1. Brook, R., et. al. (2012). Low-Sodium Dietary Approaches to Stop Hypertension Diet Reduces Blood Pressure, Arterial Stiffness, and Oxidative Stress in Hypertensive Heart Failure With Preserved Ejection Fraction. Hypertension.
This study aims to determine the effect of the Dietary Approaches to Stop Hypertension (DASH) Diet combined with a Sodium Restriction Diet (SRD) on hypertension. Subjects in this study were previously hospitalized for heart failure with preserved ejection fraction (HFPEF). Results of the study found that a DASH/SR Diet resulted in a significant decrease in hypertension both in individuals who were being treated for hypertension and those who were not. Reductions in antihypertensive treatments were seen shortly after beginning the DASH/SR Diet in multiple individuals.
2. Brown, C., Higgins, M., Donato, K. (2012). Body Mass Index and the Prevalence of Hypertension and Dyslipidemia. Obesity (8). 605-619.
This study aimed to evaluate the relationship between Body Mass Index (BMI) and blood pressure, cholesterol, and high-density lipoprotein-cholesterol (HDL-C), with hypertension and dyslipidemia patients. Using a national survey method of adults in the United States that included height, weight, blood pressure, and lipid levels, the results showed that more than one-half of the adult population is overweight, with a BMI of 25 to 29.9 or obese (BMI of 30 or greater) and that the prevalence of high blood pressure (hypertension) increased as BMI increased. Also, high levels of cholesterol were higher at BMI levels over 25. These data suggest a strong association of BMI with hypertension and abnormal lipids and further suggest that overweight and obese populations need to be especially aware of their blood pressure and lipid measurements.
3. Chu, A., et. al. (2012). Body Mass Index and Risk of Incident Hypertension over the Life Course: The Johns Hopkins Precursors Study. Circulation.
This study follows groups of Johns Hopkins medical students from their time in medical school to about 40 years later looking to compare changes in BMI to the development of hypertension. Baseline measurements were taken of the individuals BMI and blood pressures an average of 9 times during their schooling and follow up surveys were given annually. Confounding variables such as alcohol and tobacco use were taken into account. Results of the study show a significant increase for risk of hypertension later in life for individuals who were overweight in early adulthood. In addition individuals who became overweight later in life also increased their risk for hypertension in a linear pattern.
4. Goodfriend, M.D, Kelley, D., Goodpaster, B.H., and Winters, Stephen (2012). Visceral Obesity and Insulin Resistance Are Associated with Plasma Adolsterone Levels in Hypertensive Subjects. Obesity. 355-362.
This study aimed to study the effects of obesity, fat distribution, and insulin resistance on plasma levels of aldolsterone in hypertensive subjects. Twenty-eight women and twenty-seven men with varying body fat distributions underwent measurements of visceral adipose tissue by CT scan, total fat mass, blood pressure, and plasma levels of three adrenal hormones. Results showed that plasma aldolsterone correlated directly with visceral adipose tissue and that blood pressure correlated with plasma aldolsterone before and after weight loss.
5. Hall, J. E., da Silva, A. A., do Carmo, J. M., Dubinion, J., Hamza, S., Munusamy, S., Smith, G., &Stec, D. E. (2010). Obesity- induced hypertension: Role of sympathetic nervous system, Leptin, and Melanocortins. The Journal of Biological Chemistry. 17271-17276.
Excessive weight is a major cause for the development of hypertension. Increased sympathetic nervous system activity (SNS), activation of the renin-angiotensin-aldosterone system, and compression of the kidneys from accumulation of excess fat all contribute to increasing blood pressure in overweight individuals. SNS activity is increased in the kidneys and skeletal muscles which stimulates renin secretion and increases renal sodium reabsorption. Leptin, a hormone released from fat cells, is secreted in greater amounts with increased adipose tissue. While leptin typically suppresses hunger, in overweight individuals it produces the opposite effect, contributing to weight gain.
6. Hosick, P., Stec D. (2011). Heme oxygenase: a novel target for the treatment of hypertension and obesity? The American Journal of Physiology. 2565-2574.
This article reviews the action of heme oxygenase (HO), a rate-limiting enzyme in the metabolism of molecules including carbon monoxide, biliverdin, and iron, all of which are important for healthy cardiovascular events. Recent studies had shown that HO is helpful in regulating body weight and metabolism in diabetic and obese patients. Studies have also shown that HO can delay the onset of hypertension. Specifically, this article aims to investigate the current understandings of HO and the use of its metabolites in the development of drugs that could reduce blood pressure and body weight.
7. Jordan, J., Boye, S. W., Le Breton, S., Keefe, D. L., Engelis, S., & Forney Prescott, Margaret (2012). Antihypertensive treatment in patients with class 3 obesity. Therapeutic Advances in Endocrinology and Metabolism, Sage Journals. 3(3): 93–98.
Class 3 obesity is associated with an increased risk of mortality that is largely caused by increases in hypertension. Treatment for hypertensive class 3 obesity individuals is more difficult to achieve in part due to the increased body mass index (BMI). In a randomized, double-blind study, 489 hypertensive individuals with a BMI of greater than 30 tested the effectiveness of a prescription drug hydrochlorothiazide on lowering blood pressure. Subjects were prescribed 25 mg once daily for four weeks. After four weeks, those whose blood pressure remained high were then given an additional drug (aliskiren, irbesartan, amlodipine or placebo) through random assignment. Thirty-four (34%) of Class One and Two obesity subjects had their blood pressure lowered to healthy limits with just the use of hydrochlorothiazide alone while only 16.7% of Class 3 obese individuals were able to accomplish this with the remainder of the group needing additional prescriptions. The most effective blood pressure combination drug therapy was found to be aliskiren and hydrochlorothiazide while the least effective combination was irbesartan and hydrochlorothiazide. This study confirmed the need of multiple prescription drugs to effectively lower blood pressure in Class 3 obese individuals.
8. MacLaughlin, H.L, Sarafidis, P.A, Greenwood, S.A., Campbell, K., Hall, W.L., Macdougall, I.C. (2012) Compliance with a structured weight loss program is associated with reduced systolic blood pressure in obese patient. American Journal of Hypertension, 1024-9.
This study aimed to examine the efficacy of a weight loss management program (WMP) in lowering systolic blood pressure and to determine factors associated with successful weight loss in obese patients. All study participants had a body mass index of 30 or greater and were followed for three years in this cohort study. The WMP included a low-calorie diet, an exercise regimen, and appropriate pharmacology for 135 patients (56% male) with a mean age of 52.2 years and a BMI of 36.4 kg/m(2). At the culmination of the study, significant weight loss was achieved and greater compliance with the WMP was associated with decreased systolic blood pressure.
9. Mertens,
I., van Gaal, L. (2012). Overweight,
Obesity, and Blood Pressure: The Effects of Modest Weight Reduction. Journal
for Obesity Research; (4). 270-278.
Several large epidemiological studies have shown an associated between body mass index (BMI) and blood pressure in overweight and obese patients. Weight gain in adult life especially seems to be an important risk factor for the development of hypertension. Studies have shown that a modest weight loss can normalize blood pressure levels even without reaching ideal weight. In patients taking antihypertensive medication, a modest weight loss has been shown to lower or even discontinue the need for antihypertensive medication. In patients with high blood pressure, a modest weight loss can prevent the onset of hypertension. The blood pressure-lowering effect of weight loss is most likely a result of an improvement in insulin sensitivity and a decrease in sympathetic nervous system activity. In conclusion, a modest weight loss that can be maintained over a longer period of time is a valuable treatment goal in hypertensive patients.
10. Pischon, T., Sharma, A. (2008). Use of beta-blockers in obesity hypertension: potential role of weight gain. Obesity Reviews, 2(4): 275-280.
This article examines the potential effects of a popular treatment for hypertension, beta-blockers. It is well known that beta-blockers have adverse effects on the lipid and carbohydrate metabolism of patients who use the drug. This study highlights the potential that the effect of this in obese patients with hypertension is often additional weight gain. Since being overweight or obese are the largest contributors to the development of hypertension, it is proposed in this article that beta-blockers not be the first attempt at blood pressure control in individuals who are overweight or obese.
11. Rademacher, E., et. al. (2009). Relation of Blood Pressure and Body Mass Index During Childhood to Cardiovascular Risk Factor Levels in Young Adults. Journal of Hypertension,27(9): 1766–1774.
This longitudinal study follows adolescents by measuring their blood pressures and BMI’s into adulthood in order to determine to what level each measure can predict adulthood hypertension. Though the correlation is evident there had not previously been a clear distinction to which is the most predictive factor. The study examines the child’s weight and prevalence of future hypertension independently from their blood pressure and development of hypertension. The study finds that children with high blood pressure were at a greater risk of developing hypertension in adulthood independent of their BMI. Additionally, if an unhealthy BMI is also recorded, their risk is increased. This signifies the importance of weight management early in life to ensure future health.
12. Re, Richard N. (2009). Obesity-related hypertension. The Ochsner Journal. 9(3): 133–136.Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096270/
Obesity is a strong risk factor for predisposing individuals to hypertension. This relationship exists as a result of the increased blood flow, vasodilation, and cardiac output that occur with obesity. The factors that present the strongest association with obesity-related hypertension include increased sympathetic tone, activation of the renin-angiotensin system (RAS), hyperinsulinemia, structural changes in the kidney and increased fat hormones such as leptin. Obesity increases activation of the sympathetic nervous system which in turn increases renin activity in the body. Increased activation of the RAS, increases renal reabsorption of sodium and stimulates the synthesis of aldosterone, a hormone responsible for retaining sodium. Structural changes within the kidney including deposits of fat, coupled with increased abdominal pressure from excess abdominal fat causes disordered renal sodium reabsorption. Improper renal functioning leads to increases in arterial pressure. The main goal of therapy for obesity-related hypertension is weight loss. This can reverse many of the pathophysiologic mechanisms contributing to the hypertension and slow further progression of structural adaptations including within the kidney.
13. Sabo, R., Lu, S, Daniels, S., Sun, S. (2012). Serial Childhood BMI and Associations with Adult Hypertension and Obesity: The Fels Longitudinal Study. Obesity. 1741-1743.
This study expanded upon earlier studies that showed that critical periods of childhood BMI (Body Mass Index) growth was linked to adult obesity and cardiovascular issues. Data from male and female participants in the Fels Longitudinal Study were used to estimate childhood BMI growth curves and repeated measure analyses were used to estimate increases in BMI from age 2 to 17.5, based on both adult BMI and adult blood pressure (BP). Results showed that participants with lower body weight throughout childhood had lower overall BP in early adulthood. Overall, the FLS showed that increased adult BP has its genesis in part from an increased childhood BMI.
14. Scholze, J., Grimm, E., Herrmann, D., Unger, T., & Kintscher, U. (2011). Optimal Treatment of Obesity-Related Hypertension: The Hypertension-Obesity-Sibutramine (HOS) Study. Journal of the American Heart Association.
The increase in obesity has led to a greater incidence of hypertension, both of which increase ones chances of cardiovascular diseases. Weight reduction alleviates many co-occurring problems associated with obesity including insulin resistance, glucose intolerance and dyslipidemia. One of the most popular weight reducing agents is Sibutramine, which prevents the reuptake of serotonin and norepinephrine. This agent works by increasing satiety and enhancing energy expenditure but has also been shown to increase blood pressure, making it counter effective. In a study of obese hypertensive individuals, body weight reduction occurred in 54.7% of patients who took Sibutramine compared to the 14.5% in the placebo group. However, there were no differences in blood pressure readings between the two groups. While systolic blood pressure decreased in both groups, diastolic pressure was slightly increased in the Sibutramine group.
15. Sharabi, Yehenatan (2012). Management of the Unholy Trinity, Diabetes-Hypertension-Obesity (Diabesotension). Diabetes Metabolism Research and Reviews.
This article looks at the occurrence of hypertension, obesity, and diabetes together in a single individual and the connections and dangers associated with these conditions. It examines possible causes for the creation of the triad of diseases in certain individuals and specific cardiovascular risks which are increased in the presence of two or more of the conditions. The article addresses the importance of monitoring blood pressure levels and weight management in conjunction with pharmacological treatment when necessary to reduce the severe risks associated with this triad of diseases referred to diabesotension.