Obesity-related hypertension

For nearly a century, it is known that hypertension and obesity often coexist. The pathogenetic mechanisms leading to hypertension in obese patients are complex. The most important are: sympathetic nervous system overactivation, increased sodium reabsorption in the renal tubules leading to hypervolemia, insulin resistance, stimulation of the renin-angiotensin-aldosterone system and disturbances of the adipokines secretion. The goal of antihypertensive therapy in obese subjects is to obtain blood pressure below 140/90 mm Hg. Basic methods of antihypertension treatment in obese patients is to reduce body fat mass by calorie restrictive diet and increased physical activity. Recommended for advanced obesity bariatric surgery may also exert an antihypertensive effect. In pharmacotherapy of hypertension in obese patients preferentially are angiotensin converting enzyme inhibitors or angiotensin II receptor antagonists. In order to obtain the target of blood pressure in these patients usually it is necessary to use two or more antihypertensive drugs.