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Highlights of mechanisms and treatment of obesity-related hypertension

Abstract

The prevalence of obesity has increased two to three times from 1975 to 2015. Large-scale epidemiological and longitudinal prospective studies link obesity with hypertension. Research suggests that excessive weight gain, particularly when associated with visceral adiposity, may account for as much as 65% to 75% of the risk of incident hypertension. Also, exercise and bariatric/metabolic surgery significantly lowers blood pressure, whereas weight gain increases blood pressure, thus establishing a firm link between these two factors. The mechanisms underpinning obesity-related hypertension are complex and multifaceted, and include, but are not limited to, renin-angiotensin-aldosterone system/sympathetic nervous system overactivation, overstimulation of adipokines, insulin resistance, immune dysfunction, structural/functional renal, cardiac, and adipocyte changes. Though weight loss is the mainstay of treatment for obesity-related hypertension, it is often not a feasible long-term solution. Therefore, it is recommended that aggressive treatment with multiple antihypertensive medications combined with diet and exercise be used to lower blood pressure and prevent complications. The research regarding the mechanisms and treatment of obesity-related hypertension has moved at a blistering pace over the past ten years. Therefore, the purpose of this expert review is two-fold: to discuss the pathophysiological mechanisms underlying obesity-related hypertension, and to revisit pharmacotherapies that have been shown to be efficacious in patients with obesity-related hypertension.

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Fig. 1: Mechanisms of hypertension associated with obesity.

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Acknowledgements

VK was supported by a Roy J. and Lucille A. Carver College of Medicine Summer Fellowship in 2019. JP is a recipient of the Iowa Center for Research for Undergraduates Fellowship and a fellow at the Iowa Biosciences Academy.

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ES, VK, JP, RG, WO, and MC drafted the original manuscript. WO drafted the figure, and VK edited and drafted the table and figures. VK and MC critically revised the manuscript for grammar, and intellectual content. All the authors have read and approved the final manuscript.

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Correspondence to Marcelo Lima de Gusmão Correia.

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Shams, E., Kamalumpundi, V., Peterson, J. et al. Highlights of mechanisms and treatment of obesity-related hypertension. J Hum Hypertens 36, 785–793 (2022). https://doi.org/10.1038/s41371-021-00644-y

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