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The role of obesity in the pathogenesis of hypertension

Nature Clinical Practice Nephrology volume 5, pages 101–111 (2009)Cite this article

Abstract

The rapid rise in the incidence and prevalence of obesity and the concomitant increase in the incidence and prevalence of hypertension have fueled investigation into the role of obesity in the pathogenesis of hypertension. The genetic background that predisposes obese individuals to hypertension is being elucidated, and the importance of adipose tissue as an endocrine organ in the pathogenesis of hypertension is increasingly being recognized. Visceral adipose tissue is critical in the production of pathologic cytokines that are thought to mediate obesity-induced hypertension. Changes in the types and levels of adipocytokines that result from the accumulation of aberrant adipose tissue directly leads to alterations in systemic vascular resistance, sodium retention and sympathetic nervous system activity. Key changes in adipocytokine levels seen in obesity-induced hypertension include increased leptin and adiponectin levels. Another important mechanism in obesity-induced hypertension is the generation of angiotensin II and direct stimulation of aldosterone production. The increased sympathetic nervous system activity seen in obesity-associated hypertension leads to increased renal sodium retention and increased systemic vascular resistance. Increased systemic vascular resistance can also occur directly in obese individuals through vascular fibrosis and lipid deposition. Obesity should no longer be simply considered as a marker of cardiovascular risk but should be regarded as an important and primary contributor to the pathophysiology of hypertension.

Key Points

  • Increased adipose tissue (i.e. obesity) is an important factor in the development of hypertension in susceptible individuals

  • Adipose tissue is an endocrine organ that produces many cytokines integral to the development of hypertension

  • Visceral adipose tissue contributes more to obesity-induced hypertension than does peripheral or subcutaneous adipose tissue

  • Obesity-induced hypertension is mediated in part through increases in production of components of the renin–angiotensin–aldosterone system by adipose tissue

  • Obesity leads to alterations in renal, vascular and sympathetic nervous system physiology that in turn induce and maintain increases in systolic blood pressure

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Figure 1: Factors associated with the induction of obesity-related hypertension.

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  1. YE Bogaert is an Assistant Professor at the University of Colorado School of Medicine and Denver VA Medical Center and S Linas is Professor of Medicine at the University of Colorado Health Sciences Center, Denver Health Medical Center, Denver, CO, USA.,

    Yolanda E Bogaert & Stuart Linas

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Bogaert, Y., Linas, S. The role of obesity in the pathogenesis of hypertension. Nat Rev Nephrol 5, 101–111 (2009). https://doi.org/10.1038/ncpneph1022

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