Henry Ford Hospital Medical Journal


Hypertension is an important risk factor for cardiovascular morbidity and mortality. Obesity is often associated with hypertension. This strong association can be attributed to several pathophysiological changes which occur in obese subjects: increased salt and caloric intake, increased blood volume, increased cardiac output, increased basal as well as stress-stimulated sympathetic nervous system activity, hyperinsulinemia, and a relative increase in renin and aldosterone. Obesity usually increases the preload and causes an eccentric cardiac hypertrophy, while hypertension increases the afterload and causes concentric cardiac hypertrophy. When both obesity and hypertension occur in the same patient (as is often the case), they present a double burden on the heart and predispose the patient to congestive heart failure, coronary artery disease, and sudden death. Weight reduction and caloric restriction have a beneficial effect on blood pressure and should be stressed and encouraged in the management of obese hypertensive patients.