#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Hypertensi on therapy in obese pati ents


Authors: M. So uček
Authors‘ workplace: II. interní klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MU Dr. Miroslav So uček, CSc.
Published in: Vnitř Lék 2009; 55(Suppl 1)(Supplementum 1): 13-18

Overview

Inter‑relati onship between hypertensi on and obesity is very well known altho ugh the actu al gro unds for this linkage are not cle ar. There is growing evidence to support the role of incre ased sympathetic nervo us system activity and involvement of the RAAS in aeti ology of hypertensi on in obese pati ents. Visceral obesity is the type of obesity we sho uld focus on in clinical practice. Tre atment of hypertensi on sho uld start with the tre atment of obesity aiming at body weight reducti on and changes to the lifestyle. Where indicated, lifestyle changes co uld, or even sho uld, be supported with an anti‑obesity agent. Positive effect of lifestyle management as well as anti‑obesity agents on blo od pressure reducti on in obese pati ents has been established. Unfortunately, informati on abo ut pharmacological management of hypertensi on in obese pati ents and its long‑term effects in particular, is lacking. Therefore, when antihypertensives are prescribed, general recommendati ons for high blo od pressure management and preventi on of cardi ovascular dise ases sho uld be followed, taking into acco unt the so far known details of pathophysi ological relati onship between high blo od pressure and obesity.

Key words:
hypertensi on –  obesity –  visceral fat –  metabolic syndrome


Sources

1. Eckel RH. Obesity and he art dise ase: a statement for he althcare professi onals from the Nutriti on Committee, American He art Associ ati on. Hypertensi on 2000; 35: 1270– 1277.

2. Hajjar I, Kotchen TA. Trends in prevalence, awareness, tre atment, and control of hypertensi on in the United States, 1988– 2000. JAMA 2003; 290: 199– 206.

3. Cífková R, Skodová Z, Lánská V et al. Trends in blo od pressure levels, prevalence, awarness, tre atment, and control of hypertensi on in the Czech populati on from 1985 to 2000/ 01. J Hypertens 2004; 22: 1479– 1485.

4. Pelikánová T. Metabolický syndrom. Vnitř Lék 2003; 49: 900– 906.

5. Kunešová M, Čechová M, Laika M. Zpráva o projektu Životní styl a obezita. Kvantitativní výzkum STEM/ MARK pro MZ ČR a Česko u obezitologicko u společnost, 2006. Dostupné z: www. obesitas. cz/ downlo ad/ dospeli_web.ppt.

6. Sharma AM, Grassi G. Obesity and hypertensi on: ca use or consequence? J Hypertens 2001; 19: 2125– 2126.

7. Allemann Y, Hutter D, Aeschbacher BC et al. Incre ased central body fat depositi on precedes a significant rise in resting blo od pressure in male offspring of essenti al hypertensive parents: a 5 ye ar follow‑up study. J Hypertens 2001; 19: 2143– 2148.

8. Garrison RJ, Kannel WB, Stokes J 3rd et al. Incidence and precursors of hypertensi on in yo ung adults: the Framingham Offspring Study. Prev Med 1987; 16: 235– 251.

9. Svačina Š, Owen K. Syndrom inzulínové rezistence. Praha: Triton 2003.

10. Doll S, Pacca ud F, Bovet P et al. Body mass index, abdominal adiposity and blo od pressure: consistency of their associ ati on across developing and develop co untri es. Int J Obes 2002; 26: 48– 57.

11. Kanai H, Matsuzawa Y, Kotani K et al. Close correlati on of intra- abdominal fat accumulati on to hypertensi on in obese women. Hypertensi on 1990; 16: 484– 490.

12. Unger R. The physi ology of cellular liporegulati on. Annu Rev Physi ol 2003; 65: 333– 347.

13. Stevens VJ, Obarzanek E, Co ok NR et al. Long‑term weight loss and changes in blo od pressure: results of the Tri als of Hypertensi on Preventi on, phase II. Ann Intern Med 2001; 134: 1– 11.

14. Nati onal institutes of he alth. Clinical quidelines on the identificati on, evaluti on, and tre atment of overweight and obesity in adults –  The Evidence Report. Obes Res 1998; 6 (Suppl 2): 51S– 209S.

15. Staessen J, Fagard R, Amery A. The relati onship between body weight and blo od pressure. J Hum Hypertens 1988; 2: 207– 217.

16. Masuo K, Mikami M, Ogihara T et al. Differences in mechanisms between weight loss- sensitive and resistant blo od pressure reducti on in obese subjects. Hypertens Res 2001; 24: 371– 376.

17. Alvarez GE, Beske SD, Ballard TP et al. Sympathetic ne ural activati on in visceral obesity. Circulati on 2002; 106: 2533– 2536.

18. Sjöström CD, Peltonen M, Wedel H et al. Differenti ated long‑term effects of intenti onal weight loss on di abetes and hypertensi on. Hypertensi on 2000; 36: 20– 25.

19. Blair SN, Go odye ar NN, Gibbons LW et al. Physical fitness and incidence of hypertensi on in he althy normotensive men and women. JAMA 1984; 252: 487– 490.

20. Svačinová H. Pohybová léčba u paci entů s metabolickým syndromem. Vnitř Lék 2007; 52: 540– 544.

21. Hagberg JM, Park JJ, Brown MD. The role of exercise training in the tre atment of hypertensi on: an update. Sports Med 2000; 30: 193– 206.

22. Gra udal NA, Galløe AM, Garred P. Effects of sodi um restricti on on blo od pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride: a meta‑analysis. JAMA 1998; 279: 1383– 1391.

23. Dengel DR, Galecki AT, Hagberg JM et al. The independent and combined effects of weight loss and aerobic exercise on blo od pressure and oral glukose tolerance in older men. Am J Hypertens 1998; 11: 1405– 1412.

24. Miller ER 3rd, Erlinger TP, Yo ung DR et al. Results of the Di et, Exercise, and Weight Loss Interventi on Tri al (DEW- IT). Hypertensi on 2002; 40: 612– 618.

25. Ha uner H, Mei er M, Wendland et al. Weight reducti on by sibutramine in obese subjects in primary care medicine: The S.A.T. study. Exp Clin Endocrinol Di abetes 2004; 112: 201– 207.

26. Svačina Š. Prevence di abetu. Praha: Galén 2003.

27. Derosa G, Cicero AF, Murdolo G et al. Efficacy and safety comparative evalu ati on of orlistat and sibutramine tre atment in hypertensive obese pati ents. Di abetes Obes Metab 2005; 7: 47– 55.

28. Sari R, Balci MK, Cakir M et al. Comparison of efficacy of sibutramine or orlistat versus their combinati on in obese women. Endocr Res 2004; 30: 159– 167.

29. Di Marzo V, Mati as I. Endocannabino id control of fo od intake and energy balance. Nat Ne urosci 2005; 8: 585– 589.

30. Cífková R, Horký K, Widimský J st. et al. Doporučení di agnostických a léčebných postupů u arteri ální hypertenze –  verze 2004. Doporučení České společnosti pro hypertenzi. Vnitř Lék 2004; 50: 709– 722.

31. Reisin E, Weir MR, Falkner B et al. Lisinopril versus hydrochlorothi azide in obese hypertensive pati ents: a multicenter placebo- controlled tri al. Tre atment in Obese Pati ents With Hypertensi on (TROPHY) Study Gro up. Hypertensi on 1997; 30 (1 Pt 1): 140– 145.

32. Grassi G, Seravalle G, Dell’Oro R et al. Comparative effects of candesartan and hydrochlorothi azide on blo od pressure, insulin sensitivity, and sympathetic drive in obese hypertensive individu als: results of the CROSS study. J Hypertens 2003; 21: 1761– 1769.

33. Yusuf S, Sleight P, Pogue J et al. The He art Outcomes Preventi on Evalu ati on Study Investigators: Effects of an angi otensin‑converting‑enzyme inhibitor Ramipril on cardi ovascular events in high risk pati ents. N Engl J Med 2000; 324: 145– 153.

34. Lindholm LH, Ibsen H, Dahlhöf B et al. Cardi ovascular morbidity and mortality in pati ents with di abetes in the Losartan Interventi on For Endpo int reducti on in hypertensi on study (LIFE): a randomized tri al against atenolol. Lancet 2002; 359: 1004– 1010.

35. De Luca N, Izzo R, Fontana D et al. Haemodynamic and metabolic effects of rilmenidine in hypertensive pati ents with metabolic syndrome X. A do uble blind parallel study versus amlodipine. J Hypertens 2000; 18: 1515– 1522.

36. Pepine CJ, Handberg EM, Co oper- DeHoff RM et al. A calci um antagonist vs a non‑calci um antagonist hypertensi on tre atment strategy for pati ents with coronary artery dise ase. INVEST Study. JAMA 2003; 290: 2805– 2816.

37. Tatti P, Pahor M, Byington RP et al. Outcome results of the Fosinopril versus Amlodipine Cardi ovascular Events Randomized Tri al (FACET) in pati ents with hypertensi on and NIDDM. Di abetes Care 1998; 21: 597– 603.

38. Gress TW, Ni eto FJ, Shahar E et al. Hypertensi on and antihypertensive therapy as risk factor for type 2 di abetes mellitus. Atherosclerosis Risk in Communiti es Study. N Engl J Med 2000; 342: 905– 912.

39. Hansson L, Lindholm LH, Niskanen L et al. Effect of angi otensin‑converting enzyme inhibiti on compared with conventi onal therapy on cardi ovascular morbidity and mortality in hypertensi on: the Captopril Preventi on Project (CAPP) randomised tri al. Lancet 1999; 353: 611– 616.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue Supplementum 1

2009 Issue Supplementum 1

Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#