European Society of Hypertension Working Group on Obesity: background, aims and perspectives

Development and validation of a nomogram for predicting the risk of postoperative fracture blister after pilon fracture

BACKGROUND

Fracture blister (FB) is one of the most common complications in pilon fractures. This study aimed to construct and validate a nomogram for predicting postoperative FB risk in patients with pilon fractures.

METHODS

We retrospectively collected information on 1,119 patients with lower extremity fractures in the 3rd Hospital of Hebei Medical University between January 2023 and January 2024. Patients with FBs were considered as the FB group and those without FB as the non-FB group. Variables with a significance level of P < 0.05 in the univariate analysis were included in the multivariate logistic regression analysis. The backward stepwise regression method was applied to identify independent risk factors associated with FB. The selected predictors were then entered into R software for further analysis and Nomogram construction.

RESULTS

In our research, the rate of FB (119 of 1,119) was 10.63%. Several predictors of FB were found using univariate analysis, including body mass index (BMI) (p < 0.001), the presence of DVT (p < 0.001), closed fractures (p < 0.001), time from injury to admission (p < 0.001), smoking history (p < 0.01), not utilizing dehydrating agents (p < 0.010), fixation mode of fracture (p < 0.001), the mode of surgical suture (p < 0.001), postoperative infection (p < 0.001) and Elixhauser comorbidity index (ECI) (p < 0.01). In addition, FB group exhibited significantly higher levels of blood serum indicators, such as EOS (p = 0.029), HCT (p < 0.01), LYM (p = 0.01), MPV (p = 0.014), NEU (p < 0.01), CKMB (p < 0.01), PLT (p < 0.01), ALB (p < 0.01), ALP (p < 0.01), AST (p < 0.01), CK (p = 0.019), CREA(p < 0.01), DBIL (p < 0.01), GLU (p < 0.01), Na (p < 0.01), P (p < 0.01), TC (p = 0.024), ALT (p < 0.01), TCO2 (p < 0.01), TG (p < 0.01), TP (p < 0.01), UA (p = 0.018), UREA (p = 0.033) compared to the non-FB group. According to the stepwise logistic regression analysis, higher BMI (p = 0.011, OR 0.873, 95% CI 0.785-0.970), NEU (p = 0.036, OR 0.982, 95% CI 0.865-0.995) and CKMB (p < 0.014, OR 0.994, 95% CI 0.989-0.999) were associated with increased FB risk, while plate fixation (p = 0.017, OR 0.371, 95% CI 0.123-0.817), the mode of surgical suture (p < 0.01, OR 0.348, 95% CI 0.161-0.749), and postoperative infection (p = 0.020, OR 0.406, 95% CI 0.190-0.866) were also correlated with increased FB risk. The nomogram was established based on 6 predictors independently related to FB.

CONCLUSIONS

Our investigation has shown that BMI, NEU, CKMB, plate fixation, the mode of surgical suture, and postoperative infection are independent risk factors for FB in patients with pilon fractures. The predictors identified by the nomogram could potentially be used to assess the possibility of blister formation, which could be a sign of fascial compartmental pressure release.

Cardiovascular risk factors among train drivers, Mansoura, Egypt

Cardiovascular risk factors and diseases are the most prevalent health conditions in train drivers. A comparative cross-sectional study was carried out to estimate the prevalence of some cardiovascular risk factors among train drivers. A pre-designed questionnaire was used to collect socio-demographic and occupational data. Physical activity and dietary habits were assessed, psychological distress was measured. Out of 100 recruited train drivers, 62% had obesity, 46% were hypertensive, 72.8% had dyslipidemia, and 71% had mild and/or moderate level of psychological distress. Being a train driver is independently associated with the likelihood of having obesity (AOR = 14.2) and psychological distress (AOR = 6.6). The prevalence of various cardiovascular risk factors was significantly higher among train drivers than the comparison group. Being a train driver is independently associated with obesity and psychological distress.

Relationship between lifestyle factors and hypertension: a cross-sectional analysis from the Gubbio study

BACKGROUND

Hypertension (HTN) is a well-established and a major risk factor for cardiovascular disease. Lifestyle behaviours for its prevention and control are recommended within worldwide guidelines. Their relationship with HTN need more investigations.

AIM

We aimed to investigate the associations between lifestyle, anthropometric and biological measurements and BP in the Gubbio residential study.

METHODS

Cross-sectional analyses were performed using data from Gubbio study. Information concerning lifestyle factors were collected using self-reported questionnaire and were further completed with a baseline clinical examination and blood exams. Three BP measurements were performed following a standard protocol. Age-adjusted and multivariable logistic regressions were used to examine the relationships between lifestyle parameters and HTN separately for each sex. We used heterogeneity test to observe sex differences.

RESULTS

There were 3,183 persons included (48% men, 43 ± 17 years old). Mean systolic BP (SBP) was 119 ± 16 mmHg and 10.6% were hypertensives. Age [OR: 129.70 (95%CI: 18.57-905.79) in women and OR: 8.37 (95%CI: 4.01-17.48) (p < 0.0001) in men] and BMI [OR: 2.14 (95%CI: 1.32-3.46) (p = 0.006) in women and OR: 1.81 (95%CI: 1.05-3.12), p = 0.03 in men], were positively associated with SBP in both sexes. Serum uric acid [OR: 3.86 (95%CI: 2.03-7.26), p = 0.04] was positively associated with HTN in women while fasting blood glucose [OR: 3.04 (95%CI: 1.55-5.97), p < 0.001] were associated to HTN only in men.

DISCUSSION

In addition to age, BMI is associated with HTN in both sexes while sex differences were observed in the associations between serum uric acid, fasting blood glucose and HTN.

Effects of Moxonidine Administration on Serum Neuropeptide Y Levels in Hypertensive Individuals: A Prospective Observational Study

Moxonidine is a centrally acting, anti-hypertensive medication that exerts additional metabolic properties. It is unknown whether its effects are mediated by neurotransmitters or sympathetic tone regulators, including Neuropeptide Y (NPY). In this study, we evaluated the effects of moxonidine administration on serum NPY in humans. Methods: Ninety individuals with mild or moderate arterial hypertension that required monotherapy were categorized in three age and gender-matched groups according to their Body Mass Index (BMI) as normal weight (n = 30), overweight (n = 30), and obese (n = 30). Moxonidine was administered in therapeutic doses of up to 0.6 mg daily for 12 weeks, and clinical, biochemical and hormonal parameters were recorded. Results: In all three groups, a decrease in systolic and diastolic blood pressure and heart rate was shown. After treatment, BMI, 24 h urine catecholamines and catecholamines’ metabolites, and serum total cholesterol were also reduced. Most importantly, we found a decrease in serum NPY levels in all study groups, with the largest mean decrease in the group of obese and overweight participants compared to normal weight. Conclusions: Moxonidine administration results in improvement in cardio-metabolic parameters, as well as a decrease in serum NPY levels, which therefore represents it being a potent agent against obesity-associated hypertension. Its involvement in energy balance regulation warrants further investigation.

Hypertension in childhood obesity

AIM

The prevalence of childhood hypertension is rising in parallel with global increases in the prevalence of overweight and obesity. We looked at key papers and documents covering three decades.

METHODS

This mini review examined a wide range of material published in English, with the main focus on 1993-2018, including clinical trials, meta-analyses, guidelines and data produced by the World Health Organization and the World Obesity Federation.

RESULTS

The literature showed that body weight and blood pressure are closely correlated and obesity-related hypertension contributes further to the clustering of cardiovascular risk factors in obesity. Because the duration of hypertension affects the risk of end-organ damage, timely diagnosis and initiation of treatment are important. First-line interventions should aim for blood pressure control and weight reduction. However, lifestyle modifications are often not successful with regard to attaining and maintaining long-term blood pressure and weight control, despite a multidisciplinary approach. Antihypertensive treatment is recommended for all hypertensive children with failure of nonpharmacological treatment, diabetes, secondary hypertension, stage 2 hypertension or target organ damage.

CONCLUSION

We found that obesity-related hypertension was associated with a significantly increased cardiovascular morbidity and mortality, and early diagnosis and treatment for blood pressure control and weight reduction is essential.

Regulation of alternative splicing in obesity-induced hypertension

Obesity is the result of genetics which predisposes an individual to obesity and environmental factors, resulting in excessive weight gain. A well-established linear relationship exists between hypertension and obesity. The combined burden of hypertension and obesity poses significant health and economic challenges. Many environmental factors and genetic traits interact to contribute to obesity-linked hypertension. These include excess sodium re-absorption or secretion by the kidneys, a hypertensive shift of renal-pressure and activation of the sympathetic nervous system. Most individuals suffering from hypertension need drugs in order to treat their raised blood pressure, and while a number of antihypertensive therapeutic agents are currently available, 50% of cases remain uncontrolled. In order to develop new and effective therapeutic agents combating obesity-induced hypertension, a thorough understanding of the molecular events leading to adipogenesis is critical. With the advent of whole genome and exome sequencing techniques, new genes and variants which can be used as markers for obesity and hypertension are being identified. This review examines the role played by alternative splicing (AS) as a contributing factor to the metabolic regulation of obesity-induced hypertension. Splicing mutations constitute at least 14% of the disease-causing mutations, thus implicating polymorphisms that effect splicing as indicators of disease susceptibility. The unique transcripts resulting from the alternate splicing of mRNA encoding proteins that play a key role in contributing to obesity would be vital to gain a proper understanding of the genetic causes of obesity. A greater knowledge of the genetic basis for obesity-linked hypertension will assist in the development of appropriate diagnostic tests as well as the identification of new personalized therapeutic targets against obesity-induced hypertension.

Cardiometabolic crosstalk in obesity-associated arterial hypertension

Abdominal obesity and elevated blood pressure commonly occur in the same patient and are key components of the metabolic syndrome. However, the association between obesity and increased blood pressure is variable. We review mechanisms linking cardiovascular and metabolic disease in such patients including altered systemic and regional hemodynamic control, neurohumoral activation, and relative natriuretic peptide deficiency. Moreover, we discuss recent results using omics techniques providing insight in molecular pathways linking adiposity, metabolic disease, and arterial hypertension. Recognition of the mechanisms orchestrating the crosstalk between cardiovascular and metabolic regulation in individual patients may lead to better and more precise treatments. It is reassuring that recently developed cardiovascular and metabolic medications may in fact ameliorate, both, cardiovascular and metabolic risks.

Blood pressure control and risk profile in poststroke survivors: a comparison with the general population

OBJECTIVE

Recurrent strokes are associated with higher mortality, greater disability, and increased healthcare costs compared with first-ever stroke. Lifestyle measures and drug treatment in secondary prevention decrease the risk of recurrence while improving the quality of life of patients. The objective of this study was to determine the prevalence of hypertension and other cardiovascular risk factors in stroke survivors and population controls.

METHODS AND RESULTS

A total of 424 poststroke survivors (aged 66.0 ± 10.4 years) were examined 6-36 months after their first ischemic stroke. Controls of similar age and from the same geographic region were selected from the database of the Czech post-Multinational MONItoring of trends and determinants in CArdiovascular disease Study. Hypertension was found to be the most prevalent risk factor affecting 91.5% of stroke survivors and 71.8% of controls. Use of antihypertensive drugs was reported in 79.5% of stroke survivors and 56.7% of controls. However, blood pressure lower than 140/90 mmHg was achieved in only 49.5% of hypertensive stroke survivors. More than 60% of stroke survivors used statins but low-density lipoprotein-cholesterol lower than 2.5 mmol/l was achieved in only 47.4 and 37% of male and female poststroke survivors, respectively. About a third of poststroke patients continue to smoke, and obesity is a major problem, particularly in women (prevalence 47%), who also have a high prevalence of diabetes.

CONCLUSION

We found a high prevalence and poor control of major cardiovascular risk factors in patients surviving their first-ever ischemic stroke, thus showing poor implementation of guidelines for secondary prevention in clinical practice.

Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: a meta-analysis of randomised trials

BACKGROUND

The cardiovascular benefits of blood pressure lowering in obese people compared with people of normal weight might depend on choice of drug. We compared the effects of blood pressure-lowering regimens on cardiovascular risk in groups of patients categorised by baseline body-mass index (BMI).

METHODS

We used individual patient data from trials included in the Blood Pressure Lowering Treatment Trialists' Collaboration to compare the effects of different classes of blood pressure-lowering regimens for the primary outcome of total major cardiovascular events (stroke, coronary heart disease, heart failure, and cardiovascular death). We used meta-analyses and meta-regressions to assess interactions between treatment and BMI when fitted as either a categorical variable (<25 kg/m(2), 25 to <30 kg/m(2), and ≥30 kg/m(2)) or a continuous variable.

FINDINGS

Analyses were based on 135,715 individuals from 22 trials who had 14,353 major cardiovascular events. None of the six primary comparisons showed evidence that protection varied by drug class across the three BMI groups (all p for trend >0·20). When analysed as a continuous variable, angiotensin-converting-enzyme inhibitors gave slightly greater protection for each 5 kg/m(2) higher BMI than did calcium antagonists (hazard ratio 0·93, 95% CI 0·89-0·98; p=0·004) or diuretics (0·93, 0·89-0·98; p=0·002). The meta-regressions showed no relation between BMI category and the risk reduction for a given fall in systolic blood pressure. By contrast with a previous report, we noted no relation between BMI and the efficacy of calcium antagonists compared with diuretics.

INTERPRETATION

We found little evidence that selection of a particular class of blood pressure-lowering drug will lead to substantially different outcomes for individuals who are obese compared with those who are lean.

FUNDING

None.

Relationship between nutrition and blood pressure: a cross-sectional analysis from the NutriNet-Santé Study, a French web-based cohort study

BACKGROUND

Hypertension is the most prevalent chronic disease worldwide. Lifestyle behaviors for its prevention and control are recommended within worldwide guidelines. Nevertheless, their combined relationship with blood pressure (BP) level, particularly in the general population, would need more investigations. Our aim in this study was to evaluate the relative impact of lifestyle and nutritional factors on BP level.

METHODS

Cross-sectional analyses were performed using data from 8,670 volunteers from the NutriNet-Santé Study, an ongoing French web-based cohort study. Dietary intakes were assessed using three 24-hour records. Information on lifestyle factors was collected using questionnaires and 3 BP measurements following a standardized protocol. Age-adjusted associations and then multivariate associations between systolic BP (SBP) and lifestyle behaviors were estimated using multiple linear regressions.

RESULTS

SBP was higher in participants with elevated body mass indices (BMIs). Salt intake was positively associated with SBP in men but not in women. The negative relationship between consumption of fruits and vegetables and SBP was significant in both sexes. Alcohol intake was positively associated with SBP in both sexes; physical activity was not. The 5 parameters representing the well-accepted modifiable factors for hypertension reduction plus age and education level, accounted for 19.7% of the SBP variance in women and 12.8% in men. Considering their squared partial correlation coefficient, age and BMI were the most important parameters relating to SBP level. Salt intake was not associated with SBP in either sex after multiple adjustments.

CONCLUSIONS

BMI was the main contributory modifiable factor of BP level after multiple adjustments.

Epidemiology of hypertension and its relationship with type 2 diabetes and obesity in eastern Morocco

The major objectives of this work are to estimate the hypertension (HT) frequency in the east of Morocco and to study the relationship between HT, type 2 diabetes and obesity. Our sample is composed of 1628 adults aged 40 years and older, recruited voluntarily by using the convenience sampling method through 26 screening campaigns in urban and rural areas of the east of Morocco. We enumerated 516 hypertensive people (31.7%), without significant difference between women (32.5%) and men (30.2%). The known hypertensive people represent 10.1% of the whole sample. The frequency of HT, increases with age and it is more marked in rural (39.9%) than in urban areas (29%) (p < 0.001). It is significantly very high in diabetic subjects (69.9%) than among the non-diabetic ones (27.4%) (p < 0.001). The odd ratio (OR) of the diabetics to HT is 6.16 (IC95% [4.33-8.74]). Among the obese persons, HT is present at (40.8%) vs. (30.2%) among the subjects of normal weight (p < 0.05). The OR of the obese to HT is 1.6 (IC95% [1.26 - 2.04]). In conclusion, our results show a high frequency of HT in the east of Morocco; it affects nearly one third of the adult population aged 40 years and older. The relations between type 2 diabetes and obesity have also been identified and estimated.

Obesity and weight management in the elderly: a focus on men

The rising rate of overweight/obesity among the ever-growing ageing population is imposing massive and rapidly changing burdens of ill health. The observation that the BMI value associated with the lowest relative mortality is slightly higher in older than in younger adults, mainly through its reduced impact on coronary heart disease, has often been misinterpreted that obesity is not as harmful in the elderly, who suffer a large range of disabling consequences of obesity. All medical consequences of obesity are multi-factorial and most alleviated by modest, achievable weight loss (5-10 kg) with an evidence-based maintenance strategy. But severe obesity, e.g. BMI >40 may demand greater weight loss e.g. >15 kg to reverse type 2 diabetes. Since relatively reduced physical activity and reduced muscle mass (sarcopenic obesity) are common in the elderly, combining exercise and modest calorie restriction optimally reduces fat mass and preserves muscle mass - age presents no obstacle and reducing polypharmacy is a valuable outcome. The currently licensed drug orlistat has no age-related hazards and is effective in a low fat diet, but the risks from bariatric surgery begin to outweigh benefits above age 60. For the growing numbers of obese elderly with diabetes, the glucagon-like peptide-1 (GLP-1) receptor analogue liraglutide appears a safe way to promote and maintain substantial weight loss. Obesity and sarcopenia should be prevented from younger age and during life-transitions including retiral to improve future health outcomes and quality of life, with a focus on those in "obese families".

Treatment of hypertension in obese patients

Obesity is a global pandemic and with its rise, its associated co-morbidities are increasing in prevalence, particularly uncontrolled hypertension. Lifestyle changes should be an anchor for the management of obesity-related hypertension; however, they are difficult to sustain. Drug therapy is often necessary to achieve blood pressure control. Diuretics, inhibitors of the renin-angiotensin system, and dihydropyridine calcium channel blockers are often used as first trio, with subsequent additions of mineralocorticoid receptor antagonists and/or dual alpha/beta blocking agents. While a number of agents are currently available, 50 % of hypertensive patients remain uncontrolled. A number of novel drug and invasive therapies are in development and hold significant potential for the effective management of obesity-related hypertension.

High blood pressure in Chinese ethnic minorities: report from rural Yunnan province

BACKGROUND

Hypertension (HTN) is a growing cause of morbidity and mortality among rural Chinese. While HTN has been studied in various regions of China, little is known about HTN among ethnic minorities in rural China.

METHODS

A total of 36 villages were randomly selected from Yunnan province, China. From these villages, a total of 1,676 subjects from 10 ethnic minorities and the Han ethnic majority were selected for interview and blood pressure (BP) measurement. From each village, 50-80 men and women between the ages of 50 and 70 years were randomly selected. HTN prevalence, treatment, and control rates of HTN were evaluated in these 11 ethnic groups.

RESULTS

After controlling for age, gender, body mass index (BMI), smoking, alcohol, and monosodium glutamate intake, prevalence of HTN varied between 25% in the Hani minority and 64% in the Tibetan minority (P < 0.001). Treatment rates varied between 0% in the Hani minority and 41% in the Tibetan minority (P = 0.006). Control rates varied between 0% in the Hani minority and 17% in the Tibetan minority (P = 0.28). Prevalence, treatment, and control rates in the Han ethnic group were 35, 22, and 12%, respectively.

CONCLUSIONS

The prevalence of HTN varies widely among China's ethnic groups. Treatment and control rates of HTN also vary and are inadequate in the minority ethnic groups as well as in the Han majority.

Drug mechanisms to help in managing resistant hypertension in obesity

Obesity is a major risk factor for the development of hypertension. Because the prevalence of obesity is increasing worldwide, the prevalence of obesity hypertension is also increasing. Importantly, hypertension in obesity is commonly complicated by dyslipidemia and type 2 diabetes mellitus and hence imposes a high cardiovascular disease risk. Furthermore, obesity is strongly associated with resistant hypertension. Activation of the sympathetic nervous system and the renin-angiotensin system, leading to renal sodium and water retention, links obesity with hypertension. There is also evidence for the release of factors by visceral adipose tissue promoting excessive aldosterone production, and a more central role of aldosterone in obesity hypertension is emerging. Randomized studies evaluating the effect of different classes of antihypertensive agents in obesity hypertension are scarce, short-lasting, and small. Considering the emerging role of aldosterone in the pathogenesis of obesity hypertension, mineralocorticoid receptor antagonism may play a more central role in the pharmacologic treatment of obesity hypertension in the near future.

Obesity and weight management in the elderly

Our population is ageing, and obesity is increasing in the elderly bringing massive and rapidly changing burdens of ill health related to increased body weights and fat as well as the main drivers of poor diet and inactivity. Overweight and obesity, and a static body mass index (BMI) commonly conceal sarcopenia (gain in body fat but loss of muscle mass and functional capacity) in older people, aggravated by inactivity. A systematic computerized literature search using an iterative manipulation process of the keywords: obesity, elderly, weight loss. The following databases were accessed on 20 October 2010: Medline, Cochrane Collaboration, Ovid and Scholar Google. A large number of clinical consequences of overweight and obesity are particularly problematic for elderly individuals, including type 2 diabetes mellitus, arthritis, urinary incontinence and depression. The observation that the BMI value associated with the lowest relative mortality is slightly higher in older than in younger adults has often been misinterpreted that obesity is not as harmful in the elderly. BMI may be a less appropriate index in the elderly. All the medical consequences of obesity are multi-factorial but all are alleviated by modest, achievable weight loss (5-10 kg) with an evidence-based maintenance strategy. Since sarcopenic obesity is common in the elderly, a combination of exercise and modest calorie restriction appears to be the optimal method of reducing fat mass and preserving muscle mass. Reduction in polypharmacy is a valuable target for weight management. Age is not an obstacle to weight management interventions using moderate calorie restriction and exercise, and the currently licensed drug orlistat appears to have no age-related hazards. Overall balance of clinical outcomes has not been evaluated. In older people the risks from bariatric surgery outweigh benefits. Obesity, and specifically sarcopenic obesity, should also be prevented not only from younger age, but also during major life transitions including retirement, to improve better health outcomes and quality of life in later years, with a focus on those in 'obese families', where the main increases in obesity are located. Randomized controlled trials to determine health benefits and risks from long-term weight management in obese elderly are necessary.

Obesity-related hypertension: epidemiology, pathophysiology, and clinical management

The prevalence of obesity, including childhood obesity, is increasing worldwide. Weight gain is associated with increases in arterial pressure, and it has been estimated that 60-70% of hypertension in adults is attributable to adiposity. Centrally located body fat, associated with insulin resistance and dyslipidemia, is a more potent determinant of blood pressure elevation than peripheral body fat. Obesity-related hypertension may be a distinct hypertensive phenotype with distinct genetic determinants. Mechanisms of obesity-related hypertension include insulin resistance, sodium retention, increased sympathetic nervous system activity, activation of renin-angiotensin-aldosterone, and altered vascular function. In overweight individuals, weight loss results in a reduction of blood pressure, however, this effect may be attenuated in the long term. An increasing number of community-based programs (including school programs and worksite programs) are being developed for the prevention and treatment of obesity. Assessment and treatment of the obese hypertensive patient should address overall cardiovascular disease (CVD) risk. There are no compelling clinical trial data to indicate that any one class of antihypertensive agents is superior to others, and in general the principles of pharmacotherapy for obese hypertensive patients are not different from nonobese patients. Future research directions might include: (i) development of effective, culturally sensitive strategies for the prevention and treatment of obesity; (ii) clinical trials to identify the most effective drug therapies for reducing CVD in obese, hypertensive patients; (iii) continued search for the genetic determinants of the obese, hypertensive phenotype.

Impact of blood pressure lowering on cardiovascular outcomes in normal weight, overweight, and obese individuals: the Perindopril Protection Against Recurrent Stroke Study trial

There is considerable uncertainty regarding the efficacy of blood pressure-lowering therapy in reducing cardiovascular risk in obese people. In this report we examine the effects of blood pressure lowering according to baseline body mass index (kilograms per meter squared) in the Perindopril Protection Against Recurrent Stroke Study. A total of 6105 participants with cerebrovascular disease were randomized to perindopril-based blood pressure-lowering therapy or placebo. The overall mean difference in systolic/diastolic blood pressure between participants assigned active therapy or placebo was 9/4 mm Hg (SE: 0.5/0.3 mm Hg), with no difference by body mass index quarters (<23.1, 23.1 to 25.3, 25.4 to 27.8, and > or = 27.9 kg/m(2)). A consistent treatment benefit was demonstrated for protection against major vascular events across quarters with the following hazard ratios (95% CIs): 0.80 (0.62 to 1.02), 0.78 (0.61 to 1.01), 0.67 (0.53 to 0.86), 0.69 (0.54 to 0.88), and 0.74 (0.66 to 0.84; P for heterogeneity=0.16). Similar results were apparent for stroke and stroke subtypes (all P for heterogeneity > or = 0.07) or with the standard definitions of overweight and obesity (<25, 25 to 29, and > or = 30 kg/m(2); all P for heterogeneity > or = 0.28). The absolute effects of treatment were, however, more than twice that in the highest compared with the lowest body mass index quartile. Across increasing quarters of body mass index over 5 years, active therapy prevented 1 major vascular event among every 28, 23, 13, and 13 patients treated. In conclusion, blood pressure-lowering therapy produced comparable risk reductions in vascular disease across the whole range of body mass indices in participants with a history of stroke. However, the greater baseline level of cardiovascular risk in those with higher body mass index meant that these patients obtained the greatest benefit.

Freqüência de hipertensão arterial e fatores associados: Brasil, 2006

OBJETIVO: Analisar a freqüência de hipertensão arterial sistêmica auto-referida e fatores associados. MÉTODOS: Estudo baseado em dados do sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL), coletados em 2006 nas capitais brasileiras e Distrito Federal. Estimou-se a freqüência de hipertensão arterial sistêmica entre 54.369 adultos, estratificada por sexo, região geográfica, variáveis sociodemográficas e comportamentais e morbidades auto-referidas. Foram calculadas os odds ratios brutos de hipertensão e ajustados para variáveis do estudo. RESULTADOS: A freqüência de hipertensão auto-referida foi de 21,6%, maior entre mulheres (24,4% versus 18,4%), menor nas regiões Norte e Centro-Oeste e maior na Sudeste. A freqüência de hipertensão aumentou com a idade, diminuiu com a escolaridade, foi maior entre negros e viúvos e menor entre solteiros. A chance de hipertensão, ajustada para variáveis de confusão, foi maior para os indivíduos com excesso de peso, diabetes, dislipidemia e de eventos cardiovasculares. CONCLUSÕES: Cerca de um quinto da população referiu ser portadora de hipertensão arterial sistêmica. As altas freqüências de fatores de risco modificáveis indicam os segmentos populacionais alvos de intervenção, visando à prevenção e controle da hipertensão.

Secondary hypertension: obesity and the metabolic syndrome

The epidemic of obesity in the United States and around the world is intensifying in severity and scope and has been implicated as an underlying mechanism in systemic hypertension. Obese hypertensive individuals characteristically exhibit volume congestion, relative elevation in heart rate, and high cardiac output with concomitant activation of the renin-angiotensin-aldosterone system. When the metabolic syndrome is present, insulin resistance and hyperinsulinemia may contribute to hypertension through diverse mechanisms. Blood pressure can be lowered when weight control measures are successful, using, for example, caloric restriction, aerobic exercise, weight loss drugs, or bariatric surgery. A major clinical challenge resides in converting short-term weight reduction into a sustained benefit. Pharmacotherapy for the obese hypertensive patient may require multiple agents, with an optimal regimen consisting of inhibitors of the renin-angiotensin-aldosterone system, thiazide diuretics, beta-blockers, and calcium channel blockers if needed to attain contemporary blood pressure treatment goals.

Blood pressure lowering effects of rimonabant in obesity-related hypertension

Obesity-related hypertension represents a common clinical condition characterised by complex pathophysiological and therapeutic features. From a pathophysiological view point, results of experimental and animal studies have led to the hypothesis that neurogenic mechanisms participate in the development and progression of the disease. The hypothesis is based on the evidence that metabolic (i.e. insulin-resistance) and neural (sympathetic activation) alterations frequently co-exist in the obese hypertensive patient and that they reciprocally potentiate each other. From a therapeutic view point, the 2007 European Society of Hypertension/European Society of Cardiology emphasised the importance in this clinical condition of treatment not only through antihypertensive drugs but also via lifestyle changes and drug-induced interventions that reduce body weight. The four Rimonabant In Obesity (RIO) studies have shown that rimonabant can decrease body weight. A recent meta-analysis, based on the RIO results, showed that rimonabant, particularly in obese hypertensive patients, can also decrease - although modestly (2.8 mmHg for systolic and 2.2 mmHg for diastolic) - blood pressure. These effects, which appear to be triggered by the weight reduction induced by the drug, are clinically relevant because they contribute favourably to lower the elevated cardiovascular risk profile of the obese hypertensive patient.