Document Detail


Pathophysiology and treatment of obesity hypertension.
MedLine Citation:
PMID:  15579059     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Excess weight gain accounts for as much as 65-75% of the risk for essential hypertension and also greatly increases the risk for end stage renal disease (ESRD). Obesity raises blood pressure by increasing renal tubular reabsorption, impairing pressure natriuresis, and causing volume expansion due to activation of the sympathetic nervous system (SNS) and renin-angiotensin aldosterone system (RAAS), and by physical compression of the kidneys, especially when visceral obesity is present. The mechanisms of SNS activation in obesity are still unclear but may be due, in part, to hyperleptinemia that stimulates the hypothalamic pro-opiomelanocortin (POMC) pathway. With prolonged obesity, there may be a gradual loss of kidney function that worsens with time, exacerbates hypertension, and makes blood pressure more difficult to control. Lifestyle modifications, including weight reduction and increased physical activity, are essential first steps in the management of obesity hypertension and renal disease. Anti-obesity drugs offer potential pharmacotherapy for obesity hypertension, but current drugs are very limited and additional long-term studies are needed to test their safety and efficacy. Clinical trials are also needed to determine the most effective antihypertensive drugs for obese hypertensive patients. Special considerations for the obese patient, in addition to adequately controlling the blood pressure, include correcting the metabolic abnormalities and protecting the kidneys from further injury.
Authors:
Marion R Wofford; John E Hall
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.; Review    
Journal Detail:
Title:  Current pharmaceutical design     Volume:  10     ISSN:  1381-6128     ISO Abbreviation:  Curr. Pharm. Des.     Publication Date:  2004  
Date Detail:
Created Date:  2004-12-06     Completed Date:  2004-12-27     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9602487     Medline TA:  Curr Pharm Des     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  3621-37     Citation Subset:  IM    
Affiliation:
Division of Hypertension, Department of Medicine, Center of Excellence in Cardiovascular-Renal Research, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216-4505, USA. mwofford@medicine.umsmed.edu
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MeSH Terms
Descriptor/Qualifier:
Animals
Antihypertensive Agents / pharmacology,  therapeutic use*
Endothelium, Vascular / drug effects,  physiopathology
Hemodynamics / drug effects
Humans
Hypertension* / drug therapy,  etiology,  physiopathology
Kidney Failure, Chronic / etiology,  physiopathology
Life Style
Obesity / complications*,  physiopathology
Renin-Angiotensin System / drug effects,  physiology
Sympathetic Nervous System / drug effects,  physiopathology
Grant Support
ID/Acronym/Agency:
P01 HL51070/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Antihypertensive Agents

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