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Abstract
PURPOSE OF REVIEW Obesity increases the risk of hypertension. However, blood pressure decreases before any significant loss of body weight after bariatric surgery. We review the mechanisms of the temporal dissociation between blood pressure and body weight after bariatric surgery. RECENT FINDINGS Restrictive and bypass bariatric surgery lower blood pressure and plasma leptin levels within days of the procedure in both hypertensive and normotensive morbidly obese patients. Rapidly decreasing plasma leptin levels and minimal loss of body weight point to reduced sympathetic nervous system activity as the underlying mechanism of rapid blood pressure decline after bariatric surgery. After the early rapid decline, blood pressure does not decrease further in patients who, while still obese, experience a steady loss of body weight for the subsequent 12 months. The divergent effects of bariatric surgery on blood pressure and body weight query the role of excess body weight in the pathobiology of the obesity phenotype of hypertension. The decrease in blood pressure after bariatric surgery is moderate and independent of body weight. The lack of temporal relationship between blood pressure reduction and loss of body weight for 12 months after sleeve gastrectomy questions the nature of the mechanisms underlying obesity-associated hypertension.
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Affiliation(s)
- Rohan Samson
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenuew, SL-48, New Orleans, LA, 70112, USA
| | - Karnika Ayinapudi
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenuew, SL-48, New Orleans, LA, 70112, USA
| | - Thierry H Le Jemtel
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenuew, SL-48, New Orleans, LA, 70112, USA.
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Iida H, Kurita N, Takahashi S, Sasaki S, Nishiwaki H, Omae K, Yajima N, Fukuma S, Hasegawa T, Fukuhara S, Kobayashi S, Niihata K, Naganuma T, Tominaga R. Salt intake and body weight correlate with higher blood pressure in the very elderly population: The Sukagawa study. J Clin Hypertens (Greenwich) 2019; 21:942-949. [DOI: 10.1111/jch.13593] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/05/2019] [Accepted: 04/21/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Hidekazu Iida
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE) Fukushima Medical University Fukushima Japan
- You Home Clinic Tokyo Japan
- Department of Clinical Epidemiology, Graduate School of Medicine Fukushima Medical University Fukushima Japan
| | - Noriaki Kurita
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE) Fukushima Medical University Fukushima Japan
- Department of Clinical Epidemiology, Graduate School of Medicine Fukushima Medical University Fukushima Japan
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT) Fukushima Medical University Fukushima Japan
| | - Sei Takahashi
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE) Fukushima Medical University Fukushima Japan
| | - Sho Sasaki
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE) Fukushima Medical University Fukushima Japan
- Department of Nephrology/Clinical Research Support Office Iizuka Hospital Fukuoka Japan
| | - Hiroki Nishiwaki
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE) Fukushima Medical University Fukushima Japan
- Division of Nephrology, Department of Medicine Showa University Fujigaoka Hospital Yokohama Japan
| | - Kenji Omae
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE) Fukushima Medical University Fukushima Japan
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT) Fukushima Medical University Fukushima Japan
| | - Nobuyuki Yajima
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE) Fukushima Medical University Fukushima Japan
- Division of Rheumatology, Department of Medicine Showa University School of Medicine Tokyo Japan
| | - Shingo Fukuma
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE) Fukushima Medical University Fukushima Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
- Human Health Sciences, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Takeshi Hasegawa
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE) Fukushima Medical University Fukushima Japan
- Division of Nephrology, Department of Medicine Showa University Fujigaoka Hospital Yokohama Japan
- Showa University Research Administration Center Showa University Tokyo Japan
| | - Shunichi Fukuhara
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE) Fukushima Medical University Fukushima Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
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Abstract
Hypertension and associated cardiovascular diseases represent the most common health complication of obesity and the leading cause of morbidity and mortality in overweight and obese patients. Emerging evidence suggests a critical role for the central nervous system particularly the brain action of the adipocyte-derived hormone leptin in linking obesity and hypertension. The preserved ability of leptin to cause cardiovascular sympathetic nerve activation despite the resistance to the metabolic actions of the hormone appears essential in this pathological process. This review describes the evidence supporting the neurogenic bases for obesity-associated hypertension with a particular focus on the neuronal and molecular signaling pathways underlying leptin's effects on sympathetic nerve activity and blood pressure.
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Affiliation(s)
- Balyssa B Bell
- Department of Pharmacology, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA
| | - Kamal Rahmouni
- Department of Pharmacology, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA.
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA, USA.
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Backes CF, Lopes E, Tetelbom A, Heineck I. Medication and nutritional supplement use before and after bariatric surgery. SAO PAULO MED J 2016; 134:0. [PMID: 27812597 DOI: 10.1590/1516-3180.2015.0241030516] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 05/03/2016] [Indexed: 01/01/2023] Open
Abstract
CONTEXT AND OBJECTIVE: Bariatric surgery has been an effective alternative treatment for morbid obesity and has resulted in decreased mortality, better control over comorbidities and reduced use of drugs. The objective of this study was to analyze the impact of bariatric surgery on medication drug and nutritional supplement use. DESIGN AND SETTING: Longitudinal study of before-and-after type, on 69 morbidly obese patients in a public hospital in Porto Alegre. METHODS: Through interviews, the presence of comorbidities and use of drugs with and without prescription were evaluated. RESULTS: Among the 69 patients interviewed, 85.5% had comorbidities in the preoperative period, with an average of 2.3 (± 1.5) per patient. The main comorbidities reported were hypertension, diabetes and dyslipidemia. 84.1% of the patients were using prescribed drugs in the preoperative period. The mean drug use per patient was 4.8, which decreased to 4.4 after the procedure. The surgery enabled significant reduction in use of most antidiabetic (84%), antilipemic (77%) and antihypertensive drugs (49.5%). On the other hand, there was a significant increase in use of multivitamins and drugs for disorders of the gastrointestinal tract. The dosages of most of the drugs that continued to be prescribed after surgery were decreased, but not significantly. CONCLUSION: After bariatric surgery, there were increases in the use of vitamins, gastric antisecretory drugs and antianemic drugs. Nevertheless, there was an overall reduction in drug use during this period, caused by suspension of drugs or dose reduction.
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Affiliation(s)
- Charline Fernanda Backes
- Master's Student in the Postgraduate Pharmaceutical Sciences Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Edyane Lopes
- PhD. Pharmacist, School of Public Health, Health Department of the State of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Airton Tetelbom
- MD. Coordinator of the Health Technology Assessment Center, Grupo Hospitalar Conceição; Head Professor of Public Health, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA); Associate Professor of Public Health, Universidade Luterana do Brasil (ULBRA); and Contributing Professor in the Postgraduate Epidemiology Program, Department of Social Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Isabela Heineck
- PhD. Associate Professor, Postgraduate Pharmaceutical Sciences Program and Postgraduate Pharmaceutical Services, School of Pharmacy, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Gilardini L, Redaelli G, Croci M, Conti A, Pasqualinotto L, Invitti C. Effect of a Modest Weight Loss in Normalizing Blood Pressure in Obese Subjects on Antihypertensive Drugs. Obes Facts 2016; 9:251-8. [PMID: 27454447 PMCID: PMC5644874 DOI: 10.1159/000445504] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/14/2016] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To assess the effect of a lifestyle intervention in lowering/normalizing blood pressure (BP) levels in hypertensive (controlled or not) obese patients. METHODS In this prospective observational study, 490 obese hypertensive patients, 389 controlled (BP < 140/90 mm Hg; CH) and 101 uncontrolled (BP ≥ 140/90 mm Hg; UH) attended a 3-month lifestyle intervention. Before and after the intervention we assessed weight, waist circumference, fat mass, BP, metabolic and renal variables, and physical activity. A multivariate regression model was used to determine the predictors of BP changes. RESULTS 18.9% of CH and 20.0% of UH were on ≥ 3 antihypertensive drugs. Weight change (average -4.9 ± 2.7%) was independent of the antihypertensive drugs employed. Systolic BP (SBP) decreased by 23 mm Hg and diastolic BP (DBP) by 9 mm Hg, in patients with UH most of whom (89%) normalized BP levels (in 49% after a weight loss < 5%). Age, gender, whole and central obesity, concomitance of type 2 diabetes, chronic renal disease, physical activity intensification, and pharmacological therapy did not affect BP lowering. In the regression analysis with SBP change as dependent variable, weight reduction (β = 0.523, p = 0.005) and group (UH vs. CH, β = -19.40, p = 0.0005) remained associated with SBP reduction. When DBP change was entered as dependent variable, baseline uric acid remained associated with DBP reduction (β = 0.824, p < 0.05). CONCLUSION Lifestyle interventions are useful for all obese hypertensive patients in most of whom a modest weight loss is sufficient to normalize BP levels avoiding the aggressive use of multiple antihypertensive drugs.
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Affiliation(s)
- Luisa Gilardini
- *Dr. Luisa Gilardini, Department of Medical Sciences and Rehabilitation, IRCCS, Istituto Auxologico Italiano, Via Ariosto 13, 20145 Milan, Italy,
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Piché MÈ, Auclair A, Harvey J, Marceau S, Poirier P. How to choose and use bariatric surgery in 2015. Can J Cardiol 2014; 31:153-66. [PMID: 25661550 DOI: 10.1016/j.cjca.2014.12.014] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/03/2014] [Accepted: 12/03/2014] [Indexed: 01/01/2023] Open
Abstract
Severe obesity is associated with increased morbidity and mortality and represents a major health care problem with increasing incidence worldwide. Bariatric surgery, through its efficacy and improved safety, is emerging as an important available treatment for patients with severe obesity. Classically, bariatric surgery has been described as either a restrictive or a hybrid surgery, which is a combination of restriction and malabsorption. For most severely obese patients, bariatric surgery results in the remission of major obesity-related comorbidities including type 2 diabetes mellitus, sleep apnea, hypertension, and dyslipidemia. Thus, bariatric surgery reduces cardiovascular risk burden, and overall mortality risk. Early complications (< 30 days) after bariatric surgery were reported to be < 10% and tend to be lower in restrictive surgeries compared with hybrid surgeries. Most common early complications reported are gastric and anastomosis leak (1.6%-5.1%), bleeding (0.5%-3.5%), and pulmonary embolism (0.2%-1%). Long-term complications (> 30 days) might differ depending on the type of bariatric surgery. According to the type of surgery and the type of study, the 30-day operative mortality rates differ from 0.1% to 1.2%. Studies on postoperative outcomes, investigations on weight loss physiology, and mechanism of action after bariatric surgery provide a better understanding of the bariatric surgery metabolic benefits. In this article, we present an overview of bariatric procedures with their effects, including risks and benefits, on the severely obese patients' health. It provides evidence to support surgical treatment of severe obesity to achieve cardiovascular disease risk reduction in severely obese patients.
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Affiliation(s)
- Marie-Ève Piché
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Audrey Auclair
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada
| | - Jany Harvey
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada
| | - Simon Marceau
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Paul Poirier
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada.
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7
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Do ethnic differences contribute to the relationship between body composition and hypertension? J Hypertens 2014; 32:974-6. [PMID: 24695387 DOI: 10.1097/hjh.0000000000000163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Patle R, Dubb S, Alaghband-Zadeh J, Sherwood RA, Tam F, Frankel A, Moniz C, Bueter M, Vincent RP, le Roux CW. Improved blood pressure, nitric oxide and asymmetric dimethylarginine are independent after bariatric surgery. Ann Clin Biochem 2012; 49:589-94. [DOI: 10.1258/acb.2012.012069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Obesity is associated with hypertension, but the exact mechanism is not fully understood. Bariatric surgery significantly decreases weight and blood pressure (BP). Low plasma nitric oxide (NO) and raised asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NO, concentrations are associated with both obesity and hypertension. Correlations between the changes in these parameters were studied after bariatric surgery. Methods Weight, BP, plasma ADMA and NO were measured in 29 obese patients (24 female, 5 male) before and six weeks after bariatric surgery. Results Patients were 39.2 ± 1.2 (mean ± SEM) years old and weighed 126 ± 3 kg. Six weeks after the surgery, patients had lost 10 ± 0.7 kg ( P < 0.0001) and mean arterial pressure (MAP) decreased by 11 ± 1.0 mmHg ( P < 0.0001). The plasma ADMA concentration decreased by 24 ± 2% from 5 ± 0.4 to 4.0 ± 0.3 μmol/L ( P < 0.0001). The plasma total nitrite concentration increased by 15 ± 1% from 51.4 ± 2.6 to 60 ± 3 μmol/L ( P < 0.0001). The correlation between the decrease of ADMA and increase of NO subsequent to weight loss was significant ( P < 0.0001). However, MAP was not correlated to the changes in ADMA or NO. Conclusions After bariatric surgery, beneficial changes in BP, NO and ADMA occur, but our findings suggest that these BP changes are independent of changes in the NO–ADMA axis. Other causes for the changes in BP should therefore be considered.
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Affiliation(s)
- R Patle
- Clinical Biochemistry Department, King's College Hospital NHS Foundation Trust, London SE5 9RS
| | | | - J Alaghband-Zadeh
- Clinical Biochemistry Department, King's College Hospital NHS Foundation Trust, London SE5 9RS
| | - R A Sherwood
- Clinical Biochemistry Department, King's College Hospital NHS Foundation Trust, London SE5 9RS
| | - F Tam
- Renal Medicine, Imperial College London, London SW7 2AZ, UK
| | - A Frankel
- Renal Medicine, Imperial College London, London SW7 2AZ, UK
| | - C Moniz
- Clinical Biochemistry Department, King's College Hospital NHS Foundation Trust, London SE5 9RS
| | | | - R P Vincent
- Clinical Biochemistry Department, King's College Hospital NHS Foundation Trust, London SE5 9RS
| | - C W le Roux
- Clinical Biochemistry Department, King's College Hospital NHS Foundation Trust, London SE5 9RS
- Imperial Weight Centre
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9
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Different mechanisms in weight loss-induced blood pressure reduction between a calorie-restricted diet and exercise. Hypertens Res 2011; 35:41-7. [PMID: 21814218 DOI: 10.1038/hr.2011.134] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The present study compared the effectiveness of a mild calorie-restricted diet (D) alone, exercise (EX) alone and a combination of D+EX on weight loss-induced blood pressure (BP) reduction over 24 weeks. We focussed especially on the relationship between sympathetic nervous activity, as indicated from measures of plasma norepinephrine (NE), and insulin resistance (homeostasis model of insulin resistance, HOMA-IR). The three groups each comprised 30 obese, hypertensive men. Body mass index (BMI), fat mass, waist-to-hip ratio, BP, plasma NE and HOMA-IR were measured every 2 weeks during the first 4 weeks and subsequently every 4 weeks for the next 20 weeks. All basal parameters were similar among the three groups. At 24 weeks, the combination group with D+EX comprised a significantly higher prevalence of normotensive subjects than the D alone or EX alone group (P<0.05). In the D alone group, plasma NE was decreased significantly at 2 weeks, reductions in BMI, fat mass and BP were observed at 8 weeks, and waist-to-hip ratios and HOMA-IR were decreased at 12 weeks. In comparison, in the EX alone group, significant reductions of fat mass and HOMA-IR were observed at 4 weeks. Plasma NE and HOMA-IR were reduced at 8 weeks while decreases in BP were detected at 12 weeks. In the D+EX group, significant reductions in plasma NE were observed at 2 weeks followed by significant decreases in BMI, fat mass, waist-to-hip ratio, BP levels and HOMA-IR at 4 weeks. The magnitudes of reductions of all parameters were greatest in the D+EX group. These results demonstrate that D+EX exerts a stronger ameliorative effect on weight loss, weight loss-induced BP reduction, normalization of BP, sympathetic activation and insulin resistance compared with D or EX alone. D and EX might, perhaps, exert different mechanisms on weight loss and weight loss-induced BP reduction; however, a combination of caloric restriction and exercise is preferred to control BP levels in obese hypertensive patients.
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Poirier P, Cornier MA, Mazzone T, Stiles S, Cummings S, Klein S, McCullough PA, Ren Fielding C, Franklin BA. Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association. Circulation 2011; 123:1683-701. [PMID: 21403092 DOI: 10.1161/cir.0b013e3182149099] [Citation(s) in RCA: 291] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Masuo K, Lambert GW. Relationships of adrenoceptor polymorphisms with obesity. J Obes 2011; 2011:609485. [PMID: 21603275 PMCID: PMC3092628 DOI: 10.1155/2011/609485] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 02/07/2011] [Indexed: 01/28/2023] Open
Abstract
Obesity, hypertension, and type 2 diabetes are rapidly growing public health problems. Heightened sympathetic nerve activity is a well-established observation in obesity, hypertension, and type 2 diabetes. Human obesity, hypertension, and diabetes have strong genetic as well as environmental determinants. Reduced energy expenditure and resting metabolic rate are predictive of weight gain, and the sympathetic nervous system participates in regulating energy balance through thermogenesis. The thermogenic effects of catecholamines in obesity are mainly mediated via the β2, and β3-adrenergic receptors in humans. Further, β2-adrenoceptors importantly influence vascular reactivity and may regulate blood pressure. β-adrenoceptor polymorphisms have also been associated with adrenoceptor desensitization, increased adiposity, insulin resistance, and enhanced sympathetic nervous activity. Many epidemiological studies have shown strong relationships between adrenoceptor polymorphisms and obesity, but the observations have been discordant. This paper will discuss the current topics involving the influence of the sympathetic nervous system and β2- and β3-adrenoceptor polymorphisms in obesity.
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Affiliation(s)
- Kazuko Masuo
- Nucleus Network, Ltd, Baker IDI Heart and Diabetes Research Institute, 89 Commercial Road, Melbourne, VIC 3004, Australia
- Human Neurotransmitter Laboratory, Baker IDI Heart and Diabetes Research Institute, Melbourne, VIC 3004, Australia
- *Kazuko Masuo:
| | - Gavin W. Lambert
- Human Neurotransmitter Laboratory, Baker IDI Heart and Diabetes Research Institute, Melbourne, VIC 3004, Australia
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European Society of Hypertension Working Group on Obesity Antihypertensive effects of weight loss: myth or reality? J Hypertens 2010; 28:637-43. [PMID: 20125037 DOI: 10.1097/hjh.0b013e32833778e1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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13
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Nakamura Y, Ueshima H, Okuda N, Murakami Y, Miura K, Kita Y, Okamura T, Turin TC, Rodriguez B, Curb JD, Stamler J. Relation of serum leptin to blood pressure of Japanese in Japan and Japanese-Americans in Hawaii. Hypertension 2009; 54:1416-22. [PMID: 19841291 DOI: 10.1161/hypertensionaha.109.133074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Data from animal studies clearly indicate an association between leptin and hypertension; results of human studies are less concordant. We investigated the role of leptin in obesity-related higher blood pressure (BP) in Japanese Americans living in Hawaii and Japanese in Japan. Serum leptin and BP were examined by standardized methods in men and women ages 40 to 59 years from 2 population samples, one Japanese American in Hawaii (88 men and 94 women) and the other Japanese in central Japan (123 men and 111 women). Multiple linear regression models were used to assess role of leptin in obesity-related higher BP. Across quartiles of leptin, there were significantly higher mean body mass index levels, systolic BP, and diastolic BP for both sexes and sites (P<0.01 to 0.02). In multivariate regression analyses using all of the data combined, relations of body mass index and leptin to systolic BP and diastolic BP remained significant with the interaction term (body mass index x log-leptin) in the models (P<0.01 to <0.05). These findings are consistent with the inference that leptin may be an independent mediator for obesity-related elevations in BP.
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Affiliation(s)
- Yasuyuki Nakamura
- Cardiovascular Epidemiology, Kyoto Women's University, 35 Imakumano Kitahiyoshi-cho, Higashiyama-ku, Kyoto 605-8501, Japan.
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14
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Ohkuchi A, Iwasaki R, Suzuki H, Hirashima C, Takahashi K, Usui R, Matsubara S, Minakami H, Suzuki M. Normal and high-normal blood pressures, but not body mass index, are risk factors for the subsequent occurrence of both preeclampsia and gestational hypertension: a retrospective cohort study. Hypertens Res 2006; 29:161-7. [PMID: 16755151 DOI: 10.1291/hypres.29.161] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Blood pressure (BP) levels and body mass index (BMI) are known as risk factors for preeclampsia and gestational hypertension. However, there have been few investigations regarding the effects of BP and BMI levels on preeclampsia and gestational hypertension in the same cohort. In the present study, we conducted a retrospective cohort study using multiple logistic regression analysis. The cohort included 1,518 patients without nephritis. The unadjusted odds ratios (ORs) of preeclampsia and gestational hypertension were increased in pregnant women with normal BP (120-129 mmHg systolic or 80-84 mmHg diastolic), high-normal BP and hypertension in the second trimester compared to those with optimal BP. The unadjusted ORs of preeclampsia and gestational hypertension were also increased in obese women in the pre-pregnancy period compared to women with normal range BMI. When adjustment was made for both the BP levels and pre-pregnancy BMI levels, the ORs (95% confidence intervals) of normal BP, high-normal BP, hypertension and obesity for the subsequent occurrence of preeclampsia were 5.1 (2.2-12), 8.3 (3.1-22), 16 (5.0-50) and 2.0 (0.67-5.9), and those for the subsequent occurrence of gestational hypertension were 7.0 (2.6-19), 7.4 (2.1-25), 22 (6.1-83) and 1.3 (0.33-4.8), respectively. For the subsequent occurrence of preeclampsia or gestational hypertension, normal BP, high-normal BP and hypertension in the second trimester may be independent risk factors. Obesity in the pre-pregnancy period, however, may not be an independent risk factor.
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Affiliation(s)
- Akihide Ohkuchi
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Japan.
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Adami GF, Papadia F, Carlini F, Murelli F, Scopinaro N. Effect of Biliopancreatic Diversion on Hypertension in Severely Obese Patients. Hypertens Res 2005; 28:119-23. [PMID: 16025738 DOI: 10.1291/hypres.28.119] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hypertension is a medical disorder frequently associated with severe obesity, and the effect of weight loss on the reduction of blood pressure has been well established. In this study, the relationships between the weight loss surgically obtained by biliopancreatic diversion and blood pressure were investigated in a population of severely obese patients with preoperative hypertension. At 1 year following the operation, blood pressure was normalized in more than half of patients; in a further 10% of cases the hypertensive status resolved within the 3-year follow-up period. The resolution of hypertension was independently associated with age and body weight and was unrelated to sex, the amount of weight loss, or body fat distribution. In severely obese patients with hypertension undergoing bariatric surgery, biliopancreatic diversion is advisable since it achieves and supports the maintenance of body weight close to the ideal value.
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Affiliation(s)
- Gian Franco Adami
- Dipartimento di Discipline Chirurgiche e Metodologie Integrate, Facoltà di Medicina e Chirurgia, Università di Genova, Genova, Italy.
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Abstract
The association between obesity and hypertension is well documented, although the exact nature of this relation remains unclear. Sympathetic nervous and renin-angiotensin-aldosterone system activation appear to play an important role in the sodium and water retention, rightward shift in the pressure-natriuresis, and blood pressure elevation observed in obese individuals. Visceral obesity and the ectopic deposition of adipose tissue may be important in the activation of these systems and in the target organ damage that ensues. Weight loss is critical in the effective management of obesity hypertension and the accompanying target organ damage, although recidivism rates are high. However, prevention of weight gain should be the major priority for combating hypertension and its consequences in the future. The present review will provide an overview of our understanding of the etiology, pathophysiology, and treatment of obesity hypertension. Our focus is on the state of knowledge in humans. The potential role of abdominal obesity is considered throughout our review. We refer to relevant animal literature for supportive evidence and where little or no data in humans are available.
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Affiliation(s)
- Kevin P Davy
- Dept. of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA.
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Masuo K, Kawaguchi H, Mikami H, Ogihara T, Tuck ML. Serum uric acid and plasma norepinephrine concentrations predict subsequent weight gain and blood pressure elevation. Hypertension 2003; 42:474-80. [PMID: 12953019 DOI: 10.1161/01.hyp.0000091371.53502.d3] [Citation(s) in RCA: 355] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
It has been reported that hypertension and obesity often coexist with hyperuricemia. To clarify the relations between serum uric acid, plasma norepinephrine, and insulin or leptin levels in subjects with weight gain-induced blood pressure elevation, we conducted the present longitudinal study. In 433 young, nonobese, normotensive men, body mass index, blood pressure, and levels of serum uric acid, fasting plasma norepinephrine, insulin, and leptin were measured every year for 5 years. Subjects were stratified by significant weight gain and/or blood pressure elevation (>10% in body mass index or mean blood pressure) for 5 years. At entry, blood pressure, uric acid, and norepinephrine values in subjects with blood pressure elevation were greater than in those without it, although body mass index, insulin, and leptin were similar. At entry, body mass index, blood pressure, uric acid, and norepinephrine in subjects with weight gain were greater than in those without weight gain. The increases in body mass index, mean blood pressure, uric acid, norepinephrine, insulin, and leptin for 5 years were greater in subjects with blood pressure elevation and/or weight gain than in subjects without, and those increases were greatest in subjects with weight gain whose blood pressure was elevated. By multiple regression analysis, basal mean blood pressure, norepinephrine, and uric acid were significant determinant factors of changes in mean blood pressure over 5 years, and basal body mass index, norepinephrine, and uric acid were significant determinant factors of changes in body mass index. These results demonstrate that serum uric acid and plasma norepinephrine concentrations predict subsequent weight gain and blood pressure elevation.
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Affiliation(s)
- Kazuko Masuo
- Department of Geriatric Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita City, Osaka 565-0871, Japan.
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Pladevall M, Williams K, Guyer H, Sadurní J, Falces C, Ribes A, Paré C, Brotons C, Gabriel R, Serrano-Ríos M, Haffner S. The association between leptin and left ventricular hypertrophy: a population-based cross-sectional study. J Hypertens 2003; 21:1467-73. [PMID: 12872039 DOI: 10.1097/00004872-200308000-00009] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Plasma leptin levels have been shown to be an independent risk factor for cardiovascular disease. Leptin has been shown to have sympathetic and vascular effects, and may increase cardiovascular risk through increased blood pressure, left ventricular hypertrophy, or atherosclerotic mechanisms. This study examines whether leptin levels, independent of body mass and insulin resistance, are a risk factor for hypertension and left ventricular hypertrophy. METHODS AND PARTICIPANTS A population-based, cross-sectional sample of 410 adults from rural Spain was studied. The correlations between plasma leptin levels and left ventricular mass index, sum of wall thicknesses, and blood pressure were calculated. Multiple linear regression analysis was used to adjust for other cardiovascular risk factors. RESULTS After adjusting for age, body mass index, systolic blood pressure, sex, and insulin resistance, leptin was inversely associated with left ventricular mass index (beta = -0.20, P < 0.01). Leptin was also inversely related to the sum of wall thicknesses; however, this association did not reach statistical significance (beta = -0.12, P = 0.063). Leptin was not statistically associated with blood pressure after adjusting for body mass index. CONCLUSIONS The results do not support the hypothesis that leptin increases cardiovascular risk by increasing left ventricular mass index or blood pressure. Other mechanisms, related to atherosclerosis, could explain the increased risk of cardiovascular diseases observed with high leptin levels.
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Affiliation(s)
- Manel Pladevall
- Center for Health Services Research, Henry Ford Health System, Detroit, Michigan, USA [corrected]
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Laaksonen DE, Laitinen T, Schönberg J, Rissanen A, Niskanen LK. Weight loss and weight maintenance, ambulatory blood pressure and cardiac autonomic tone in obese persons with the metabolic syndrome. J Hypertens 2003; 21:371-8. [PMID: 12569268 DOI: 10.1097/00004872-200302000-00029] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cardiac autonomic function may play a role in obesity-associated hypertension. Most studies on the effects of weight loss on blood pressure and autonomic function do not distinguish between acute or continuing weight loss and steady-state weight maintenance after weight loss. OBJECTIVES We sought to clarify the changes in ambulatory blood pressure, heart rate and heart rate variability as assessed by spectral analysis during rapid weight loss and extended weight maintenance. PARTICIPANTS Abdominally obese (body mass index 35.2 +/- 2.1 kg/m2, waist 114.3 +/- 9.0 cm) men and women (n = 41) with the metabolic syndrome. METHODS AND RESULTS The 34 men and women completing the 1-year weight maintenance period lost 14.6 +/- 3.5 kg during the 9-week very-low-calorie diet and maintained a 12.5 +/- 7.5 kg weight loss to the end of the trial. Ambulatory 24-h blood pressure decreased dramatically during the diet (-9.0 +/- 8.0/-4.6 +/- 4.9 mmHg), but had risen to near baseline levels by the end of weight maintenance (-2.2 +/- 8.2 /-1.2 +/- 6.1 mmHg). Night-time heart rate decreased (-5.5 +/- 9.6 beats/min, P = 0.012), and heart rate variability total and low-frequency power measured during 5 min of controlled breathing increased by 46-56% (P = 0.003-0.09) during rapid weight loss. These changes gradually attenuated during weight maintenance, and only the change in night-time heart rate was still of borderline significance after 1 year of weight maintenance (-3.6 +/- 8.6 beats/min, P = 0.063). Heart rate variability high-frequency power tended to increase during weight loss and weight maintenance. CONCLUSION Despite successful weight maintenance, the decrease in ambulatory blood pressure after rapid weight loss was largely transient. The increase in parasympathetic tone was more sustained, but also gradually attenuated during 1 year of weight maintenance.
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Affiliation(s)
- David E Laaksonen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
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Barba G, Russo O, Siani A, Iacone R, Farinaro E, Gerardi MC, Russo P, Della Valle E, Strazzullo P. Plasma leptin and blood pressure in men: graded association independent of body mass and fat pattern. OBESITY RESEARCH 2003; 11:160-6. [PMID: 12529499 DOI: 10.1038/oby.2003.25] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The role of leptin in the association between body mass, central adiposity, and blood pressure (BP) is controversial. This study evaluated the relationship between leptin and BP in relation to body mass index (BMI) and fat distribution in a large sample of untreated male adults. RESEARCH METHODS AND PROCEDURES The study population was made up of 457 untreated male employees of the Olivetti factory in Naples. Plasma leptin, complete anthropometry, BP, and relevant biochemical variables were measured. RESULTS Log-transformed plasma leptin levels were directly associated with BMI (r = 0.661, p < 0.001) and waist circumference (r = 0.630; p < 0.001). Leptin also correlated with systolic (r = 0.258) and diastolic (r = 0.277) BP (p < 0.001). The association between leptin and BP was maintained after accounting for age, BMI (or waist circumference), log-insulin, and serum creatinine (p < 0.01); this association was stronger than that with BMI. Logistic regression analysis showed that an increased prevalence of hypertension (BP >or= 140 and/or 90 mm Hg) was associated with high plasma leptin levels when controlling for age and waist circumference (odds ratio, 1.99; 95%CI, 1.06 to 3.72) or for age and BMI (odds ratio, 1.92; 95%CI, 1.02 to 3.61). DISCUSSION A graded positive relationship between plasma leptin levels and BP was observed in this sample of untreated male adults. This association was independent of age, BMI, abdominal adiposity, and fasting plasma insulin. Moreover, elevated plasma leptin concentrations were associated with greater probability of hypertension, again independently of potential confounders.
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Affiliation(s)
- Gianvincenzo Barba
- Epidemiology and Population Genetics, Institute of Food Science, National Research Council, Avellino, Italy
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Tozawa M, Iseki K, Iseki C, Oshiro S, Higashiuesato Y, Ikemiya Y, Takishita S. Impact of multiple risk factor clustering on the elevation of blood pressure. Hypertens Res 2002; 25:811-6. [PMID: 12484502 DOI: 10.1291/hypres.25.811] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A family history of hypertension, obesity, diabetes mellitus, hypercholesterolemia, and hypertriglyceridemia have all been associated with risk of hypertension. We retrospectively conducted a longitudinal study in a large screened cohort to explore the effect of the clustering of these five risk factors on the elevation of blood pressure (BP) in normotensive subjects at baseline. The study group comprised 4,857 normotensive subjects not treated with antihypertensive drugs (systolic BP < 140 mmHg, diastolic BP < 90 mmHg, 3,111 men and 1,746 women) who were followed up from 1997 to 1999. By 1999, 360 subjects had BP at the hypertensive level (systolic BP > or = 140 mmHg or diastolic BP > or = 90 mmHg). The incidence of subjects whose BP became hypertensive was 37 per 1,000 person-years. After adjusting for age, sex, systolic BP and other clinical factors, multiple logistic analysis showed that the relative risk of BP elevation was 1.49 (95% Cl: 1.09 to 2.05) in subjects with one risk factor; 1.65 (95% Cl: 1.15 to 2.27) in those with two risk factors; 1.42 (95% Cl: 0.91 to 2.32) in those with three; and 4.86 (95% Cl: 2.58 to 9.16) in those with four or more when compared with subjects with no risk factors. Multiple regression analysis showed that the number of risk factors was positively correlated with an increase in BP from 1997 to 1999; the regression coefficient was 0.51 (p = 0.001) for increase in systolic BP, and 0.31 (p = 0.008) for increase in diastolic BP after adjusting for age and sex. In conclusion, clustering of risk factors significantly predicted the development of hypertension.
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Affiliation(s)
- Masahiko Tozawa
- Third Department of Internal Medicine and Dialysis Unit, University of the Ryukyus, Okinawa General Health Maintenance Association, Okinawa, Japan.
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Abstract
Hypertension is a major risk factor for many cardiovascular diseases including stroke, coronary heart disease, cardiac failure, and endstage renal disease. Therefore, prevention of hypertension becomes an important goal in overall efforts to control blood pressure and reduce the incidence of hypertension-related cardiovascular and renal complications and outcomes. Many risk factors underlying hypertension have been identified including nonmodifiable factors such as age, gender, genetic factors, and race, as well as modifiable factors including overweight, high sodium intake, low potassium intake, alcohol consumption, and reduced physical activity. A number of studies have demonstrated that interventions aimed at changing these modifiable factors might decrease blood pressure and even prevent the development of hypertension. Thus, present national recommendations and guidelines include lifestyle modifications ranging from weight loss in case of obesity, engagement in regular isotonic physical activity, reduced sodium diet (<100 mmol/d), supplementation of potassium, and alcohol moderation (<1 ounce of ethanol or its equivalent per day).
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Affiliation(s)
- Michel Slama
- Hypertension Research Laboratories, Division of Research, Oschner Clinic Foundation, New Orleans, LA 70121, USA.
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Abstract
The dramatic increase in the prevalence of obesity is a global phenomenon associated with increased risk of the development of cardiovascular and renal disease. Changes in renal structure and function that occur early in the development of obesity may lead to urine outflow obstruction and increased intrarenal pressure, mechanisms sufficient to shift the pressure-natriuresis relation to higher blood pressure levels. Another important alteration that may lead to hypertension with obesity is the increase in sympathetic nervous system activity. Several studies point to higher leptin levels associated with hypertension in humans, and animal data now convincingly suggest that leptin has direct central effects that increase sympathetic outflow to the kidneys, associated with increases in blood pressure. Although understanding of the pathophysiology of obesity-associated hypertension has made substantial progress during the past years, treatment of obese hypertensives remains largely empirical and clearly deserves to be addressed in larger randomized, controlled trials.
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Affiliation(s)
- Stefan Engeli
- Franz Volhard Clinic, Helios Klinikum Buch-Charité, Medical Faculty of the Humboldt University Berlin, Germany
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Masuo K. Obesity-related hypertension: role of the sympathetic nervous system, insulin, and leptin. Curr Hypertens Rep 2002; 4:112-8. [PMID: 11884266 DOI: 10.1007/s11906-002-0035-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Heightened sympathetic nervous system activity, hyperinsulinemia, insulin resistance, and hyperleptinemia contribute to obesity-related hypertension. However, the precise mechanism and sequence of events in this pathophysiologic event have not been clarified. This review concentrates on studies helping to clarify the mechanisms of blood pressure elevation associated with weight change, concentrating on the temporal changes in neuroendocrine factors that are known to control energy metabolism and blood pressure. A better understanding of the pathophysiologic mechanisms of obesity-related hypertension may help in prevention, treatment, and slowing of the cardiovascular complications of obesity.
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Affiliation(s)
- Kazuko Masuo
- Department of Geriatric Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita City, Osaka 565-0871 Japan.
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