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How does obesity contribute to hypertension?
The association between obesity and hypertension has been known since the days of the Framingham Heart Study. However, a causative role was unclear considering the long-standing view that adipose tissue was a hormonally and metabolically inert substance. More recent evidence suggests a direct role of visceral obesity in the development and maintenance of hypertension—a process driven by elevations in leptin and aldosterone. Leptin is synthesized and secreted by adipocytes and upregulates sympathetic activity. Visceral fat also produces angiotensin, which serves as a substrate in the renin angiotensin aldosterone system, and ultimately leads to higher circulating aldosterone levels. Elevations in aldosterone levels and enhanced sympathetic activity ultimately promote urinary sodium retention, and, thus, hypertension. Finally, obesity suppresses adiponectin, a natriuretic hormone.
In addition to obesity, there are a number of lifestyle issues discussed in this chapter that can directly reduce BP if done consistently.
Lifestyle Issues that Can Directly Reduce Blood Pressure
Approximate Impact on SBP | ||||
---|---|---|---|---|
NON-PHARMACOLOGIC INTERVENTION | DOSE | HYPERTENSION | NORMOTENSION | |
Physical activity | Aerobic | • 90–150 min/week• 65%–75% heart rate reserve | -5/8 mm Hg | -2/4 mm Hg |
Dynamic Resistance | • 90–150 min/week• 50%–80% 1 rep maximum• 6 exercises, 3 sets/exercise, 10 repetitions/set | -4 mm Hg | -2 mm Hg | |
Isometric Resistance | • 4 × 2 minutes (hand grip), 1 minute rest between exercises, 30%–40% maximum voluntary contraction, 3 sessions/week• 8–10 weeks | -5 mm Hg | -4 mm Hg | |
Healthy diet | DASH dietary pattern | Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated and total fat | -11 mm Hg | -3 mm Hg |
Weight loss | Weight/body fat | Ideal body weight is the best goal, but at least 1 kg reduction in body weight for most adults who are overweight | -5 mm Hg | -2/3 mm Hg |
Reduced intake of dietary sodium | Dietary sodium | <1500 mg/day is the optimal goal but at least 1000 mg/day reduction in most adults | -5/6 mm Hg | -2/3 mm Hg |
Enhanced intake of dietary potassium | Dietary potassium | 3500–5000 mg/day, preferably by consumption of a diet rich in potassium | -4/5 mm Hg | -2 mm Hg |
Moderation in alcohol intake | Alcohol consumption | In individuals who drink alcohol, reduce alcohol to:• Men: ≤2 drinks daily• Women: <1 drink daily | -4 mm Hg | -3 mm Hg |
DASH, Dietary Approaches to Stop Hypertension; SBP, systolic blood pressure.