Abstract

There is an obesity/type-2 diabetes (DM2)/hypertension epidemic in developed countries around the world. The purpose of this review is to examine the interrelationships between obesity, DM2 and hypertension in young/middleaged subjects, highlighting the importance of raised sympathetic nerve activity and treatment implications. Central obesity is associated with insulin-resistance, and high plasma insulin and leptin levels. Insulin and leptin act upon the mid-brain, resulting in increased sympathetic nerve activity and blood pressure. Chronically raised sympathetic nerve activity, independent of blood pressure, is a powerful predictor of myocardial infarction in the middle-aged. Weight-loss, via life-style change or bariatric surgery, results in blood pressure reduction. Anti-hypertensive agents that increase sympathetic nerve activity, e.g. diuretics, dihydropyridine calcium antagonists, and angiotensin receptor blockers (ARBs), do not reduce (and may increase) the risk of myocardial infarction in younger/middleaged subjects with hypertension and DM2. Beta-1 blockade, which is effective in regressing and stabilising coronary atheromataous plaque, is preferable to ACE-inhibition, and is the first-line treatment of choice.

Highlights

  • Since 1980 there has been a marked global increase in body mass index (BMI) [1]

  • The nine countries of Oceania have the highest BMI in the world, being 35.0 kg/m2 for women, and 33.9 kg/m2 for men [1]: the lowest BMIs occur in Bangladesh and in sub-Saharan Africa [1]

  • The highest BMIs within developed countries are in the USA, where 66% of adults are overweight / obese

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Summary

Introduction

Since 1980 there has been a marked global increase in body mass index (BMI) [1]. The nine countries of Oceania have the highest BMI in the world, being (on average) 35.0 kg/m2 for women, and 33.9 kg/m2 for men [1]: the lowest BMIs occur in Bangladesh and in sub-Saharan Africa [1].The highest BMIs within developed countries are in the USA, where 66% of adults are overweight / obese Diabetes, Hypertension and High Sympathetic Nerve Activity and Heart Rates Central obesity is linked to hypertension in the young/ middle-aged, and to a high resting heart rate and cardiac output [22].

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