New developments in the pathogenesis of obesity-induced hypertension. J Hypertens. 2015;33:1499-1508. [PMID: 26103132 DOI: 10.1097/hjh.0000000000000645]

Obesity and cardiovascular disease: An executive document on pathophysiological and clinical links promoted by the Italian Society of Cardiovascular Prevention (SIPREC)

The prevalence of obesity worldwide has increased in recent decades not only among adults, but also in children and adolescents. This phenomenon contributes to an increased risk of cardiovascular diseases (CVD), also after the adjustment for conventional risk factors such as hypertension, diabetes and dyslipidemia. Indeed, obesity contributes to the development of insulin resistance, endothelial dysfunction, sympathetic nervous system activation, increased vascular resistance and inflammatory and prothrombotic state which promote the incidence of major cardiovascular events. On the basis of this evidence, in 2021 obesity has been acknowledged as a definite pathological identity and identified as a recurrent, chronic non-communicable disease. Therapeutic strategies for the pharmacological treatment of obesity include the combination of naltrexone and bupropione and the lipase inhibitor orlistat and they have been recently implemented with the glucagon like peptide-1 receptor agonists semaglutide and liraglutide, which have produced positive and sustained effects on body weight reduction. If drug interventions are not effective, bariatric surgery may be considered, representing an efficacious treatment option for extreme obesity or obesity with comorbidities. The present executive paper is aimed to increase knowledge on the relationships between obesity and CVD, to raise the perception of this condition which is currently insufficient and to support the clinical practice management.

Improvement of obesity by Liupao tea is through the IRS-1/PI3K/AKT/GLUT4 signaling pathway according to network pharmacology and experimental verification

BACKGROUND

Obesity is a state of accumulating excessive body fat, charactering by a high blood lipid and associating with various metabolic diseases. As a kind of dark tea, many studies revealed that long-term drinking Liupao tea (LT) can reduce weight (Liu et al., 2014). However, the anti-obesity mechanism and active ingredients of LT are not known.

METHODS

Liquid chromatography-mass spectrometry (LC-MS) combined with network pharmacology was used to screen the active components and related targets of Liupao tea water extract (LTWE). The key anti-obesity targets and pathways of LTWE were predicted by protein-protein interaction (PPI) networks, and enrichment analyses using Kyoto Encyclopedia of Genes and Genomes and Gene Ontology databases. Then, the active components selected by high-performance liquid chromatography (HPLC) fingerprinting were used together with LTWE in an adipogenic model and insulin resistance (IR) model in vitro.

RESULTS

Most of the compounds identified from LTWE were flavonofids, esters, and amides. Key targets such as RAC-alpha serine/threonine-protein kinase, insulin, and tumor necrosis factor (TNF) were involved in the phosphatidylinositol-3-kinase-protein kinase B (PI3K-AKT) signaling pathway, pathways in cancer, and other pathways. Four active components were screened by network pharmacology combined with HPLC fingerprinting. The in vitro experiment of LTWE and its four active components showed that in insulin-resistant 3T3-L1 cells, LTWE, (-)-epigallocatechin gallate (EGCG) and gallic acid (GA) inhibited adipocyte differentiation. Three factors could inhibit the differentiation of 3T3-L1 cells by decreasing gene expression of peroxisome proliferators-activated receptor γ (PPARγ), fatty acid synthase (FAS), CCAAT/enhancer binding proteins-α (C/EBPα) and interleukin-6 (IL-6). Caffeine and ellagic acid (EA) showed opposite results, but their effects on promoting adipose differentiation diminished with increasing concentrations of drug. In dexamethasone-induced insulin-resistant 3T3-L1 cells, the fluorescence intensity of 2-Deoxy-2-[(7-nitro-2,1,3-Benzoxadiazol-4-yl)amino]-d-glucose revealed that LTWE, GA, EGCG, caffeine, and EA significantly promoted glucose consumption. LTWE, GA, and EA improved insulin resistance in adipocytes by upregulating gene expression of insulin receptor substrate-1 (IRS-1), PI3K, AKT, and glucose transporter 4 (GLUT4).

CONCLUSION

LC-MS combined with network pharmacology preliminarianized that LTWE acts mainly on the PI3K-AKT signaling pathway. Cell experiments revealed that the anti-obesity effect of LTWE is the result of multi-component action, which inhibits the proliferation and differentiation of preadipocytes by regulating gene expression of adipogenic transcription factors and proinflammatory factors, and improves IR by activating the IRS-1/PI3K/AKT/GLUT4 pathway.

Association of body mass index trajectory and hypertension risk: A systematic review of cohort studies and network meta-analysis of 89,094 participants

Introduction

Body mass index (BMI) trajectories, such as non-linear time trends and nonlinear changes in BMI with age, can provide information on the underlying temporal health patterns. The relationship between BMI trajectories and the risk of hypertension remains controversial.

Methods

PubMed, Embase, Cochrane, Scopus, and Web of Science databases were searched from their inception to January 31, 2022. We categorized BMI trajectories as "Stable high," "table normal," "Stable low," "Fluctuated (sharp increase)," and "Fluctuated (elevated-decrease)." The main outcome was the relative risk for the prevalence of hypertension in the different BMI trajectories. Potential sources of heterogeneity were examined using meta-regression and subgroup analysis. A publication bias test and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach were also used.

Results

The 18 cohort studies included 89,094 participants. Compared with the "Stable normal" trajectory, "Stable high," "Fluctuated (sharp increase)," and "Fluctuated (elevated-decrease)" trajectories were associated with an increased relative risk of hypertension: [RR (95% CI)]: 1.80 (1.29 2.50), p < 0.001; 1.53 (1.27 1.83), p < 0.001; 1.30 (1.24 1.37), p = 0.001, respectively. The "Stable low" trajectory was associated with a reduced risk of hypertension [0.83 (0.79 0.83), p < 0.001]. The "Stable high" trajectory (surface under the cumulative ranking curve = 88.1%) had the highest probability of developing hypertension in the population. The certainty of the evidence for direct comparisons of the incidence of hypertension between various BMI trajectories was generally very low.

Conclusion

Our findings suggested that "Stable high," "Fluctuated (sharp increase)," and "Fluctuated (elevated-decrease)" trajectories were associated with an increased relative risk of hypertension, with the "Stable high" trajectory most likely associated with hypertension.

Systematic review registration

[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=308575], identifier [CRD42022308575].

Comparison of 10 obesity-related indices for predicting hypertension based on ROC analysis in Chinese adults

Objective

To compare the predictive performance of the percentage body fat (PBF), body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-hip ratio (WHR), waist-height ratio (WHtR), a body shape index (ABSI), body roundness index (BRI), abdominal volume index (AVI), and conicity index (CI) for identifying hypertension.

Methods

A cross-sectional study was conducted among 2,801 adults (1,499 men and 1,302 women) aged 18 to 81 in Ningbo, China. The receiver operator characteristic (ROC) analysis and multiple non-parametric Z tests were used to compare the areas under the curve (AUC). The maximum Youden's indices were used to determine the optimal cut-off points of 10 obesity-related indices (ORI) for hypertension risk.

Results

The AUC of all the indices were statistically significant (P < 0.05). The AUC of all the indices in men and women were 0.67-0.73 and 0.72-0.79, respectively. Further non-parametric Z tests showed that WHR had the highest AUC values in both men [0.73 (95% CI: 0.70, 0.76)] and women (0.79 (95% CI: 0.75, 0.83)], and several central ORI (men: WHR, WC, BRI, AVI, and CI, 0.71-0.73; women: WC, WHR, and AVI, 0.77-0.79) were higher than general ORI (PBF and BMI, 0.68 in men; 0.72-0.75 in women), with adjusted P < 0.05. The optimal cut-off points for identifying hypertension in men and women were as follows: PBF (23.55%, 32.55%), BMI (25.72 kg/m², 23.46 kg/m²), HC (97.59 cm, 94.82 cm), WC (90.26 cm, 82.78 cm), WHR (0.91, 0.88), WHtR (0.51, 0.55), ABSI (0.08 m^7/6/kg^2/3, 0.08 m^7/6/kg^2/3), BRI (4.05, 4.32), AVI (16.31 cm², 13.83 cm²), and CI (1.23 m^2/3/kg^1/2, 1.27 m^2/3/kg^1/2). Multivariate logistic regression models showed that all indices were statistically significant (P < 0.05) with the adjusted ORs (per 1-SD increase) at 1.39-2.06 and ORs (over the optimal cut-off points) at 1.80-2.64.

Conclusions

All 10 ORI (PBF, BMI, HC, WC, WHR, WHtR, ABSI, BRI, AVI, and CI) can effectively predict hypertension, among which WHR should be recommended as the best predictor. Central ORI (WHR, WC, and AVI) had a better predictive performance than general ORIs (PBF and BMI) when predicting the risk of hypertension.

Isolated systolic hypertension in the young: a heterogeneous condition

Isolated systolic hypertension in the youth, is still a challenging problem. The prevalence of this hypertensive subtype may vary according to the different population study and is peculiar of male subjects among the youngest age classes. Several are the mechanisms reported as possible underlying causes of isolated systolic blood pressure elevation and again these differ according to the different study cohort and may vary from overweight and obesity status, linked to sympathetic overactivity, to increased and earlier arterial stiffness, hyperkinetic state, or exaggerated pulse pressure amplification form central to peripheral sites, due to enhanced arterial elasticity. Evidence is lacking regarding whether this condition is benign or associated to unfavorable cardiovascular events. The few long-term studies that followed isolated systolic hypertensives in the long-term, again reported conflicting results. Waiting for future studies, some clinical and hemodynamic characteristics of young isolated systolic hypertensives may help clinicians to better characterized patient's risk profile and decide whether to perform a strict follow-up with non-pharmacological measurements or to start drug treatment.

Highlights of mechanisms and treatment of obesity-related hypertension

The prevalence of obesity has increased two to three times from 1975 to 2015. Large-scale epidemiological and longitudinal prospective studies link obesity with hypertension. Research suggests that excessive weight gain, particularly when associated with visceral adiposity, may account for as much as 65% to 75% of the risk of incident hypertension. Also, exercise and bariatric/metabolic surgery significantly lowers blood pressure, whereas weight gain increases blood pressure, thus establishing a firm link between these two factors. The mechanisms underpinning obesity-related hypertension are complex and multifaceted, and include, but are not limited to, renin-angiotensin-aldosterone system/sympathetic nervous system overactivation, overstimulation of adipokines, insulin resistance, immune dysfunction, structural/functional renal, cardiac, and adipocyte changes. Though weight loss is the mainstay of treatment for obesity-related hypertension, it is often not a feasible long-term solution. Therefore, it is recommended that aggressive treatment with multiple antihypertensive medications combined with diet and exercise be used to lower blood pressure and prevent complications. The research regarding the mechanisms and treatment of obesity-related hypertension has moved at a blistering pace over the past ten years. Therefore, the purpose of this expert review is two-fold: to discuss the pathophysiological mechanisms underlying obesity-related hypertension, and to revisit pharmacotherapies that have been shown to be efficacious in patients with obesity-related hypertension.

Assessing 48 SNPs in Hypertensive Paediatric Patients and Young Adults with Review of Genetic Background of Essential Hypertension

Essential hypertension in paediatric patients and young adults is rising, mostly on account of obesity-related hypertension. Clinically, the difference between obese hypertensive and non-obese hypertensive individuals is evident; yet, the pathophysiology of essential and obesity-related hypertension is multifactorial, complex and not fully understood. The aim of our study was to obtain a comprehensive view of the clinical differences between obesity-related hypertension and hypertension in non-obese paediatric patients and young adults and to do genetic tests to possibly highlight some of the pathophysiological differences with a review of their genetic backgrounds. Four hundred and thirty-six hypertensive paediatric patients and young adults were included in the study, and a study of 48 single-nucleotide polymorphisms, using Kompetitive allele specific PCR, was conducted. The subjects were divided into 243 non-obese participants with hypertension and 193 obese participants with hypertension. The data for the clinical comparison of both groups were collected as well. The differences in some clinical and biochemical parameters were confirmed. Genetic tests showed a significant difference in one allele frequency between both groups in five SNPs: rs6232, rs6235, rs12145833, rs59744560 and rs9568856. In rs6235 and rs59744560, a direct effect of different allele states could be implied. Obesity-related hypertension at a young age differs from essential hypertension in those non-obese. The reported genetic differences could be important in understanding the complex pathophysiology of early-onset obesity-related hypertension and should be further evaluated.

Risk Factors for the Comorbidity of Hypertension and Renal Cell Carcinoma in the Cardio-Oncologic Era and Treatment for Tumor-Induced Hypertension

Advances in tumor diagnosis and treatment, especially the use of targeted therapies, have remarkably improved the survival rate of patients with renal cell carcinoma (RCC), accompanied by higher hypertension (HTN) incidence among patients with RCC, reflecting the coming of a cardio-oncologic era. Therefore, for patients with RCC and HTN simultaneously, finding risk factors for the comorbidity and giving better clinical treatment have been urgent problems. In this review, we thoroughly investigated risk factors for the comorbidity of HTN and RCC based on preclinical and clinical studies. Firstly, RCC and HTN may have common risk factors, such as obesity, smoking, and other modifiable lifestyles. Secondly, RCC and HTN may lead to each other directly or indirectly by their therapies. We then discussed measures of reducing the comorbidity and treatment of HTN in patients with RCC. We also discussed the deficiency of current studies and pointed out future directions. In conclusion, this review aims to deepen the understanding of cardio-oncology and bring benefit to the population who are at high risk of getting or have already got RCC and HTN simultaneously.

Human amniotic mesenchymal stem cells-conditioned medium protects mice from high-fat diet-induced obesity

Background

Obesity is a metabolic disorder syndrome characterized by excessive fat accumulation that is related to many diseases. Human amniotic mesenchymal stem cells (hAMSCs) have a great potential for cell-based therapy due to their characteristics such as pluripotency, low immunogenicity, no tumorigenicity, potent paracrine effects, and no ethical concern. Recently, we observed that both hAMSCs and their conditioned medium (hAMSCs-CM) efficiently repaired skin injury, inhibited hepatocellular carcinoma, and alleviated high-fat diet (HFD)-induced diabetes. However, the effects and the underlying mechanisms of hAMSCs-CM on high-fat diet (HFD)-induced obesity were not explored.

Methods

The characteristics of hAMSCs were confirmed by flow cytometry, RT-PCR, and immunofluorescence. Obese mice were induced by administrating HFD for 15 weeks and simultaneously, the mice were intraperitoneally injected with hAMSCs-CM weekly to evaluate the effects of hAMSCs-CM on HFD-induced obesity. GTT and ITT assays were used to assess the effects of hAMSCs-CM on HFD-induced glucose tolerance and insulin resistance. The lipid accumulation and adipocytes hypertrophy in mouse adipose tissues were determined by histological staining, in which the alterations of blood lipid, liver, and kidney function were also examined. The role of hAMSCs-CM in energy homeostasis was monitored by examining the oxygen consumption (VO₂), carbon dioxide production (VCO₂), and food and water intake in mice. Furthermore, the expressions of the genes related to glucose metabolism, fatty acid β oxidation, thermogenesis, adipogenesis, and inflammation were determined by western blot analysis, RT-PCR, and immunofluorescence staining. The roles of hAMSCs-CM in adipogenesis and M1/M2 macrophage polarization were investigated with 3T3-L1 preadipocytes or RAW264.7 cells in vitro.

Results

hAMSCs-CM significantly restrained HFD-induced obesity in mice by inhibiting adipogenesis and lipogenesis, promoting energy expenditure, and reducing inflammation. The underlying mechanisms of the anti-obesity of hAMSCs-CM might be involved in inhibiting PPARγ and C/EBPα-mediated lipid synthesis and adipogenesis, promoting GLUT4-mediated glucose metabolism, elevating UCP1/PPARα/PGC1α-regulated energy expenditure, and enhancing STAT3-ARG1-mediated M2-type macrophage polarization.

Conclusion

Our studies demonstrated that hAMSCs significantly alleviated HFD-induced obesity through their paracrine effects. Obviously, our results open up an attractive therapeutic modality for the prevention and treatment of obesity and other metabolic disorders clinically.

Graphic Abstract

The cytokines, exosomes, or micro-vesicles secreted from hAMSCs significantly inhibited HFD-induced obesity in mice by inhibiting lipid production and adipogenesis, promoting energy consumption, and reducing inflammation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13287-021-02437-z.

Comparison of bioelectrical body and visceral fat indices with anthropometric measures and optimal cutoffs in relation to hypertension by age and gender among Chinese adults

Background

Few studies have compared bioelectrical body and visceral fat indices with anthropometric measures, or evaluated their optimal cutoffs in relation to hypertension among Asians. We compared the efficiencies of bioelectrical indices (percentage of body fat, PBF; visceral fat area, VFA) with anthropometric measures (body mass index, BMI; waist-hip ratio, WHR) for hypertension and re-evaluated the optimal cutoffs of each index by age and gender.

Methods

We conducted a cross-sectional survey among 8234 adults for health examination. PBF, VFA, BMI, WHR, and data on hypertension and behaviors were collected. Receiver operating characteristic (ROC) curve and areas under curves (AUCs) were used to analyze the efficiencies of the indices for hypertension, optimal cutoffs were estimated using the Youden index.

Results

A total of 8234 individuals aged 21–91 with median age 44 (interquartile range [IQR] 33–56) years were included and 40.56% were men. The overall prevalence of hypertension was 27.47%. The studied indices were all associated with hypertension in all age-specific groups both among men and women except for WHR in 21–29 years old men and PBF in in 21–29 years old women. Among males, there were no statistical differences in powers of four indices for hypertension in all age-specific groups, except for 40–49 years, in which WHR was better than VFA. Among females, no differences were found among the indices in 30–39 and 70–79 years groups, while WHR was the best in 21–29 years group, VFA was better than PBF in 30–39 and 50–59 years groups, BMI was better than PBF and WHR in 60–69 years group. The optimal cutoffs of PBF, VFA, BMI and WHR ranged from 23.9 to 28.7%, 86.4 to 106.9cm², 23.5 to 27.1 kg/m², 0.92 to 0.96 across the age categories in males, and 32.8 to 36.3%, 75.9 to 130.9cm², 21.9 to 26.4 kg/m², 0.84 to 0.95 across the age categories in females, respectively.

Conclusions

The obesity indices’ efficiencies for hypertension varied by age and gender, and their cutoff values varied across the age categories and gender. Specific indices and cutoffs based on person’s age and gender should be used to identify individuals with hypertension.

Alpha-melanocyte-stimulating hormone during exercise recovery has prognostic value for coronary artery disease

PURPOSE

Alpha-melanocyte-stimulating hormone (alpha-MSH) has proven cardiovascular effects and plays a significant role as an endogenous countermeasure to ischemia-reperfusion injury. The aim of the current study was to examine the response of alpha-MSH during exercise in patients diagnosed with coronary artery disease (CAD) and evaluate its value in the assessment of severity and prognosis.

METHODS

Forty subjects with documented CAD (i.e., lesions on coronary angiography ≥ 50%) were included. Cardiopulmonary exercise testing (CPET) on a treadmill (TM) and recumbent ergometer (RE) were performed on two visits, 2-4 days apart, during 2 months of coronary angiography; subsequently, the subjects were followed up for 32 ± 10 months. At rest, at peak CPET, and after 3 min of recovery, plasma levels of alpha-MSH were measured by enzyme-linked immunosorbent assay technique.

RESULTS

Mean ejection fraction was 56.7 ± 9.6%. Alpha-MSH similarly increased from rest to peak CPET on both modalities. There were no significant differences in alpha-MSH values during testing in patients with 1,2- and 3-vesel CAD, nor in patients with a SYNTAX score </≥ 23 (p > 0.05). Among CPET and hormonal parameters, ∆alpha-MSH recovery/peak during RE CPET was the best predictor of cardiac event occurrence (chi-square 6.67, HR = 0.51, CI = 0.25-1.02, p = 0.010).

CONCLUSION

∆alpha-MSH recovery/peak during RE CPET has predictive value for CAD prognosis, demonstrating involvement of alpha-MSH in CAD and a link between stress hormones and cardiac events.

Obesity cardiomyopathy: evidence, mechanisms, and therapeutic implications

The prevalence of heart failure is on the rise and imposes a major health threat, in part, due to the rapidly increased prevalence of overweight and obesity. To this point, epidemiological, clinical, and experimental evidence supports the existence of a unique disease entity termed “obesity cardiomyopathy,” which develops independent of hypertension, coronary heart disease, and other heart diseases. Our contemporary review evaluates the evidence for this pathological condition, examines putative responsible mechanisms, and discusses therapeutic options for this disorder. Clinical findings have consolidated the presence of left ventricular dysfunction in obesity. Experimental investigations have uncovered pathophysiological changes in myocardial structure and function in genetically predisposed and diet-induced obesity. Indeed, contemporary evidence consolidates a wide array of cellular and molecular mechanisms underlying the etiology of obesity cardiomyopathy including adipose tissue dysfunction, systemic inflammation, metabolic disturbances (insulin resistance, abnormal glucose transport, spillover of free fatty acids, lipotoxicity, and amino acid derangement), altered intracellular especially mitochondrial Ca²⁺ homeostasis, oxidative stress, autophagy/mitophagy defect, myocardial fibrosis, dampened coronary flow reserve, coronary microvascular disease (microangiopathy), and endothelial impairment. Given the important role of obesity in the increased risk of heart failure, especially that with preserved systolic function and the recent rises in COVID-19-associated cardiovascular mortality, this review should provide compelling evidence for the presence of obesity cardiomyopathy, independent of various comorbid conditions, underlying mechanisms, and offer new insights into potential therapeutic approaches (pharmacological and lifestyle modification) for the clinical management of obesity cardiomyopathy.

Trajectories of body mass index and risk of incident hypertension among a normal body mass index population: A prospective cohort study

It is unclear whether there are different body mass index (BMI) trajectories among a population with normal BMI levels, and the association between BMI patterns and incident hypertension is not well characterized. This prospective cohort study includes surveys conducted at baseline and three follow‐ups. 3939 participants who are free of hypertension at baseline or first two follow‐ups were enrolled. At baseline, the age of participants ranged from 35 to 82 years and the mean age was 45.9 years. The BMI trajectories were identified using latent mixture modeling with data from the baseline and first two follow‐ups. The effects of different BMI trajectories on the development of hypertension were analyzed using a Cox proportional hazard model. Four distinct BMI trajectories were identified over the study period (2004‐2010): normal‐stable (n = 1456), normal‐increasing (n = 2159), normal‐fluctuated (n = 166), and normal‐sharp‐increasing (n = 158). Relative to the normal‐stable BMI group, the hazard ratios (HRs) and 95% confidence intervals (CIs) after adjustment for confounding factors of the normal‐increasing, normal‐fluctuated, and normal‐sharp‐increasing groups were 1.244 (1.103‐1.402), 1.331 (1.008‐1.756), and 1.641 (1.257‐2.142), respectively. Additionally, subgroup analysis showed that the normal‐fluctuated BMI trajectory was associated with a significantly higher risk of hypertension only in women (HR = 1.362; 95% CI = 1.151‐1.611). The BMI trajectories were significant predictors of hypertension incidence, and increasing BMI trajectories within the currently designated normal range were associated with an increased hypertension risk, especially in women.

Comparison of different obesity indices related with hypertension among different sex and age groups in China

BACKGROUND AND AIMS

To compare the relationships of five obesity-related routine anthropometric indicators (body mass index (BMI), body adiposity index (BAI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR)) for hypertension in both sexes and among different age groups of the Chinese population.

METHODS AND RESULTS

A total of 12,064 adult participants (5638 males and 6426 females) were included. Odds ratios (OR) and 95% confidence intervals were used with binary logistic regression models to estimate the risk of hypertension for each obesity index. For the males, WHtR had the highest OR value in all age groups. The degrees of correlation between hypertension and the obesity indices for different age groups were different among the females. WC, BMI, and WHtR were the highest in the 18-44, 45-59, and ≥60 years age groups, respectively. Furthermore, we compared the area under the ROC curve (AUC) of each obesity index for the criterion of hypertension under the influence of risk factors. For the males, the AUC of WHtR was the largest (0.814, 0.710, and 0.662). WC (AUC = 0.820), BMI (AUC = 0.765), and WHtR (AUC = 0.668) tended to be the best criteria for hypertension among females in the 18-44, 45-59, and ≥60 years age groups respectively. In addition, BAI, as an obesity indicator proposed in recent years, has a positive association with hypertension except in 18-44 years women, which was not stronger than other obesity indicators.

CONCLUSIONS

For males, WHtR appears to be the best obesity index related with hypertension. For young, middle-aged, and elderly women, the best obesity indices related with hypertension are WC, BMI, and WHtR, respectively.

Impact of Overweight in Mens with Family History of Hypertension: Early Heart Rate Variability and Oxidative Stress Disarrangements

Aim

To evaluate cardiovascular, autonomic, and oxidative stress markers in eutrophic and overweight offspring of hypertensive parents comparing them to eutrophic and overweight offspring of normotensive parents.

Methods

We conducted a cross-sectional study. We selected 71 male and sedentary subjects, divided into 4 groups: eutrophic group with a negative family history of hypertension (EH-, n = 18) or positive family history of hypertension (EH+, n = 17), overweight group with a negative family history of hypertension (OH-, n = 19) or a positive family history of hypertension (OH+, n = 17), and aged between 18 and 35 years.

Results

Blood glucose was higher in the OH+ group when compared to other groups. Diastolic blood pressure was increased in OH- and OH+ groups when compared to eutrophic groups. Regarding the HRV, the LF abs was higher in OH- and OH+ groups when compared to the EH- group. LF/HF values were higher in EH+ and OH+ groups when compared to the EH- and OH- groups. As to oxidative stress and the metabolism of nitric oxide, we observed an increase in hydrogen peroxide and nitrite levels in the OH+ group, and in the NADPH oxidase in OH- and OH+ groups when compared to the other groups.

Conclusion

Our findings demonstrate that the overweight group with a family history of hypertension presented all the dysfunctions observed in isolation from these risk factors. We observed an exacerbation of cardiac sympathetic modulation and early prooxidants increase, which may be associated with target organ damage and cardiovascular risk in this population.

Obesity, Hypertension, and Bariatric Surgery

PURPOSE OF REVIEW

Obesity increases the risk of hypertension. However, blood pressure decreases before any significant loss of body weight after bariatric surgery. We review the mechanisms of the temporal dissociation between blood pressure and body weight after bariatric surgery.

RECENT FINDINGS

Restrictive and bypass bariatric surgery lower blood pressure and plasma leptin levels within days of the procedure in both hypertensive and normotensive morbidly obese patients. Rapidly decreasing plasma leptin levels and minimal loss of body weight point to reduced sympathetic nervous system activity as the underlying mechanism of rapid blood pressure decline after bariatric surgery. After the early rapid decline, blood pressure does not decrease further in patients who, while still obese, experience a steady loss of body weight for the subsequent 12 months. The divergent effects of bariatric surgery on blood pressure and body weight query the role of excess body weight in the pathobiology of the obesity phenotype of hypertension. The decrease in blood pressure after bariatric surgery is moderate and independent of body weight. The lack of temporal relationship between blood pressure reduction and loss of body weight for 12 months after sleeve gastrectomy questions the nature of the mechanisms underlying obesity-associated hypertension.

Effects of long- and short-term body mass index changes on incident hypertension are different

OBJECTIVES

The aim of this study was to evaluate hypertension risk associated with long- and short-term body mass index (BMI) changes.

METHODS

This prospective cohort study included four examinations: 2004 to 2006, 2008, 2010, and 2017. Adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of BMI changes on incident hypertension. The difference of β coefficients between long- and short-term BMI changes were examined using Fisher Z-test.

RESULTS

Relative to stable, normal BMI, both long- and short-term elevated BMI conferred an increased risk for hypertension, with HRs of 1.507 (95% CI, 1.286-1.767) and 1.197(95% CI, 1.019-1.405), respectively. In contrast, relative to stable overweight, both long- and short-term decreased BMI conferred a reduced risk for hypertension, with HRs of 0.651(95% CI, 0.536-0.789) and 0.775 (0.625-0.962), respectively. Additionally, for BMI changing from normal to overweight, long-term changes were relatively more strongly associated with increased risk for incident hypertension than short-term based on regression coefficients (β = 0.410 versus β = 0.179, P < 0.001). For BMI changing from overweight to normal, long-term changes were relatively more strongly associated with lower risk than short-term based on regression coefficients (β = -0.430 versus β = -0.254, P = 0.007). Additionally, there was no correlation between absolute changes in BMI and systolic blood pressure for long- (P = 0.744) and short-term (P = 0.097).

CONCLUSION

For participants with normal BMI, risk tended to be higher in adults whose elevated BMI occurred during the long-term. For those who are overweight, long-term decreased BMI can reduce the risk for incident hypertension to a greater extent. No correlation was found between absolute changes in BMI and systolic blood pressure.

Identifying poor cardiorespiratory fitness in overweight and obese children and adolescents by using heart rate variability analysis under resting conditions

Background: Childhood obesity, including overweight, continues increasing worldwide affecting health expectancy, quality of life and healthcare expenditure. These subjects have higher probability of suffering or developing cardio metabolic risk factors. Recent studies have revealed cardiorespiratory fitness (CRF) as a valuable clinical parameter to identify these subjects and have even suggested cut-off values. However, evaluating CRF in overweight and obese youth can be difficult to implement, unfriendly and expensive.Objective: Develop a screening tool to identify high-risk subjects in a representative population of those attending overweight/obesity assessment programmes without prior intervention. It will be based on heart rate variability parameters, which has strong association with CRF and cardio metabolic risk factors.Methods: Sixty-three subjects, overweight and obese, between 9 and 17 years of age, and of both sexes were enrolled. None of them had secondary obesity syndromes and/or suffered from acute or chronic disease. Anthropometric parameters, electrocardiogram signal recording under resting conditions and cardiorespiratory fitness - evaluated by oxygen consumption and time elapsed of cardiopulmonary exercise test - were measured.Results: Significant differences in the sympathetic nervous system activity - assessed by heart rate variability analysis - are observed when grouping by overweight and obesity degree as well as by CRF (poor/normal). Body mass index, puberty and sympathetic nervous system activity are the significant variables of a logistic regression model develop to identify poor CRF individuals. Its accuracy reaches 92%.Conclusions: A screening tool based on heart rate variability and anthropometric parameters was developed to identify subjects with higher probability of suffering or developing cardio metabolic risk factors.

Analysis of Dose-response Relationship between BMI and Hypertension in Northeastern China Using Restricted Cubic Spline Functions

High body mass index (BMI) was significantly associated with hypertension. The purpose of this study is to investigate the association between BMI and hypertension in people in northeast China. Our study was a cross-sectional study conducted from June to August 2012. According to multistage, stratified cluster sampling, a total of 21435 inhabitants aged between 18 and 79 years in Jilin Province were selected randomly. The prevalence of hypertension was 35.66% overall. After adjusting for potential confounders, the multivariable-adjusted odds ratios for the BMI- hypertension association for overweight and obesity were 2.503 (95% confidence interval = 1.912-2.204) and 4.259 (95% confidence interval = 3.883-4.671). The results of multivariable restricted cubic spline regression analysis showed that there was a non-linear relationship between the continuous change of BMI and hypertension (P < 0.001) after adjusting the confounding factors of different genders and age groups, which indicated that there was an adjusted dose-response association between continuous BMI and hypertension.

Obesity and cardiovascular risk: a call for action from the European Society of Hypertension Working Group of Obesity, Diabetes and the High-risk Patient and European Association for the Study of Obesity: part A: mechanisms of obesity induced hypertension, diabetes and dyslipidemia and practice guidelines for treatment

: Obesity is a key factor for cardiovascular diseases and complications. Obesity is associated with hypertension, dyslipidemia and type II diabetes, which are the major predictors of cardiovascular disease in the future. It predisposes for atrial fibrillation, heart failure, sudden cardiac death, renal disease and ischemic stroke that are the main causes of cardiovascular hospitalization and mortality. As obesity and the cardiovascular effects on the vessels and the heart start early in life, even from childhood, it is important for health policies to prevent obesity very early before the disease manifestation emerge. Key roles in the prevention are strategies to increase physical exercise, reduce body weight and to prevent or treat hypertension, lipids disorders and diabetes earlier and efficiently to prevent cardiovascular complications.Epidemiology and mechanisms of obesity-induced hypertension, diabetes and dyslipidemia will be reviewed and the role of lifestyle modification and treatment strategies in obesity will be updated and analyzed. The best treatment options for people with obesity, hypertension, diabetes and dyslipidemia will discussed.

The Additive Interaction between Body Mass Index and Hypertension Family History in Han and Yugur: The China National Health Survey (CNHS)

OBJECTIVE

To estimate the additive interaction of body mass index (BMI) and family history of hypertension (FHH) on hypertension and explore whether the interaction could be influenced by behavioural risk factors.

METHODS

The cross-sectional data on 5791 participants were from the China National Health Survey in Gansu province in 2016. We assessed the additive interaction by calculating the relative excess risk due to interaction (RERI), the attributable proportion due to interaction (AP), and the synergy index (SI).

RESULTS

ORs for hypertension were highest in Han (13.52, 95% CI: 9.45 to 19.34) and Yugur (13.85, 95% CI: 8.48 to 22.63) with the combination of obesity and FHH. The interaction of BMI and FHH was significant in Han people, with the RERI, AP, and SI and their 95% CIs being 2.48 (1.13 to 3.82), 0.33 (0.19 to 0.47), and 1.61 (1.26 to 2.07) for overweight and FHH and 6.32 (1.91 to 10.73), 0.47 (0.27 to 0.67), and 2.02 (1.33 to 3.07) for obesity and FHH, respectively. The interaction of BMI and FHH was not significant in Yugur people. Adjustment for behavioural risk factors had little influence on the interactions, and risks of hypertension remained increased.

CONCLUSIONS

BMI and FHH were associated with hypertension, and the interaction of BMI and FHH on hypertension was significant in Han but not in Yugur people. Behavioural risk factors had little influence on the associations and interactions. The exacerbation of hypertension risks by overweight or obesity in hypertension families deserves attention in weight control and community care.

Effects and Mechanisms of Tea Regulating Blood Pressure: Evidences and Promises

Cardiovascular diseases have overtaken cancers as the number one cause of death. Hypertension is the most dangerous factor linked to deaths caused by cardiovascular diseases. Many researchers have reported that tea has anti-hypertensive effects in animals and humans. The aim of this review is to update the information on the anti-hypertensive effects of tea in human interventions and animal studies, and to summarize the underlying mechanisms, based on ex-vivo tissue and cell culture data. During recent years, an increasing number of human population studies have confirmed the beneficial effects of tea on hypertension. However, the optimal dose has not yet been established owing to differences in the extent of hypertension, and complicated social and genetic backgrounds of populations. Therefore, further large-scale investigations with longer terms of observation and tighter controls are needed to define optimal doses in subjects with varying degrees of hypertensive risk factors, and to determine differences in beneficial effects amongst diverse populations. Moreover, data from laboratory studies have shown that tea and its secondary metabolites have important roles in relaxing smooth muscle contraction, enhancing endothelial nitric oxide synthase activity, reducing vascular inflammation, inhibiting rennin activity, and anti-vascular oxidative stress. However, the exact molecular mechanisms of these activities remain to be elucidated.

Replacing Saturated Fat With Walnuts or Vegetable Oils Improves Central Blood Pressure and Serum Lipids in Adults at Risk for Cardiovascular Disease: A Randomized Controlled-Feeding Trial

Background Walnuts have beneficial effects on cardiovascular risk factors, but it is unclear whether these effects are attributable to the fatty acid ( FA ) content, including α-linolenic acid ( ALA ), and/or bioactives. Methods and Results A randomized, controlled, 3-period, crossover, feeding trial was conducted in individuals at risk for cardiovascular disease (n=45). Following a 2-week standard Western diet run-in (12% saturated FAs [ SFA ], 7% polyunsaturated FAs, 12% monounsaturated FAs), participants consumed 3 isocaloric weight-maintenance diets for 6 weeks each: a walnut diet ( WD ; 7% SFA , 16% polyunsaturated FAs, 3% ALA , 9% monounsaturated FAs); a walnut FA -matched diet; and an oleic acid-replaced- ALA diet (7% SFA , 14% polyunsaturated FAs, 0.5% ALA , 12% monounsaturated FAs), which substituted the amount of ALA from walnuts in the WD with oleic acid. This design enabled evaluation of the effects of whole walnuts versus constituent components. The primary end point, central systolic blood pressure, was unchanged, and there were no significant changes in arterial stiffness. There was a treatment effect ( P=0.04) for central diastolic blood pressure; there was a greater change following the WD versus the oleic acid-replaced-ALA diet (-1.78±1.0 versus 0.15±0.7 mm Hg, P=0.04). There were no differences between the WD and the walnut fatty acid-matched diet (-0.22±0.8 mm Hg, P=0.20) or the walnut FA-matched and oleic acid-replaced-ALA diets ( P=0.74). The WD significantly lowered brachial and central mean arterial pressure. All diets lowered total cholesterol, LDL (low-density lipoprotein) cholesterol, HDL (high-density lipoprotein) cholesterol, and non- HDL cholesterol. Conclusions Cardiovascular benefits occurred with all moderate-fat, high-unsaturated-fat diets. As part of a low- SFA diet, the greater improvement in central diastolic blood pressure following the WD versus the oleic acid-replaced-ALA diet indicates benefits of walnuts as a whole-food replacement for SFA . Clinical Trial Registration URL : https://www.clinicaltrials.gov . Unique identifier: NCT02210767.

Generality of genomic findings on blood pressure traits and its usefulness in precision medicine in diverse populations: A systematic review

Remarkable findings from genome-wide association studies (GWAS) on blood pressure (BP) traits have made new insights for developing precision medicine toward more effective screening measures. However, generality of GWAS findings in diverse populations is hampered by some technical limitations. There is no comprehensive study to evaluate source(s) of the non-generality of GWAS results on BP traits, so to fill the gap, this systematic review study was carried out. Using MeSH terms, 1545 records were detected through searching in five databases and 49 relevant full-text articles were included in our review. Overall, 749 unique variants were reported, of those, majority of variants have been detected in Europeans and were associated to systolic and diastolic BP traits. Frequency of genetic variants with same position was low in European and non-European populations (n = 38). However, more than 200 (>25%) single nucleotide polymorphisms were found on same loci or linkage disequilibrium blocks (r² ≥ 80%). Investigating for locus position and linkage disequilibrium of infrequent unique variants showed modest to high reproducibility of findings in Europeans that in some extent was generalizable in other populations. Beyond theoretical limitations, our study addressed other possible sources of non-generality of GWAS findings for BP traits in the same and different origins.

Association of Age-Related Trends in Blood Pressure and Body Composition Indices in Healthy Adults

Purpose: Adiposity is one of the important determinants of blood pressure. The aim of this study is to evaluate the association between blood pressure and body composition indices throughout the whole lifespan of healthy adults.

Patients and Methods: This study was from an ongoing cross-sectional survey of the Chinese health wherein data included basic physiological parameters. Partial Pearson correlation analysis was used to assess the correlation between blood pressure and body composition indices. Multiple linear regression analysis was used to assess the association of body mass index, lean mass percent, and visceral fat rating against blood pressure in each age group.

Results: In the whole population stratified by gender, while body mass index had the highest r-value of correlation with systolic blood pressure in both males (r = 0.296, p < 0.001) and females(r = 0.237, p < 0.001), and fat mass percent had the highest r-value of correlation with diastolic blood pressure in males (r = 0.351, p < 0.001) and females(r = 0.277, p < 0.001), the strength of association with blood pressure were similar across most of the body composition indices. In multiple linear regression analysis, both body mass index and visceral fat rating were positively while lean mass percent was negatively associated with blood pressure in all age groups in both genders, whereas all the association was weaker in the elderly compared to the younger.

Conclusion: Maintain the total body fat in a favorable range and appropriately increase the body muscle mass is a strategy to reduce the occurrence of cardiovascular event by decreasing the risk of hypertension through the whole adult life.

Cancer and comorbidity: The role of leptin in breast cancer and associated pathologies

Obesity is an important risk factor for postmenopausal breast cancer and also a poor prognostic factor among cancer patients. Moreover, obesity is associated with a number of health disorders such as insulin resistance/type-2 diabetes mellitus, hypertension, and other cardiovascular diseases. Frequently, these health disorders exhibit as components/complications of the metabolic syndrome. Nevertheless, obesity-related diseases may coexist with postmenopausal breast cancer; and these comorbid conditions could be substantial. Therefore, it may be assumed that different diseases including breast cancer could originate from a common pathological background in excessive adipose tissue. Adipocyte-released hormone-like cytokine (or adipokine) leptin behaves differently in a normal healthy state and obesity. A growing body of evidence suggests an important role of leptin in our major obesity-related health issues such as insulin resistance, hypertension, and neoplasia. In this context, this review describes the relationships of the abovementioned pathologies with leptin.

Anti-Inflammatory Effects of Melatonin in Obesity and Hypertension

PURPOSE OF REVIEW

Here, we review the known relations between hypertension and obesity to inflammation and postulate the endogenous protective effect of melatonin and its potential as a therapeutic agent. We will describe the multiple effects of melatonin on blood pressure, adiposity, body weight, and focus on mitochondrial-related anti-inflammatory and antioxidant protective effects.

RECENT FINDINGS

Hypertension and obesity are usually associated with systemic and tissular inflammation. The progressive affection of target-organs involves multiple mediators of inflammation, most of them redundant, which make anti-inflammatory strategies ineffective. Melatonin reduces blood pressure, body weight, and inflammation. The mechanisms of action of this ancient molecule of protection involve multiple levels of action, from subcellular to intercellular. Mitochondria is a key inflammatory element in vascular and adipose tissue and a potential pharmacological target. Melatonin protects against mitochondrial dysfunction. Melatonin reduces blood pressure and adipose tissue dysfunction by multiple anti-inflammatory/antioxidant actions and provides potent protection against mitochondria-mediated injury in hypertension and obesity. This inexpensive and multitarget molecule has great therapeutic potential against both epidemic diseases.

Apigetrin inhibits adipogenesis in 3T3-L1 cells by downregulating PPARγ and CEBP-α

Background

Apigetrin, a flavonoid found in many plant leaves and seeds, has been known to possess antimutagenic, anti-cancer, antioxidant and anti-inflammatory properties. Here, we are investigating the effect of the apigetrin on adipocytes differentiation in 3T3-L1 adipocytes, and elucidating the mechanism of its action.

Methods

Lipids accumulation was measured by Oil Red O staining and cell cycle was analyzed by flow cytometry. The antioxidant effect of apigetrin was evaluated against hydrogen peroxide. The expression of various genes, involved in adipogenesis and inflammation, was studied by real-time PCR.

Results

Our results showed that apigterin treatment inhibited significantly lipid accumulation without effect on cell viability at 100 μM, and it exerted the anti-adipogenic effect during the early stages of differentiation. Flow cytometry analysis showed that apigenin-7-O-glucoside (Ap7G) inhibited cell proliferation during mitotic clonal expansion and caused cell cycle delay. Quantitative PCR analysis revealed that the mRNA levels of C/EBP-α, PPAR-γ, SREBP-1c and FAS were suppressed after apigetrin treatment at 100 μM. Moreover, the mRNA level of pro-inflammatory genes (TNF-α and IL-6) were suppressed after apigterin treatment, at high concentration preadipocyte cells.

Conclusion

Taken together, these results indicated that apigenin-7-O-glucoside inhibits adipogenesis of 3T3-L1 preadipocytes at early stage of adipogenesis.

Glomerular Hyperfiltration as Predictor of Cardiometabolic Risk Factors among Children and Adolescents: The Childhood and Adolescence Surveillance and Prevention of Adult-V Study

Background

The prevalence of glomerular hyperfiltration and chronic kidney disease is increasing worldwide in parallel with obesity hypertension epidemic. The effect of increases in glomerular filtrations (GFR) in children with metabolic syndrome has not been studied. The purpose of the present study is to investigate the relationship between GFR and cardiometabolic risk factors in a large sample of pediatric population.

Methods

In this nationwide survey, 3800 participants were selected by cluster random sampling from 30 provinces in Iran. Anthropometric measures, biochemical, and clinical parameters were measured. We also measured estimated GFR (eGFR) using the recently modified Schwartz equations and other known cardiometabolic risk factors such as elevated total cholesterol, high low-density lipoprotein cholesterol (LDL-C), and obesity.

Results

The response rate was 91.5% (n = 3843). The mean and standard deviation (SD) (Mean ± SD) of eGFR for girls, boys, and total population were 96.71 ± 19.46, 96.49 ± 21.69, and 96.59 ± 20 ml/min/1.73 m², respectively. Overall, 38.7% of the participants did not have any cardiometabolic risk factor. In multivariate models, the risk of elevated systolic blood pressure (BP) (odds ratio [OR]: 1.48; 95% confidence interval [CI]: 1.08-2.02), elevated diastolic BP (OR: 1.48; 95% CI: 1.08-2.02), elevated LDL-C (OR: 1.35; 95% CI: 1.07-1.70), and obesity (OR: 1.70; 95%CI: 1.24-2.33) were significantly higher in participants with higher eGFR level than those with the lower level but not with low level of high-density lipoprotein cholesterol (OR: 0.72; 95% CI: 0.60-0.88).

Conclusions

This study demonstrates an association between glomerular hyperfiltration and obesity-related hypertension in a large sample of the Iranian pediatric population, independently of other classical risk factors.

Is waist-to-height ratio the best predictive indicator of hypertension incidence? A cohort study

BACKGROUND

The best anthropometric indicator to verify the association between obesity and hypertension (HTN) has not been established. We conducted this study to evaluate and compare the discriminatory power of waist-to-height ratio (WHtR) in relation to body mass index (BMI) and waist circumference (WC) in predicting HTN after 13 years of follow-up.

METHODS

This study was an observational prospective cohort study performed in the city of Firminópolis, in Brazilian's midwest. The cohort baseline (phase 1) was initiated in 2002 with the evaluation of a representative sample of the normotensive population (≥ 18 years of age). The incidence of HTN was evaluated as the outcome (phase 2). Sociodemographic, dietary and lifestyle variables were used to adjust proportional hazards models and evaluate risk of HTN according to anthropometric indices. The areas under the receiver operating characteristic (ROC) curves were used to compare the predictive capacity of these indices. The best HTN predictor cut-offs were obtained based on sensitivity and specificity.

RESULTS

A total of 471 patients with a mean age of 38.9 ± 12.3 years were included in phase 1. The mean follow-up was 13.2 years, and 207 subjects developed HTN. BMI, WC and WHtR were associated with risk of HTN incidence and had similar power in predicting the disease. However, the associations were only significant for women. The cut-off points with a better HTN predictive capacity were in agreement with current recommendations, except for the WC in men.

CONCLUSIONS

The results suggest that both overall obesity (BMI) and central obesity (WC and WHtR) anthropometric indicators can be used in this population to evaluate the risk of developing hypertension.

Gut microbiota in kidney disease and hypertension

The human gut microbiota is being composed of more than one hundred trillion microbial cells, including aerobic and anaerobic species as well as gram-positive and negative species. Animal based evidence suggests that the change of normal gut microbiota is responsible for several clinical implications including blood pressure increase and kidney function reduction. Trimethylamine-N-Oxide, short-chain fatty acids and inflammatory factors are originated from the gut microbes and may induce changes in arteries, kidneys and blood pressure. Prebiotics and probiotics change the gut microbiota and may reduce high blood pressure and ameliorate chronic kidney disease suggesting a new treatment target in patients for the initial stages of hypertension concomitant with other life style changes such as increased physical exercise and weight reduction to reduce cardiovascular disease complications.

Comparison Among Recommendations for the Management of Arterial Hypertension Issued by Last US, Canadian, British and European Guidelines

Guidelines for the management of hypertension have been issued by different hypertension societies or organizations. Despite many similarities one can identify major differences in the diagnosis, management and treatment of the hypertensive patients among ESH/ESC, NICE, Canadian and NJC8 guidelines. Differences that can be identified are in the definition of hypertension in the elderly population, the optimal blood pressure targets in different hypertensive populations such as patients with diabetes and chronic kidney disease patients and the choose of the initial and appropriate antihypertensive agent depending on comorbidities of the treated population. Everyday clinical praxis physicians are confused by these differences and these incongruities contribute to doctor and patient inertia to reduce blood pressure levels at an optimal level. Community physicians cannot easily distinguish what recommendations are the best to be used for their patients. The critical view of these differences can also help the guidelines committees to make appropriate changes and finally to agree to a global view of recommendations for the management and treatment of hypertension.

The incidence of hypertension and its risk factors in the German adult population: results from the German National Health Interview and Examination Survey 1998 and the German Health Interview and Examination Survey for Adults 2008-2011

OBJECTIVE

To analyze incident hypertension and its risk factors based on 11.9 years follow-up of a recent National Examination Survey cohort in Germany.

METHODS

Out of 7124 participants of the German National Health Interview and Examination Survey 1998 (GNHIES98), 640 had died at follow-up 2008-2011 and 3045 were reexamined as part of the German Health Interview and Examination Survey for Adults 2008-2011 (DEGS1). Baseline and follow-up included standardized blood pressure (BP) measurements. Hypertension was defined as BP of at least 140/90 mmHg or intake of antihypertensive medication in participants with known hypertension.

RESULTS

Out of 2231 GNHIES98-DEGS1 participants aged 18-79 years without hypertension in 1998, 26.2% developed hypertension within a mean of 11.9 (range 10.0-14.1) years (men 29.0%, women 23.4%). In univariate analysis, hypertension incidence was positively associated with age, BMI, initial BP levels, pulse pressure, and alcohol consumption. Comorbidities such as diabetes and hyperlipidemia increased the chance to develop hypertension. In the multivariate model, initial SBP and DBP levels had the strongest influence on the development of future hypertension (7% increase in men and 5% in women per mmHg SBP). The percentage of aware, treated, and controlled hypertensive patients were 75.8, 62.1, and 50.3% in men and 83.8, 73.3, and 59.0% in women.

CONCLUSION

The high 11.9-year incidence in all age groups points to the lifelong potential for prevention of hypertension.

Impact of Cardiorespiratory Fitness and Risk of Systemic Hypertension in Nonobese Versus Obese Men Who Are Metabolically Healthy or Unhealthy

Few data are available regarding the influence of body phenotype on systemic hypertension (SH) and whether cardiorespiratory fitness (CRF) attenuates this relation. We tested the hypothesis that obesity phenotypes and CRF would predict incident hypertension, evaluating 3,800 Korean men who participated in 2 health examinations in1998 to 2009. All participants were normotensive at baseline and were divided into 4 groups based on body mass index using the Asia-Pacific descriptors for obesity and metabolic health status and the National Cholesterol Education Program's adult treatment panel III (ATP-III) criteria. A metabolically healthy obese (MHO) phenotype was defined as a body mass index of ≥25 kg/m² with <2 metabolic abnormalities. CRF was directly measured by peak oxygen uptake, and the participants were divided into unfit and fit categories based on age-specific peak oxygen uptake percentiles. Compared with the metabolically healthy nonobese phenotype, MHO and metabolically unhealthy nonobese (MUNO) phenotypes were at increased risk of SH (relative risk [RR] = 1.47; 95% confidence interval [CI], 1.07 to 2.02 and 1.62, 1.21 to 2.16) after adjusting for potential confounders. Joint analysis showed that MHO or MUNO unfit men had 1.91 and 2.27 greater risk of incident SH, respectively. However, MHO fit men had no significant RR of incident SH (RR 1.37; 95% CI, 0.93 to 2.03), whereas MUNO fit men remained at increased risk (RR 1.48; 95% CI, 1.04 to 2.11) compared with their metabolically healthy nonobese fit counterparts. In conclusion, MHO and MUNO men were at increased risk of SH, but these risks were attenuated by fitness.

Sympathetic neural activity, metabolic parameters and cardiorespiratory fitness in obese youths

OBJECTIVE

The main objective of this cross-sectional study is to assess the cardiac autonomic neural activity in the presence of abnormally increased body weight in youths and its relationship to metabolic risk factors and cardiorespiratory fitness (CRF).

METHODS

Sixty-four overweight and obese patients, aged 9-17 years, of both sexes, stratified according to the international BMI cut-off, were enrolled. Continuous ECG was recorded during 15 min in resting conditions, and the heart rate variability (HRV) was measured in the time domain, frequency domain and for nonlinear dynamics. In addition, cardiometabolic risk factors and CRF in effort conditions were assessed.

RESULTS

Among the overweight and obese youths, no significant differences were observed regarding metabolic parameters and heart rate, although CRF was the lowest in the severely obese youths. Likewise, no significant differences were observed in HRV, independent of how it was assessed. A positive and significant relationship, independent of the degree of obesity, pubertal stage and breathing rate under resting conditions, has been observed among sympathovagal balance, insulin and the homeostatic model assessment index. Furthermore, CRF assessed by volume oxygen peak was associated with insulin levels (r = -0.273; P < 0.05), the SD of the NN interval series (r = 0.268, P < 0.05) and the long-term variation using the Poincaré plot (PS1: r = 0.275, P < 0.05; PS2: r = 0.273, P < 0.05).

CONCLUSION

The key findings of the present study were the presence of a link among fasting insulin, HRV and CRF independent of the degree of obesity, indicating the heterogeneity of obese children and adolescents.

Pathophysiology and Potential Non-Pharmacologic Treatments of Obesity or Kidney Disease Associated Refractory Hypertension

PURPOSE OF REVIEW

The review assesses the role of non-pharmacologic therapy for obesity and chronic kidney disease (CKD) associated refractory hypertension (rf HTN).

RECENT FINDINGS

Hypertensive patients with markedly heightened sympathetic nervous system (SNS) activity are prone to develop refractory hypertension (rfHTN). Patients with obesity and chronic kidney disease (CKD)-associated HTN have particularly heightened SNS activity and are at high risk of rfHTN. The role of bariatric surgery is increasingly recognized in treatment of obesity. Current evidence advocates for a greater role of bariatric surgery in the management of obesity-associated HTN. In contrast, renal denervation does not appear have a role in the management of obesity or CKD-associated HTN. The role of baroreflex activation as adjunctive anti-hypertensive therapy remains to be defined.

Agreement between specific measures of adiposity and associations with high blood pressure in black South African women

OBJECTIVES

To derive percentage body fat (%BF) cut-points according to body mass index (BMI) categories for adult black South African women and to investigate the agreement between adiposity classifications according to WHO BMI and %BF cut-points. The secondary aim was to determine the association between these different adiposity measures and high blood pressure.

METHODS

Black women aged 29-65 years (n = 435) from Ikageng, South Africa, were included in this cross-sectional study. Socio-demographic and anthropometric data were collected (weight, height and BMI). %BF using dual-energy X-ray absorptiometry and blood pressure were measured.

RESULTS

There was significant agreement between three %BF categories: low/normal (<35.8% age 29-49 years; or <38% age 50-65 years), overweight range (35.8-40.7% age 29-49 years; or 38-42.1% age 50-65 years) and obese (≥40.7% age 29-49 years; or ≥42.1% age 50-65 years) and three BMI categories: low/normal (<25 kg/m² ), overweight range (25-29.9 kg/m² ) and obese (≥30kg/m² ); (κ = 0.62, P < .0001). Despite statistically significant agreement between groups, more than half of overweight individuals were misclassified as having either a normal (30.2%) or obese %BF (25.5%). %BF misclassification was low in the low/normal and obese BMI ranges. After adjustment for confounders, obesity (BMI ≥ 30kg/m² ), as well as high %BF were significantly associated with high blood pressure (OR = 1.75, 95% CI 1.09-2.81 versus OR = 1.92, 95% CI 1.15-3.23, respectively).

CONCLUSION

Despite significant agreement between BMI and %BF categories, considerable misclassification occurred in the overweight range. Participants with excessive %BF had a greater odds of high blood pressure than those in the highest BMI category.

Dietary capsaicin and its anti-obesity potency: from mechanism to clinical implications

Obesity is a growing public health problem, which has now been considered as a pandemic non-communicable disease. However, the efficacy of several approaches for weight loss is limited and variable. Thus, alternative anti-obesity treatments are urgently warranted, which should be effective, safe, and widely available. Active compounds isolated from herbs are similar with the practice of Traditional Chinese Medicine, which has a holistic approach that can target to several organs and tissues in the whole body. Capsaicin, a major active compound from chili peppers, has been clearly demonstrated for its numerous beneficial roles in health. In this review, we will focus on the less highlighted aspect, in particular how dietary chili peppers and capsaicin consumption reduce body weight and its potential mechanisms of its anti-obesity effects. With the widespread pandemic of overweight and obesity, the development of more strategies for the treatment of obesity is urgent. Therefore, a better understanding of the role and mechanism of dietary capsaicin consumption and metabolic health can provide critical implications for the early prevention and treatment of obesity.

Red meat and chicken consumption and its association with high blood pressure and obesity in South Korean children and adolescents: a cross-sectional analysis of KSHES, 2011-2015

Background

The impact of meat consumption on high blood pressure (HBP) and obesity in children and adolescents is a subject of debate. The aim of this study was thus to evaluate the association between meat consumption and both HBP and obesity in this group.

Methods

We performed a cross-sectional analysis using nationally representative samples of children and adolescents aged 9, 12, and 15 years old (n = 136,739) who were included in the Korea School Health Examination Survey (KSHES) for the 2011–2015 period. Multiple linear and logistic regression analysis was used to determine the factors influencing systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index (BMI, kg/m²) levels, and to test the strength of these relationships.

Results

Adjusted for covariates, 6.3% of those subjects who consumed >5 servings of meat (including beef, pork, and chicken) per week were obese, compared with 9.1% of the subjects who consumed <1 serving of meat/wk (obesity adjusted odds ratio [OR]: 1.44; 95% confidence interval [CI]: 1.21–1.70; P ≤0.001). Those who consumed <1 serving of meat/wk had an HBP prevalence of 8.2%, compared with 7.2% for subjects who consumed >5 servings of meat/wk (systolic HBP adjusted OR: 1.30; 95% CI: 1.05–1.62; P ≤0.01, diastolic HBP adjusted OR: 1.25; 95% CI: 1.02–1.54; P <0.05). Obese subjects were estimated to have a higher SBP (β = 7.497, P < 0.001) and DBP (β = 4.123, P <0.001) than subjects who had no excess weight. Compared to subjects who consumed >5 servings of meat/wk, those who consumed <3 servings of meat/wk had a higher SBP (β = 0.574, P <0.001) and DBP (β = 0.376, P = 0.003) after adjusting for BMI. The intake of milk, fruit, and vegetables was not associated with either SBP or DBP (P >0.05). In contrast, BMI was significantly associated with milk, fruits, and vegetables (P <0.01).

Conclusions

Among children and adolescents, a higher level of meat consumption was associated with lower SBP, DBP, and BMI, and greater height, suggesting that consuming an appropriate amount of meat is important for healthy growth at a young age.

The obesity paradox: is it really a paradox? Hypertension

This article is a narrative overview of the role of hypertension on the relationships between obesity, morbidity, and mortality. We used as sources MEDLINE/PubMed, CINAHL, EMBASE, and Cochrane Library, from inception to March 2016. Key words include overweight, obesity, visceral obesity, obesity paradox, and hypertension. In addition, we hand-searched references from the retrieved articles. This work is one of the works of the topical collection "Obesity Paradox". The positive association between overweight, obesity, and cardiovascular diseases is well established, though this relation is typically U shaped with an increased risk in low-weight subjects or even a beneficial effect of overweight and obesity, the so-called "obesity paradox". In addition, the relationship between obesity and arterial hypertension has been demonstrated in both children and adults by many epidemiological studies. Moreover, weight reduction is followed by a decrease in blood pressure in many patients and ameliorates the cardiovascular risk profile. Recent studies using more appropriate obesity indices raise some doubt about the real significance of obesity paradox and there are several studies that central obesity shows either no protective or even a worse effect. These observations raise the question: what kind of obesity is protective and what kind of obesity is harmful? The studies of obesity paradox suffer from several methodological limitations: most of these are retrospective analyses or were not specifically designed to study obesity paradox as a primary goal; a few studies have data on preceding unintentional weight loss and on some particular confounding variables. In conclusion, more prospective and accurate studies are necessary to better elucidate the clinical importance of obesity paradox. When weight loss is functional to reduce hypertension and cardiovascular risk, it should be encouraged, while an unintentional weight in a patient with chronic diseases may indicate an unfavorable course.

Combination therapy with lercanidipine and enalapril in the management of the hypertensive patient: an update of the evidence

Hypertension is an important risk factor for premature death as it increases the probability of stroke, myocardial infarction, and heart failure. Antihypertensive drugs can decrease cardiovascular (CV) morbidity and mortality. The majority of hypertensive patients need more than one antihypertensive agent to attain blood pressure (BP) targets. Monotherapy can effectively reduce BP only in 20%–40% of patients. Multiple mechanisms including increased peripheral vascular resistance, increased cardiac work, and hypervolemia are involved in the pathogenesis of hypertension. Targeting multiple pathways may more potently reduce BP. Increasing the dose of a single agent in many cases does not provide the expected BP-lowering effect because the underlying mechanism of the BP increase is either different or already corrected with the lower dose. Moreover, drugs acting on different pathways may have synergistic effects and thus better control hypertension. It is well known that diuretics enhance the actions of renin–angiotensin aldosterone system and activate it as a feedback to the reduced circulated blood volume. The addition of a renin–angiotensin aldosterone system blocker to a diuretic may more effectively reduce BP because the system is upregulated. Reducing the maximal dose of an agent may also reduce possible side effects if they are dose dependent. The increased prevalence of peripheral edema with higher doses of calcium channel blockers (CCBs) is reduced when renin–angiotensin aldosterone system blockers are added to CCBs through vein dilation. The effectiveness of the combination of enalapril with lercanidipine in reducing BP, the safety profile, and the use of the combination of angiotensin-converting enzyme inhibitors with CCBs in clinical trials with excellent CV hard end point outcomes make this combination a promising therapy in the treatment of hypertension.

Feeling the pressure: (patho) physiological mechanisms of weight gain and weight loss in humans

Obesity is an ongoing global epidemic and has adverse consequences for cardiovascular health. Obesity is often associated with hypertension, which is, itself, a common condition and an important cause of morbidity and mortality worldwide. Although animal models of obesity have provided extensive data on the links between obesity and hypertension, a greater understanding of the pathways linking obesity and hypertension in humans is likely to assist translation of animal data, and may, itself, identify important treatment strategies. Ultimately, this could have a substantial impact on human health, both at an individual and population level. The current review will focus specifically on studies of experimental weight gain and weight loss in humans and the following key areas, which are strongly related to blood pressure: cardiovascular function, autonomic nervous system function, metabolic function and the impact of cardiorespiratory fitness.

Mechanisms underlying elevated SBP differ with adiposity in young adults: the Enigma study

Objectives:

The positive association between adiposity and hypertension is well recognized. However, not all overweight individuals have elevated blood pressure (BP). Moreover, different factors may be associated with high BP in normal-weight versus overweight individuals. The aim of the current study was to examine the influence of adiposity on the relationship between SBP and underlying haemodynamic mechanisms in young adults.

Method:

Data from 2502 patients were available from the Enigma study. Detailed demographic, biochemical, and haemodynamic data were obtained in all individuals. Data were analysed between lower and upper tertiles of BMI and SBP, separately for each sex.

Results:

In normal-weight individuals, cardiac output (CO) was elevated in those with higher SBP, independently of body size. Moreover, higher CO was associated with an increased stroke volume in men (P < 0.001), but an increased heart rate in women (P = 0.002). In contrast, in overweight individuals, peripheral vascular resistance (PVR) was elevated in men with higher SBP (P = 0.02) and those with lower SBP had the lowest PVR of all groups. In linear regression analyses, there was a stronger association between SBP and CO in normal-weight individuals, but a stronger association between SBP and PVR in overweight individuals.

Conclusion:

Different haemodynamic mechanisms are associated with elevated SBP in young adults, depending on body size and sex. These data suggest the need for differential approaches to the identification and management of young adults with elevated BP.

Impact of Gut Microbiota on Obesity, Diabetes, and Cardiovascular Disease Risk

Gut microbiota has been recently established to have a contributory role in the development of cardiometabolic disorders, such as atherosclerosis, obesity, and type 2 diabetes. Growing interest has focused on the modulation of gut microbiota as a therapeutic strategy in cardiovascular diseases and metabolic disorders. In this paper, we have reviewed the impact of gut microbiota on metabolic disorders and cardiovascular disease risk, focusing on the newest findings in this field.