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Joint statement of the European Association for the Study of Obesity and the European Society of Hypertension: obesity and difficult to treat arterial hypertension.
MedLine Citation:
PMID:  22573071     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Obese patients are prone to arterial hypertension, require more antihypertensive medications, and have an increased risk of treatment-resistant arterial hypertension. Obesity-induced neurohumoral activation appears to be involved. The association between obesity and hypertension shows large inter-individual variability, likely through genetic mechanisms. Obesity affects overall cardiovascular and metabolic risk; yet, the relationship between obesity and cardiovascular risk is complex and not sufficiently addressed in clinical guidelines. The epidemiological observation that obesity may be protective in patients with established cardiovascular disease is difficult to translate into clinical experience and practice. Weight loss is often recommended as a means to lower blood pressure. However, current hypertension guidelines do not provide evidence-based guidance on how to institute weight loss. In fact, weight loss influences on blood pressure may be overestimated. Nevertheless, weight loss through bariatric surgery appears to decrease cardiovascular risk in severely obese patients. Eventually, most obese hypertensive patients will require antihypertensive medications. Data from large-scale studies with hard clinical endpoints on antihypertensive medications specifically addressing obese patients are lacking and the morbidity from the growing population of severely obese patients is poorly recognized or addressed. Because of their broad spectrum of beneficial effects, renin-angiotensin system inhibitors are considered to be the most appropriate drugs for antihypertensive treatment of obese patients. Most obese hypertensive patients require two or more antihypertensive drugs. Finally, how to combine weight loss strategies and antihypertensive treatment to achieve an optimal clinical outcome is unresolved.
Authors:
Jens Jordan; Volkan Yumuk; Markus Schlaich; Peter M Nilsson; Barbara Zahorska-Markiewicz; Guido Grassi; Roland E Schmieder; Stefan Engeli; Nick Finer
Publication Detail:
Type:  JOURNAL ARTICLE    
Journal Detail:
Title:  Journal of hypertension     Volume:  30     ISSN:  1473-5598     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-5-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8306882     Medline TA:  J Hypertens     Country:  -    
Other Details:
Languages:  ENG     Pagination:  1047-1055     Citation Subset:  -    
Affiliation:
aInstitute of Clinical Pharmacology, Medical School Hannover, Germany bDepartment of Medicine, Division of Endocrinology and Metabolism, Istanbul University Cerrahpasa Medical Faculty, Turkey cBaker IDI Heart & Diabetes Institute, Melbourne, Australia dDepartment of Clinical Sciences, Lund University, University Hospital, Malmö, Sweden eDepartment of Pathophysiology, Medical University of Silesia, Katowice, Poland fClinica Medica, University of Milano-Bicocca, Ospedale San Gerardo, Monza gIstituto di Ricerca a Caratteree Scientifico IRCCS Multimedica, Sesto san Giovanni, Milan, Italy hDepartment of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany iInstitute of Cardiovascular Science, University College London, UK.
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