Obesity and hypertension: Obesity medicine association (OMA) clinical practice statement (CPS) 2023

Abstract

Background: This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) provides an overview of the mechanisms and treatment of obesity and hypertension.

Methods: The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership.

Results: Mechanisms contributing to obesity-related hypertension include unhealthful nutrition, physical inactivity, insulin resistance, increased sympathetic nervous system activity, renal dysfunction, vascular dysfunction, heart dysfunction, increased pancreatic insulin secretion, sleep apnea, and psychosocial stress. Adiposopathic factors that may contribute to hypertension include increased release of free fatty acids, increased leptin, decreased adiponectin, increased renin-angiotensin-aldosterone system activation, increased 11 beta-hydroxysteroid dehydrogenase type 1, reduced nitric oxide activity, and increased inflammation.

Conclusions: Increase in body fat is the most common cause of hypertension. Among patients with obesity and hypertension, weight reduction via healthful nutrition, physical activity, behavior modification, bariatric surgery, and anti-obesity medications mostly decrease blood pressure, with the greatest degree of weight reduction generally correlated with the greatest degree of blood pressure reduction.

Keywords: Adiposopathy; High blood pressure; Hypertension; Obesity.

Fig. 1

Obesity, adiposopathy (sick fat disease), fat mass disease, and obesity complications. An increase in body fat can ultimately lead to endocrine/metabolic and biomechanical/structural abnormalities, potentially leading to complications such as increased blood pressure [17].

Fig. 2

Fat mass disease and hypertension. Increased body fat leading to biomechanical and structural abnormalities (i.e., “fat mass disease”) may lead to hypertension through promotion of sleep apnea, kidney/renal vessel compression, perivascular adipose tissue, and increased cardiac output (heart rate x stroke volume) [[8], [9], [10],17,18].

Fig. 3

Adiposopathy and hypertension. Positive caloric balance, especially in an environment of limited adipocyte proliferation, often leads to dysfunctional adipocyte hypertrophy and adipose tissue accumulation (i.e., “sick fat disease”), which in turn leads to immunopathies, endocrinopathies, and increased circulating free fatty acids that may promote hypertension [[8], [9], [10],17,18].

Fig. 4

Obesity-related hypertension. Overweight and/or obesity may result in multiple mechanisms that help account for increased blood pressure.

Fig. 5

Implementation of healthful nutrition may help treat metabolic abnormalities, such as high blood sugar, high blood lipids, and high blood pressure (Copied with permission from Ref. [21]).

Fig. 6

Illustrative adiposopathic factors that may contribute to hypertension. Beyond the adverse biomechanical effects of fat mass alone shown in Fig. 2, positive caloric balance may lead to adipocyte hypertrophy and adipose tissue accumulation with pathogenic adipose tissue (including perivascular adipose tissue) [23] endocrine and immune factors that may contribute to hypertension. 11β-HSD1: beta-hydroxysteroid dehydrogenase type 1.