioning

confidence: 99%

Changes in hemodynamics associated with metabolic syndrome are more pronounced in women than in men

Kangas

Tikkakoski

Kettunen

et al. 2019

Sci Rep

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The increase in cardiovascular risk associated with metabolic syndrome (MS) seems higher in women than in men. We examined hemodynamics during head-up tilt in 252 men and 250 women without atherosclerosis, diabetes, or antihypertensive medication, mean age 48 years, using whole-body impedance cardiography and radial pulse wave analysis. MS was defined according to Alberti et al. 2009. Men and women with MS presented with corresponding elevations of systolic and diastolic blood pressure (10-14%, p ≤ 0.001) versus controls. Supine pulse wave velocity (16–17%, p < 0.001) and systemic vascular resistance (7–9%, p ≤ 0.026), and upright cardiac output (6–11%, p ≤ 0.008) were higher in both MS groups than controls. Elevation of supine aortic characteristic impedance was higher in women than in men with MS (16% vs. 8%, p = 0.026), and in contrast to men, no upright impedance reduction was observed in women. When upright, women but not men with MS showed faster return of reflected pressure wave (p = 0.036), and smaller decrease in left cardiac work (p = 0.035) versus controls. The faster upright return of reflected pressure, lower upright decrease in left cardiac work, and higher elevation of aortic characteristic impedance may contribute to the greater increase in MS-related cardiovascular risk in women than in men.

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“…3,5,7,8 However, previous findings have suggested that sympathetic activity differs in normal weight and obese essential hypertension patients. 7,9,10 In normal weight essential hypertension, the total spillover of norepinephrine to plasma is increased and higher than in obesity hypertension. 7,9 Furthermore, it has been reported that body mass index (BMI) moderated the association between urinary norepinephrine and blood pressure in women without OSA.…”

Section: Introductionmentioning

confidence: 99%

Moderating Effect of BMI on the Relationship Between Sympathetic Activation and Blood Pressure in Males with Obstructive Sleep Apnea

Chen

Somers

Tang

et al. 2021

NSS

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Background: Sympathetic activation is a primary mechanism mediating increased blood pressure (BP) in obstructive sleep apnea (OSA). However, the relationships between overweight/obesity, sympathetic activation and BP in OSA are not well understood. We hypothesized that increased sympathetic drive is associated with increased BP in normal weight, but not in overweight/obese males with OSA. We therefore examined the effects of body mass index (BMI) on the association between sympathetic activation and BP in males with OSA. Methods: We studied 115 males with OSA recruited consecutively from clinic. Twenty-fourhour urinary norepinephrine was used to assess sympathetic activation. Blood pressure was measured both in the evening and in the morning. Hypertension was defined based on either BP measurements or an existing diagnosis. Linear and logistic regressions were conducted to examine the associations between sympathetic activation and both BP and risk of hypertension. Results: We found 24-hour urinary norepinephrine levels were associated with systolic and diastolic BP (SBP, β=0.157, p=0.082; DBP, β=0.212, p=0.023) and mean arterial pressure (MAP, β=0.198, p=0.032) after adjusting for confounders. Interestingly, these associations were modified by overweight/obesity. After adjusting for confounders, increased 24-hour urinary norepinephrine levels were significantly associated with elevated SBP (β=0.454, p=0.012), DBP (β=0.399, p=0.041), and MAP (β=0.432, p=0.023) in normal weight, but not in overweight/obese patients (all p>0.2). Similar findings were observed in the associations between 24-hour urinary norepinephrine levels and hypertension. Conclusion: Sympathetic activation is associated with elevated BP in normal weight but not in overweight/obese males with OSA, suggesting that BMI may moderate the association between sympathetic activation and BP in males with OSA.

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Obesity Paradox in Hypertension

Cited by 56 publications

References 127 publications

The Association between Antihypertensive Medication Use and Blood Pressure Is Influenced by Obesity

The Association between Antihypertensive Medication Use and Blood Pressure Is Influenced by Obesity

Changes in hemodynamics associated with metabolic syndrome are more pronounced in women than in men

Moderating Effect of BMI on the Relationship Between Sympathetic Activation and Blood Pressure in Males with Obstructive Sleep Apnea

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