Obesity‐related hypertension: Pathogenesis, cardiovascular risk, and treatment—A position paper of the The Obesity Society and the American Society of Hypertension

Abstract

In light of the worldwide epidemic of obesity, and in recognition of hypertension as a major factor in the cardiovascular morbidity and mortality associated with obesity, The Obesity Society and The American Society of Hypertension agreed to jointly sponsor a position paper on obesity-related hypertension to be published jointly in the journals of each society. The purpose is to inform the members of both societies, as well as practicing clinicians, with a timely review of the association between obesity and high blood pressure, the risk that this association entails, and the options for rational, evidenced-based treatment. The position paper is divided into six sections plus a summary as follows: pathophysiology, epidemiology and cardiovascular risk, the metabolic syndrome, lifestyle management in prevention and treatment, pharmacologic treatment of hypertension in the obese, and the medical and surgical treatment of obesity in obese hypertensive patients. The United States is currently facing a very real obesity epidemic. The most recent National Health and Nutrition Examination Survey indicates that approximately two thirds of US adults are presently classified as overweight or obese (body mass index [BMI] !25) and one third as obese (BMI !30) (1,2). While the numbers alone are formidable, they leave unaddressed the medical costs associated with obesity and obesity-related comorbidities, not the least of which is obesity-related hypertension. Given the frequent concurrence of obesity and hypertension, it is no coincidence that as the rate of obesity continues to rise, so too does the rate of hypertension. It is estimated that at least 75% of the incidence of hypertension is related directly to obesity (1). It is essential, therefore, to develop treatment strategies for the management of obesity in order to reduce the development of obesity-related hypertension as well as to effectively manage high blood pressure (BP) in the obese.Recent publications have estimated that the annual medical burden of obesity and obesity-related diseases in the United States totaled roughly $147 billion in 2008 (1) and that projected obesity-related medical expenses will more than double by 2018, topping $344 billion, or about 21% of total healthcare spending (1). Although lifestyle changes aimed at prevention, especially in childhood, are the ultimate solution to the societal problem of obesity and its complications, the scope of illness caused by obesity demands immediate attention and therapeutic intervention in the obese population. Given the important role that obesity plays in the pathogenesis of hypertension, the leadership of both The Obesity Society and The American Society of Hypertension have commissioned this position paper for the purpose of providing the membership of both societies, as well as the community of clinicians in practice, with a current and timely summary on the relationship between weight and BP, on the cardiovascular (CV) risk imposed and on the management of obesity-related hypertension.

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Obezite Hastalarında Anestezi Yönetimi

“…Hiperinsülinemi ve leptin salınımına bağlı olarak SSS aktivasyonu sonucu renin salınımı ile vazokonstrüktör etkili anjiyotensin, aldesteron ve RAAS metabolitlerinin aktivasyonunun hipertansiyon ile ilişkili olduğu düşünülmektedir. SSS aktivasyonu sonucu böbreklerden sodyum tutulumu da artmaktadır 11 . Ayrıca leptin ve hiperinsülinemi damar endotel harabiyetine de neden olarak hipertansiyon gelişimine katkı sağlamaktadır.…”