Hypertension and Obesity

What is Hypertension?

Hypertension or the high blood pressure refers to the pressure that the amount of blood the heart pumps and the amount of resistance to blood flow in the arteries blood applies. Most people with high blood pressure generally have no signs or any symptoms, even if blood pressure readings reach dangerously high levels.

Hypertension and Obesity

The most important issue to remember is that obesity is associated with hypertension, and hypertension is associated with numerous other metabolic diseases that can affect the overall health and the life expectancy of an individual. Anti-hypertension medications should be started if hypertension is diagnosed along with weight-loss. A significant fall in blood pressure may permit a decrease in the number and the amount of medication taken. Prevention by maintaining a good lifestyle would be better than any drug.

Use lifestyle changes with weight reduction by maintaining BMI, DASH diet by eating fruits, vegetables, and low-fat dairy products with reduced content of saturated and total fat, a decrease in dietary sodium, an increase in physical activity for about 30 minutes per day and moderate consumption of alcohol. The weight-loss is the most important step in reducing both hypertension and improving a better and healthy life.

Obesity-related hypertension often is accompanied by:

Organ damage can be done by obesity hypertension. The elevated blood pressure due to obesity can cause long-term damage to the body's vital organs and their functions.

Diastolic dysfunction is evident early in obesity and characterized by impaired ventricular filling dynamics and relaxation and there may also be systolic dysfunction and an enlarged heart with prolonged obesity. Obesity and hypertension worsen the symptoms of left ventricular hypertrophy in a synergistic manner, and this translates into a greater risk of congestive heart failure. The weight loss improves systolic and diastolic function and reduces left ventricular mass.

There is a potential association between obesity hypertension and obstructive sleep apnea. Obesity is an important risk factor for obstructive sleep apnea but this may be more closely associated with the enlarged abdomen than overall body obesity. Obstructive sleep apnea has been linked to hypertension in both epidemiological studies and clinical.

Complications leading to uncontrolled high blood pressure include:

Heart attack or stroke:  High blood pressure can cause hardening and thickening of the arteries known as atherosclerosis, which can lead to a heart attack, stroke or various other complications.

Aneurysm: The increased blood pressure can cause blood vessels to bulge and weaken, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.

Heart failure: To pump blood against the higher pressure in the vessels, the heart has to work harder by causing the walls of the heart's pumping chamber to thicken known as the left ventricular hypertrophy. Eventually, the thickened muscle may have a hard time pumping enough blood, which later can lead to heart failure.

Weakened and narrowed blood vessels in the kidneys can prevent these organs from functioning normally.

In the eyes causes thickening, narrowing or torn blood vessels which can result in vision loss.

Metabolic syndrome: This syndrome is a cluster of disorders from the body's metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL) cholesterol, the "good" cholesterol; high blood pressure and high insulin levels. These conditions will likely later develop diabetes, heart disease, and stroke.

The uncontrolled high blood pressure affects the ability to remember, think and learn and further cause’s trouble with memory or understanding concepts is more common in people with high blood pressure.

Dementia:  Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia known as vascular dementia. A stroke interrupts the blood flow to the brain which also causes vascular dementia.

Impact of Obesity on Cardiovascular diseases

Obesity and Diet

The role of diet is crucial in the development and prevention of cardiovascular disease and is the key modifiable risk factor for heart diseases. The obesity is an epidemic which is spreading from low- to the middle-income countries as a result of new dietary habits and sedentary ways of life, fuelling chronic diseases and premature mortality.

This sneaky inflammation and the inflammatory factors when released increase the risk of developing atherosclerosis and the build-up of plaque in the walls of the arteries. Obesity also releases substances in the blood that can make plaque rupture, which then leads to heart attacks. The extra weight carrying does put the heart under increased stress, in particular during the relaxation phase of the cardiac cycle, which is known as the diastole. As the heart fills with blood, there’s higher pressure in the heart valves, which with over time, can lead to causing people to have heart failure symptoms.

Association between Obesity and Cardiovascular outcomes

As Obesity increases there are adverse cardiac events occurring in many ways, which may be indirectly mediated through risk factors associated with metabolic syndrome like diabetes, dyslipidemia, glucose intolerance, hypertension, and or effects from sleep disorders associated with obesity.  Metabolic syndrome is associated with central or abdominal obesity, which is associated with the distribution of fat predominantly in the abdominal viscera rather than the extremities in the body. Waist circumference or waist-hip ratio is useful ways of assessing this type of fat distribution and increased values confer additional cardiovascular risk. In abdominal obesity, there is an increase in the level of various inflammatory markers along with the occurrence of a prothrombotic state. The Obese patients have increased concentrations of many adipokines and other chemical mediators like interleukin-6, resistin, plasminogen activator inhibitor-1, tumor necrosis factor-alpha, retinol binding protein, acylation stimulating protein, lipoprotein lipase, cholesteryl ester transport protein, estrogens, leptin, angiotensinogen, and insulin-like growth factor-1, but these proteins have various adverse effects on the cardiovascular system by creating a pro-inflammatory and prothrombotic state as well as causing endothelial damage and vascular hypertrophy. There is also a higher incidence of sleep apnea/hypoventilation syndromes in obesity, which can also affect the heart in different ways.

Obesity also poses considerable challenges in making a precise cardiovascular diagnosis because of limitations in the physical examination as well as with various investigations like imaging studies, electrocardiograms (ECGs), and cardiac catheterization.

The direct effect of Obesity on the heart in obese individual results in cardiomyopathy which is also known as the adipositas cordis. Initially, it increases the fat content of the heart because of a metaplastic phenomenon and is not an infiltrative process. The various tissues of the heart, like the atrioventricular node, sinus node, right bundle branch, and the myocardium near the atrioventricular ring, are replaced by fat cells. The conduction defects can occasionally occur in the sinoatrial block, bundle branch block, and, rarely, an atrioventricular block which results in irregular bands of adipose tissue which may separate and cause pressure-induced atrophy in the myocardial cells. These adipose cells surrounding the heart valves may also secrete active molecules like adipokines, which indirectly cause injurious effects on the adjacent myocardial cells or the heart cells. Accumulation of triglycerides in nonfat cells like myocytes can also directly cause cell dysfunction due to lipotoxicity.

Heart Disease and Obesity Treatment

In addition to weight loss, the sodium restriction may be helpful in the treatment of heart disease, since high intake of sodium increases fluid retention in the body. There a number of series of medically supervised weight loss programs, starting from alterations in dietary and physical habits to pre-packed meals, pharmacotherapy and weight loss surgery, which can be used to make an impact on both cardiovascular diseases and obesity.