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Hypertension and Obesity

Ashish Aneja^*, Fadi El-Atat, Samy I. McFarlane and James R. Sowers^¶

^* Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, New York 11203
Division of Cardiovascular Medicine, Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, New York 11203
Division of Endocrinology, Hypertension and Diabetes, Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, New York 11203
^¶ Department of Internal Medicine, University of Missouri-Columbia, Columbia, Missouri 65212

Obesity is a common problem in much of the western world today in that is linked directly with several disease processes, notably, hypertension. It is becoming clear that the adipocyte is not merely an inert organ for storage of energy but that it also secretes a host of factors that interact with each other and may result in elevated blood pressure. Of particular importance is the putative role of leptin in the causation of hypertension via an activation of the sympathetic nervous system and a direct effect on the kidneys, resulting in increased sodium reabsorption leading to hypertension. Obesity per se may have structural effects on the kidneys that may perpetuate hypertension, leading to an increased incidence of end-stage renal disease that results in further hypertension. Adipose tissue may elaborate angiotensin from its own local renin-angiotensin system. The distribution of body fat is considered important in the genesis of the obesity-hypertension syndrome, with a predominantly central distribution being particularly ominous. Weight loss is the cornerstone in the management of the obesity-hypertension syndrome. It may be achieved with diet, exercise, medications, and a combination of these measures. Anti-obesity medications that are currently undergoing clinical trials may play a promising role in the management of obesity and may also result in lowering of blood pressure. Antihypertensives are considered important components in the holistic approach to the management of this complex problem.

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