Obesitas-gerelateerde hypertensie

Conflict of interest: none declared. Financial support: none declared.

• Hypertension occurs in more than 40% of obese adults and leads to increased risk for cardiovascular disease and death. In practice, obesity-related hypertension is often difficult to control with pharmacological treatment.

• The association of obesity and hypertension can partly be explained by mutual risk factors, but there is also an etiological relation.

• Increasing obesity may lead to dysfunctional adipose tissue, characterised e.g. by deranged production of hormones and cytokines (adipokines). This results in sympathoactivation, upregulation of the renin-angiotensin-aldosterone system (RAAS) and systemic low grade inflammation and oxidative stress. The common result of these deregulations is increased resistance of the peripheral vasculature due to endothelial dysfunction, vasoconstriction and vascular wall hypertrophy, and increased circulating volume due to impaired pressure natriuresis. This leads to the development of hypertension that is relatively resistant to drug therapy.

• Lifestyle modifications by means of weight reduction and salt restricted diet are the cornerstones of obesity-related hypertension treatment. Pharmacological treatment with beta-blockers or diuretics is not self-evident, since this increases the risk of developing de novo diabetes mellitus.