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Obesity and Hypertension;

The Spectrum of metabolic Syndrome


Haerani Rasyid
Faculty of Medicine, Hasanuddin University
➢Introduction
➢Obesity and Hypertension
➢Treatment of Obesity-Related Hypertension
➢Summary
Metabolic Syndrome
• A cluster of related metabolic abnormalities,
including central obesity, hypertension, dyslipidemia,
hyperglycemia, and insulin resistance, with insulin
resistance and central obesity in particular
recognized as causative factors.
Mendrick DL, Diehl AM, Topor LS, et al. Metabolic Syndrome and Associated Disease: From the Bench to the Clinic. Toxicol Sci. 2018; 162(1): 36-42.
Srikanthan K, Feyh A, Visweshwar H, et al. Systematic Review of Metabolic Syndrome Biomarkers: A Panel for Early Detection, Management, and Risk Stratification in The West Virginian Population. Int J Med Sci. 2016; 13(1): 25-38
Metabolic syndrome:
The NCEP ATP III definition*

Three or more of the following five risk factors:


Risk Factor Defining Level
Abdominal obesity Waist circumference
Men >102 cm (>40 in)
Women >88 cm (>35 in)
Triglycerides ≥150 mg/dL (1.7 mmol/L)
HDL cholesterol
Men <40 mg/dL (1.04 mmol/L)
Women <50 mg/dL (1.30 mmol/L)
Blood pressure ≥130/ ≥85 mmHg
Fasting glucose ≥100 mg/dL (5.6 mmol/L)
Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult
Treatment Panel III) Final Report. Circulation. 2002;106;3143.
Obesity
• Definition:excessive weight
that may impair health
• The value of BMI is now used
to diagnose:
– Overweight→ BMI:25.9-29
kg/m2
– Obesity → BMI:>30 kg/m2

Srikanthan K et al.. Int J Med Sci. 2016; 13(1): 25-38


Imbalance between energy
intake and expenditure
• Weight Gain

Calories Consumed > Calories Used

• Weight Loss

Calories Consumed < Calories Used

• No Weight Change

Calories Consumed = Calories Used


Shu-Zhong J et al. Exp Ther Med. 2016; 12: 2395-9
Obesity
• Growing global health concern
• The growing obesity epidemic is a major source of
unsustainanble health costs and morbidity and mortality
because of Hypertension, Type 2 DM, dyslipidemia,
certain cancers and major cardiovascular diseases

Leggio M et al. Hypertens Res. 2017; 40: 947-63.


Just The Facts !
WHO 2005 → approximately 1.6 billion overweight adults and over 400 million obese ones
WHO 2015 → approximately 2.3 billion overweight adults and over 700 million obese ones

The situation is critical due to the fact that the diseases that can occur
due to obesity are becoming increasingly prevalent, particulary
cardiovascular disease, currently the leading cause of mortality
worldwide

Xie D, Bollag WB. Obesity, Hypertension and Aldosterone:is Leptin the link?. J Endocrinol. 2016; 230: 7-11.
The Obesity Epidemic
40
35,2
35 34,0
33,1

30 28,1

Percent of Population
26,0
25
20,6
Over
20 the last 3 decades, mean BMI has increased
16,8 17,1
15,7
15 by12,20.412,8kg/m2 per decade worlwide
10,7
10

0
Men Women

1960-62 1971-75 1976-80 1988-94 1999-2002 2003-06

Source: Health, United States, 2009 (NCHS)

Roger VL et al. Circulation. 2011;123(4):e18-e209.


Aljabri KS et al. Arch Dia & Obes. 2018: 1(2): 36-41
Prevalence of central obesity in
Indonesia

RISKESDAS 2018
Adverse effect of Obesity

It is estimated that at least 75% of the incidence


of Hypertension is related to obesity

Parloop B. GMJ. 2010; 2(65): 54-9.


Kotchen TA. Am J Hypertens. 2010; 11(23): 1170-8
Hypertension
• Similiar to obesity, Hypertension is a key unfavorable
health metric that has disastrous health implications
• Globally, Hypertension accounts for 9.4 million deaths
annually
• It has been estimated that the world wide prevalence of
Hypertension was 972 million in 2000, and this number
will increase by 60% by the year 2025.
Leggio M et al. Hypertens Res. 2017; 40: 947-63.
Oni OA et al. Inv J Med Med Sci. 2014; 1(5): 60-4.
Prevalence of Hypertension in
Indonesia
Percent %

RISKESDAS 2018
There is a link between
obesity and hypertension

Obesity-Related Hypertension

Kotchen TA. Am J Hypertens. 2010; 11(23): 1170-8


➢Introduction
➢Obesity and Hypertension
➢Treatment of Obesity-Related Hypertension
➢Summary
Obesity and Hypertension

• Epidemiological data unequivocally support the


link between body weight and BP, thus indicating
greater body weight as one of the major risk
factors for high BP
• The accumulation of excess adipose tissue
initiates a cascade of events that give rise to an
elevated blood pressure
Rahmouni K et al. J Hypertens. 2005; 45: 9-14.
Leggio M et al. Hypertens Res. 2017; 40: 947-63.
Leggio M et al. Hypertens Res. 2017; 40: 947-63.
70 68 67.5 NHANES 1999-2002
Diabetes Mellitus
Hypertension 62.2 62.5
60 Dyslipidemia
53.1 52.9
51.3
50
% of Patients

44
40 38.2 39.3

30.8
30 27.3 28.9
24 25.3
22.3
20 17.6 16.4
10.1 12.2
10 9
5.7
1.7 4.2
0
<18.5 18.5-24.9 25-26.9 27-29.9 30-34.9 35-39.9 40 OVERALL

Lean Normal Overweight Obese


Bays HE, et al. Int J Clin Pract. 2007;61:737-747.
Bays HE. Am J Med. 2009;122(1 suppl):S26-37.
Body Mass Index (BMI)
Shu-kang W et al. PLOS One. 2014; p: 1-10
Kumar C et al. Int J Med Sci Public Health. 2016; 12(5): 2545-9.
Mechanisms of obesity-related
hypertension

Kotchen TA. Obesity-Related Hypertension: Epidemiology, Pathophysiology, and Clinical Management. Am J Hypertens. 2010; 11(23): 1170-8
Rahmouni K et al. J Hypertens. 2005; 45: 9-14.
Pathogenesis of Obesity-Related Hypertension

Leggio M, lombardi M, caldarone E, et al. The Relationship Between obesity and Hypertension: an Updated Comprehensive overview on vicious twins.
Hypertens Res. 2017; 40: 947-63.
Srikanthan K et al. Int J. Med. Sci. 2016; 13: 26.
➢Introduction
➢Obesity and Hypertension
➢Treatment of Obesity-Related Hypertension
➢Summary
Therapy for obesity-related hypertension for
the most part follows the standar line of high
blood pressure treatment but perhaps with the
greater emphasis on healthy lifestyle
Non-pharmacological treatment
• Adoption of healthy lifestyle
• The core tenets of a healthy lifestyle as it relates to
maintenance of a normal body weight include
sufficient levels of physical activity and consuming a
nutritious, calorically balanced diet.
Leggio M et al. Hypertens Res. 2017; 40: 947-63.
• Systematic reviews consistently report a decrease in SBP
of about 1 mmHg per kg of weight loss with follow-up of
2-3 years.
• There is attenuation in the long term, with a decrease of
about 6 mmHg in SBP per 10 kg of weight loss.

Leggio M et al. Hypertens Res. 2017; 40: 947-63.


Diet
• Very low calorie (500-1000 kcal deficit per day)
• Balanced deficit (reduction in protein, fat and carbohydrates)
• Changes in specific nutrient (low fat, low carbohydrate, low
glycemic index)
• DASH diet
• Rich in potassium, calcium and magnesium and fiber dan low
in salt and saturated fat)
Leggio M et al. Hypertens Res. 2017; 40: 947-63.
Physical activity
• Aerobic can reduce weight and BP
• A more recent meta-analysis found that resistance
training of at least 4 weeks resulted in an estimated
decrease of 3.9/3.9 mmHg in normotensive or
prehypertensive individuals, but a decrease of 4.1/1.5
mmHg in hypertensive patients
Leggio M et al. Hypertens Res. 2017; 40: 947-63.
Bariatric surgery
• Significant weight loss is achieved in individuals who
undergo bariatric surgery.
• Bariatric surgery is associated with a significant reduction
in BP and improvement in the pathophysiological
alterations (SNS, renal system and systemic
inflammation) precipitated by obesity
Leggio M et al. Hypertens Res. 2017; 40: 947-63.
First choices Use of Antihypertensive drug classes in Obesity Hypertension

There is no yet evidence that one specific


therapy has been proved superior to others in
the treatment of obesity related hypertension.

Wenzel UO et al. Semin-Nephrol. 2013; 1(3): 66-74


Rahmouni K et al. J Hypertens. 2005; 45: 9-14.
Therapeutic Strategies

DeMarco VG, Aroor AR, Sowers JR. The Pathophysiology of Hypertension in Patients With Obesity. Nat Rev Endocrinol. 2014; 10(6): 364-76.
➢Introduction
➢Obesity and Hypertension
➢Treatment of Obesity-Related Hypertension
➢Summary
• Obesity and Hypertension is an important
public health issue
• Obesity is a risk factor for hypertension
• Obesity-related hypertension can occur via
multiple mechanisms:insulin resistance,
inflammation, inappropiate SNS and RAAS
activation, structural and functional
abnormalities in the kidney and
vasculature
• Treating Hypertension in obese requires
adressing the obesity as part of the
therapeutic plan