Development of hypertension in overweight adolescents: a review

Abstract

The upward trend in adolescent hypertension is widely attributed to the adolescent obesity epidemic. Secular trends in adolescent prehypertension and hypertension have risen in congruence with increasing trends in the prevalence of overweight and obesity. The correlation between body mass index and blood pressure in adolescence is moderate to strong in most studies and strongest in those classified as overweight or obese. The mechanisms relating to the development of hypertension in overweight adolescents are unclear; however, a number of nonmodifiable and modifiable factors have been implicated. Importantly, certain clinical and biochemical markers in overweight adolescents are indicative of high risk for hypertension, including family history of hypertension and hyperinsulinemia. These characteristics may prove useful in stratifying overweight adolescents as high or low risk of comorbid hypertension. The treatment of overweight and obesity related hypertension in this population focuses on two key modalities: lifestyle change and pharmacotherapy. These approaches focus almost exclusively on weight reduction; however, a number of emerging strategies target hypertension more specifically. Among adolescents with overt hypertension there are also several factors that indicate higher risk of concurrent subclinical disease, persistent adult hypertension, and adult cardiovascular disease. This group may benefit substantially from more aggressive pharmacological treatments. Limitations in the literature relate to the paucity of studies reporting specific effects for the adolescent age group of overweight and obese individuals. Nonetheless, intervention for adiposity-related hypertension in adolescence may partially mitigate some of the cardiovascular risk in adulthood.

Keywords: blood pressure; childhood; obesity; prevention; risk factors.

Figure 1

Scatterplot demonstrating the relationship between proportion of obese participants and proportion of overweight participants and the magnitude of SBP and DBP correlation coefficients. Notes: LOESS creates smoothed curves for both SBP and DBP. There were 16 SBP data points and 15 DBP data points. Some data points are stratified according to sex or region. Abbreviations: DBP, diastolic blood pressure; LOESS, locally-weighted scatterplot smoothing; SBP, systolic blood pressure.

Figure 2

Factors associated with the development of hypertension in overweight adolescents. Note: *Denotes studies that present effective estimates in adolescents only. Abbreviations: ACE I/D, angiotensin converting enzyme insertion/deletion; CRP, C-reactive protein; eNOS, endothelial nitric oxide synthase; HDL, high-density lipoprotein; HOMA-IR, homeostasis model assessment-estimated insulin resistance; IGF2, insulin-like growth factor; LDL, low-density lipoprotein; NT-proBNP, n-terminal pro-brain natriuretic peptide; Y2R, Y2 receptor.