The Obese Hypertensive

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It has long been accepted that the cardiovascular risk burden of hypertension is attributable to more than blood pressure itself. Many patients with hypertension have a constellation of risk factors that add to their risk, notably features of the metabolic syndrome. The link between obesity and the metabolic syndrome is well recognized.1 However, obesity also is associated with an increased prevalence of hypertension.2 Although body mass index often is used to define obesity, visceral adiposity is more important in defining the relationship between blood pressure and obesity. Studies using magnetic resonance imaging to accurately quantify the distribution of body fat have shown that in untreated hypertensive men, fat preferentially accumulates intra-abdominally and intrathoracically and that the magnitude of visceral adiposity is quantitatively related to the elevation in blood pressure.3 It is important to note that this link between adiposity and blood pressure is observable from early childhood and is a key predictor of the likelihood of developing overt hypertension.4 Visceral fat accumulation in people with hypertension also underpins the link between hypertension and the metabolic syndrome and ultimately the increased risk of people with hypertension developing diabetes mellitus. Consequently, lifestyle interventions, including weight loss, are an important means of reducing blood pressure, the associated metabolic disturbances, and the risk of progression to diabetes.1,5 Article p 1991 The preferred strategy to reduce body weight toward the ideal in people with hypertension is lifestyle modification. However, not uncommonly, this approach fails to achieve …