Obesity-related hypertension: pathogenesis, cardiovascular risk, and treatment: a position paper of The Obesity Society and the American Society of Hypertension

Abstract

In light of the worldwide epidemic of obesity, and in recognition of hypertension as a major factor in the cardiovascular morbidity and mortality associated with obesity, The Obesity Society and the American Society of Hypertension agreed to jointly sponsor a position paper on obesity-related hypertension to be published jointly in the journals of each society. The purpose is to inform the members of both societies, as well as practicing clinicians, with a timely review of the association between obesity and high blood pressure, the risk that this association entails, and the options for rational, evidenced-based treatment. The position paper is divided into six sections plus a summary as follows: pathophysiology, epidemiology and cardiovascular risk, the metabolic syndrome, lifestyle management in prevention and treatment, pharmacologic treatment of hypertension in the obese, and the medical and surgical treatment of obesity in obese hypertensive patients.

Figure 1

Predicted 10‐year risk for hard coronary heart disease events for a 50‐year‐old man with selected levels of risk factors and blood pressure (BP) stages. Note that risk increases dramatically with greater risk factor burden and with higher BP level at any given risk factor burden. The increase in risk across BP strata is more pronounced when other risk factors are at more adverse levels. Data calculated from reference. ⁶³

Figure 2

Thirty‐two year rates of death due to cardiovascular disease in participants of the Chicago Heart Association Detection Project in Industry cohort, stratified by baseline body mass index (BMI) and hypertension (HTN) status. CVD indicates cardiovascular disease.