Therapeutic Considerations in the Treatment of Obesity Hypertension

Marion R. Wofford, MD, MPH; Margaret Miller Davis, MD; Kimberly G. Harkins, MD; Deborah S. King, PharmD; Sharon B. Wyatt, PhD, RN, CS; Daniel W. Jones, MD

In This Article

Association Between Obesity and Hypertension

The concept that excess body weight and increased blood pressure are linked was demonstrated many years ago by the Framingham Heart Study investigators.[1] This association has been documented in other large, cross-sectional studies.[2,6,8] Overweight individuals have a three-fold increased risk for the development of hypertension compared to normal-weight individuals.[9] The prevalence of hypertension among the obese approaches 50%.[5] In the Framingham Study,[10] 70% of the new cases of essential hypertension were related to excess body fat. For every 10-lb weight gain, systolic blood pressure increased an average of 4.5 mm Hg.

The continuous variables of BMI and blood pressure are linked not only in overweight groups but in the lean as well. The linear relationship between body mass and blood pressure in 22,500 Korean subjects is shown in the Figure.[11] In this society, the majority of individuals are not overweight, yet the continuum between BMI and blood pressure exists. In the International Study of Salt and Blood Pressure (INTERSALT),[12] a cross-sectional survey of 52 populations worldwide, BMI was strongly associated with blood pressure independently of dietary sodium and potassium intake. Although the association between obesity and hypertension has been well established, the pathophysiology that links these comorbid conditions is unclear and is an area of active research.

Relationship between mean diastolic blood pressure and body mass index.[11]


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