Obese Hypertensive Patients Research Articles

The Association Between Obesity and Visit-to-Visit Variability in Systolic Blood Pressure: A Prospective Study

Abstract With the prevalence of obesity and all accompanying health risks, both prevention and health education, as well as identifying predictors for the development of obesity-related diseases are primary. The pathophysiological relationship between obesity and visit-to-visit variability in systolic blood pressure (SBPV) has not been completely resolved. To investigate the association between obesity and SBPV in hypertensive patients. The prospective study comprised three visits was performed at the hypertension outpatient clinic during the follow up period of 22-months between March 2014 and January 2016. This study included 300 randomly selected hypertensive patients (average 67.76±9.84 years), who were divided in groups of obese/non-obese examinees. SBPV was defined as the standard deviation (SD) from three values of SBP. The values of SBP and SBP-SD were significantly higher in the group of obese hypertensive patients than in the group of non-obese patients (127.06±8.30 vs. 120.37±7.75; 11.29±5.67 vs. 7.37±3.94 mmHg; p<0.01). The highest SBPV was recorded in the 4th quartile in obese patients (43.13±7.50 mmHg). SBPV was strongly correlated with BMI and Waist cirumferences (WC) (ρo=0.425, ρo=0.356, p<0.01). During 22-months follow up there was a significant decrease of SBPV for 8.2 mmHg, BP for 31/5 mmHg, BMI for 3.8 kg/m2, WC for 10 cm and body weight for 8.24 kg. During 22-months follow-up, reduction of body weight was associated with reduction of blood pressure variability in hypertensive patients. Persistently decrease both body weight and long term visit-to-visit variability may explain lower cardiovascular risk in obese-related disease.

Obesity-related hypertension: a review of pathophysiology, management, and the role of metabolic surgery

Obesity is a significant public health challenge worldwide and is inextricably linked to adverse cardiovascular outcomes. The relationship between excess adiposity and increased blood pressure is well established, and it is estimated that obesity accounts for 65-78% of cases of primary hypertension. The mechanisms through which obesity causes hypertension are complex and include sympathetic nervous system overactivation, stimulation of the renin-angiotensin-aldosterone system, alterations in adipose-derived cytokines, insulin resistance, and structural and functional renal changes. Weight loss is the primary goal of treatment for obesity-related hypertension, although few individuals achieve success with nonpharmacological management alone. Specific considerations apply when selecting the most appropriate pharmacological therapy for obese hypertensive patients. Metabolic surgery has proved to be the most effective means of ensuring substantial and sustained weight loss and has also been shown to confer beneficial effects in type 2 diabetes mellitus. Increasing evidence suggests that metabolic surgery may also be an effective treatment for obesity-related hypertension, although prospective data on long-term blood pressure outcomes are awaited. This review will discuss the pathophysiological mechanisms that link obesity with hypertension and will provide an overview of treatment strategies, with a focus on metabolic surgery.

Evaluation of Lipid Profile in Obese and Non-Obese Hypertensive Adult Patients Attended in Medicine Department of a Medical College Hospital of Bangladesh

Background: By the dawn of this modern era of science, the prime challenge of physician is cardiovascular disease (CVD). The most important modifiable risk factors of CVDs are unhealthy diet, physical inactivity and tobacco use. The effects of unhealthy diet and physical inactivity include abnormal blood lipid, obesity and hypertension. We tried to evaluate and correlate the pattern of lipid profile in obese and non-obese hypertensive patients. Objectives: This study was conducted at medicine department of Cumilla Medical College Hospital. The principal aim was to evaluate the lipid profile in obese and non-obese adult hypertensive patients. Methodology: During this cross sectional analytical study, a total of 100 adult hypertensive patients were taken by purposive sampling. Among them 50 (group 1) patients were taken those were obese and 50 (group 2) patients taken those were non-obese according to BMI measurement on operational definition. Diagnosis of hypertension would be established with the help of ambulatory BP measurements two occasions few minutes apart. The staging of hypertension was done according to JNC7 Criteria. Morning blood samples were taken after 8 - 12 hours of fasting and lipid profiles were done on authentic laboratories. The laboratory values were interpreted according to the operational definition of dyslipidaemia. The ethical research and review committee approved the study protocol and signed informed consent was obtained from the participants. The statistics was analyzed using the IBM SPSS software of version 19.0. Statistical significance was set at p Results: Among the two groups, there were 56 (56%) males and 44 (44%) females. The mean age of group 1 (46.10 ± 11.09) was compared to that of group 2 (45.5 ± 10.6). Lipid profile abnormalities were significantly higher in the stage 2 hypertension (59.62%) and stage 3 hypertension (66.66%), higher in class 2 obese (100%) and class 3 obese subjects (100%), female hypertensive patients had significantly higher BMI than their male counterparts (27.24 ± 3.63 kg/m2 versus 29.29 ± 3.99 kg/m2), lipid profiles were higher in the female than male hypertensive patients (63.33% vs 55.35%) but only TC was statistically significant (4.45 ± 1.19 mmol/l versus 4.86 ± 1.29 mmol/l, p (76%) of the obese hypertensive patients had dyslipidaemia whereas 21 (42%) of non-obese hypertensive patients had dyslipidaemia. In multivariate regression, TG was significantly and directly associated with BMI of subjects. Dyslipidaemia was more prevalent in the age group 30 - 59 of adult hypertensive patients. It showed that obese hypertensive patients had significantly higher SBP (p (p mmol/l versus 4.15 ± 0.57 mmol/l, t = -9.70, p mmol/l versus 2.10 ± 0.45 mmol/l, t = -5.37, p mmol/l versus 2.44 ± 0.53 mmol/l, t = -9.11, p mmol/l versus 1.24 ± 0.57 mmol/l, t = -0.25, p = 0.08)...

Prevalence and determinants of Masked Hypertension among obese individuals at the Yaoundé Central Hospital: A cross-sectional study in sub-Saharan Africa

Several studies on the prognosis of masked hypertension suggest that it portends risks for cardiovascular morbidity and mortality that are comparable to the risks of sustained hypertension. obese individuals could have an increased risk of developing masked hypertension, data on the topic are scarce in our context. The aim of this study was to investigate the prevalence and associated factors of masked hypertension in obese patients in Yaoundé. We carried out a cross-sectional study from January to September 2017 at the National Obesity Center of the Yaoundé Central Hospital. Masked hypertension was defined when the mean 24-hour Systolic Blood Pressure was greater than or equal to 130 mmHg and/or the mean 24 hour Diastolic Blood Pressure was greater than or equal to 80 mmHg with normal office blood pressure. Logistic regression was used to examine the relationship of masked hypertension with associated factors. Among the 90 participants included, 67.8% were females. Mean age (± SD) was 46 (± 8) years. The mean clinical measurements were 120 ± 9.4 mm Hg and 75.5 ± 7.9 mm Hg respectively for the systolic and the diastolic blood pressure. On 24-hour Ambulatory measurement, the mean was 123.9 ± 14.4/74.7 ± 8.9 mm Hg respectively for the systolic/diastolic blood pressure. The prevalence of masked hypertension was 33.3%. Masked hypertension was significantly associated with high-normal office blood pressure [odds ratio (OR) =2.90, P = 0.02] and to dyslipidemia [OR = 3.60, P = 0.01], but not to male sex, diabetes, physical activity, tobacco/alcohol. Our findings suggest that the prevalence of masked hypertension is high and that physicians should consider ambulatory blood pressure monitoring for obese individuals with high-normal office blood pressure and/or dyslipidemia.

Telmisartan combined with moxonidine in the treatment of arterial hypertension in obese patients

<h3></h3> У 60% пациентов с артериальной гипертензией (АГ) отмечается избыточная масса тела или ожирение, что обуславливает увеличение риска развития сердечно-сосудистых осложнений. Согласно современным рекомендациям, данной категории пациентов постулируется необходимость назначения комбинации двух антигипертензивных препаратов в качестве стартовой терапии. В статье приведен клинический пример использования комбинации телмисартана с моксонидином в реальной клинической практике у пациента с АГ, ожирением, дислипидемией и нарушением гликемии натощак. С помощью суточного мониторирования артериального давления показана высокая антигипертензивная эффективность данной комбинации. Представлены литературные данные о благоприятном влиянии телмисартана на риск возникновения сердечно-сосудистых осложнений. Телмисартан, в отличие от других блокаторов рецепторов ангиотензина II, активирует PPAR-γ рецепторы, что улучшает углеводный и липидный обмен. Моксонидин, в свою очередь, повышает чувствительность тканей к инсулину у пациентов с избыточной массой тела, инсулинорезистентностью и нарушением углеводного обмена. Назначение моксонидина в комбинации с телмисартаном представляется одной из возможных стратегий антигипертензивной терапии при лечении пациентов с АГ и ожирением.

Prevalence of obesity among hypertensive patients in Primary Care Clinic, Security Forces Hospital, Riyadh, Saudi Arabia 2017-2018: A prospective cross-sectional study.

Background:Saudi Arabians suffer from overweight and obesity which contribute significantly to the poor control of hypertension (HTN).Aim:To compare the percentage of HTN between obese and nonobese hypertensive patients who visit Primary Care Center in Security Forces Hospital (SFH), Riyadh, Saudi Arabia between (December-February) 2017–2018 and to calculate and compare the percentage of a number of antihypertensive medication usage in groups with different body mass index (BMI).Methods:This study was a prospective cross-sectional study which included all hypertensive patients on medication or patients with (BP >140/90) who attended the Primary Care Center in Security Forces Hospital (SFH), Riyadh, Saudi Arabia between (December-February) 2017–2018. Data were extracted from the computerized medical records database at the hospital. According to the practice followed at the hospital, the diagnosis of obesity was achieved based on a calculation of body mass ≥30.Results:About 56.1% of participants were females and 43.9% were males, the most prevalent age group of obese students (55.2%) was above 55 years. We also found that 2.1% of students were normal in weight whereas 1.3% of patients were underweight. A significant correlation with weight (89.02 ± 19.765) and BMI (34.742 ± 6.3818) was also noted (P value <0.001).Conclusion:This study revealed that most of the HTN patients in the SFH, Riyadh, Saudi Arabia, suffer from overweight and obesity that could contribute significantly to the incidence of HTN.

Dominant Factors of Central Obesity in Hypertensive Patients

Background: Central obesity, which has increased in hypertensive patients over the past ten years, is a risk factor for long term complications such as type 2 diabetes, cancer and cardiovascular diseases. These diseases have health consequences ranging from increasing risk of early death to severe chronic conditions reducing the quality of life. When a person becomes overweight or obese at a young age, the incidence and severity of long-term complications due to obesity also increases significantly. Objectives: This cross-sectional research study identifies the difference between sleep quality and other factors of central obesity in hypertensive patients. The study sample included hypertensive patients studied at the Puskesmas Tegal Gundil. Material and Method: We recruited 92 hypertensive patients from Puskesmas Tegal Gundil, North Bogor District.Data were collected in 2017. The Global Physical Activity Questionnaire was used to assess physical and sedentary activity. Sleep quality and duration were assessed using Pittsburgh Sleep Quality Index. Energy, carbohydrate, protein, fat and dietary fiber intake are analyzed with the semi-quantitative food frequency questionnaire and Nutrisurvey software. Result: The frequency of central obesity in our sample was 82.6%, and there were significant relationships between central obesity and sleep quality, energy and carbohydrate intake. Conclusion: A dietary approach to stop hypertension for Indonesians (DASHI) should be socialized for hypertensive patients.

The Formation of Resistance to Antihypertensive Therapy in Patients with Hypertensive Disease with Obesity

The objective: of the study was to study factors that influence the formation of the general resistance in hypertensive patients with obesity.Materials and methods. 200 patients with hypertension and obesity from 45 to 55 years old were examined, who provided informed written consent to participate in the study and met the inclusion criteria.Results. The data of the logistic regression method showed that the formation of the general resistance of hypertensive obese patients was influenced by such quantitative indicators as adiponectin (p=0,0113), DBP (p=0,0488), MDA (p=0,0027), TIM CCA (p=0,0091) and blood insulin (p=0,0152). Moreover, qualitative indicators, such as the genetic polymorphism IRS-1 and ADIPOQ (p=0,0000 and p=0,0030, respectively) also influenced the formation of resistance. The greatest degree of influence is characteristic of TIM OCA and genetic polymorphism IRS-1 and ADIPOQ, which was confirmed by the highest values of the regression coefficients. The model of general resistance after treatment included a part of indicators that had an effect on the pre-treatment stage (adiponectin, DBP, MDA and ADIPOQ genetic polymorphism), and new indicators (pulse blood pressure, triglycerides and physical activity). Moreover, indicators such as reduced physical activity, ADIPOQ genetic polymorphism and high triglycerides had the greatest influence on the formation of this model, which was confirmed by the highest values of regression coefficients. ROC analysis confirms the prognostic value of the created model of general resistance in obese hypertensive patients.Conclusion. А model of general resistance was created with the identification of factors that have the greatest influence on the formation of resistance to antihypertensive therapy in patients with comorbidity of hypertension and obesity.

Serum chymase levels in obese individuals: the relationship with inflammation and hypertension

Abstract Background Inflammation related hypertension is reported in obesity due to synthesis of angiotensin-II (Ang-II) and proinflammatory compounds in obese adipose tissue. Mast cell chymase (MC) also stimulate Ang-II synthesis, and activate transforming growth factor beta-1 (TGF-β1) and matrix metalloproteinase-9 (MMP-9). The aim of our study is to evaluate the relation of serum chymase levels, a serine protease enzyme secreted from mast cells, in obese patients with hypertension and cytokines that lead to cell damage. Materials and methods Three study groups are composed of individuals aged between 19 and 63 with following characteristics; (1) control (n = 30): healthy subjects with body mass index (BMI) &lt;25; (2) obese (n = 30): patients with BMI &gt;30; (3) obese + HT (n = 20): patients BMI &gt;30 and hypertension. Serum Ang-II, MC, TGF-β1 and MMP-9 are determined by commercial ELISA. Angiotensin converting enzyme (ACE) activity is determined with enzymatic colorimetric assay. Results Serum chymase levels did not vary between groups. Chymase levels showed significant negative correlation with ACE activity (r = −0.278, p = 0.013) and positive correlation with Ang-II levels (r = 0.251, p = 0.024). No correlation was evident between chymase levels and hsCRP, TGF-β1 and MMP-9. Conclusion Serum chymase, Ang-II, TGF-β1 and MMP-9 levels did not change in obese and hypertensive-obese patients despite evident hyperinsulinemia, increased insulin resistance and elevated hsCRP levels.

Intra-abdominal hypertension in obese patients undergoing coronary surgery: A prospective observational study

BackgroundCoronary artery bypass grafting surgery has an increased risk of adverse events in obese patients. This increased risk might be explained in part by an increased intra-abdominal pressure and the development of intra-abdominal hypertension. Therefore, the objective of this study was to investigate the correlation between obesity and intra-abdominal hypertension and to evaluate its possible impact after coronary artery bypass grafting. MethodsA total of 50 consecutive patients scheduled to undergo coronary artery bypass grafting at a single center were selected prospectively before undergoing elective coronary artery bypass grafting. Based on the body mass index, 25 obese (body mass index ≥ 30) patients were matched with 25 control patients. Each patient had intra-abdominal pressure taken at baseline followed by one measurment every 4 hours until 24 hours after coronary artery bypass grafting. The serum markers for liver and kidney functions were collected once a day for 7 days after coronary artery bypass grafting. ResultsObese patients had a greater (mean ± SD) peak intra-abdominal pressure (15.4 ± 1.6 mm Hg versus 10.6 ± 1.6 mm Hg; P = .011) and mean change of intra-abdominal pressure from baseline (5.1 ± 3.3 mm Hg versus 2.2 ± 2.4 mm Hg; P = .001). The mean abdominal perfusion pressure was less in the obese group (63.0 ± 8.0 mm Hg versus 70.1 ± 11 mm Hg; P = .017). The liver dysfunction, as determined by the Schindl liver function scoring system between the obese and control groups, was not statistically significant (28% vs 8%; P = .066). More patients in the obese group developed renal injury based on the calculated glomerular filtration rate (32% vs 8%; P = .034). Obesity was highly associated with developing intra-abdominal hypertension (odds ratio: 2.99; 95% confidence interval: 1.92–3.53; P < .001). ConclusionObesity is associated with the development of intra-abdominal hypertension after coronary artery bypass grafting. This effect might indirectly impair the renal and liver functions through a decrease in the abdominal perfusion pressure.

Impact of polycystic ovarian syndrome (pcos) associated with hypertension on some metabolic markers

The polycystic ovary syndrome (PCOS) is multifactorial, consisting in hyper androgenic, ovulatory disorders and polycystic appearance of the ovaries. PCOS is a metabolic disorder associated with an increased risk of insulin resistance, hyper insulin blood level, central obesity, high blood pressure, type 2 diabetes, dyslipidemia and cardiovascular disease. The variability of its expression and the difficulty of precise definition hinders the visibility of this disease. Several studies have reported hypertension in obese patients with PCOS. The aim of this work was to study the impact of the combination of hypertension and PCOS on the metabolic disturbances (hepatic, lipid and renal). We recruited 26 hypertensive patients with PCOS in the Tlemcen University Hospital and 30 healthy control women. After obtaining informed consent, the patients benefited from a biochemical assessment of the liver function (transaminases TGO, TGP), the renal function (uric acid, creatinine, urea), and the lipid profile (total cholesterol, LDL, triglycerides). We observed abnormalities of hepatic metabolism, evidenced by elevated levels of transaminases (TGO, TGP), kidney damage by increased creatinine and urea levels, with altered lipid profile in hypertensive women with PCOS compared to control women. In conclusion, PCOS associated with hypertension is associated with numerous metabolic dysfunctions (dyslipidemia, kidney and hepatic impairment). Thus, early dietary and medical management of PCOS is needed to reduce associated metabolic complications.

PROTOCOL OF THE HYPERTENSION THERAPY WITH IRBESARTAN VERSUS EPLERENONE FOR OBESE HYPERTENSIVE PATIENTS (HEBRO)

Objective: Hypertension and obesity often coexist and activation of the renin-angiotensin- aldosterone (RAS) axis plays a major pathophysiological role. Since obese hypertensive patients are less frequently controlled within-goal compared with hypertensives without obesity, we aimed to determine whether RAS blocking at the level of aldosterone (eplerenone) is accompanied by better blood pressure (BP) efficacy compared with the traditional blocking at an intermediate axis level (irbesartan). Design and method: A multicentre Hellenic-ESH Excellence centres setting was chosen and a parallel open-label, randomized-controlled, phase IV trial was projected to demonstrate two-sided superiority between comparator-drugs over a period 24-weeks. We include obese (body mass index from 30 to less than 40, aged 30–75 years), newly diagnosed or drug-naive patients with mild to moderate hypertension, confirmed by ambulatory BP monitoring (ABPM). Randomization (1:1) to either eplerenone or irbesartan will be pursued taking into account age, gender, baseline office systolic BP levels and renal function. At eight, sixteen and twenty-four weeks, ABPM will demonstrate BP control, and a stepped-care approach with the addition of amlodipine and indapamide will be followed in those uncontrolled during the two intermediate trial time frames. Renal function, electrolyte disorders, fatal and non-fatal cardiovascular events and adverse events will be also evaluated. A sample size of 336 patients (allowing 15% dropouts) will confer 80% power to detect a 4 mmHg ABPM averaged systolic BP difference. The primary endpoint is the 24-h systolic BP difference at 24 weeks. Secondary endpoints: 1) the change in office BP at 24 weeks;2) the intermediate change in 24-h systolic BP;3) the change in left ventricular mass and microalbuminuria at 24 weeks; 4) discontinuations from treatment because of adverse events. Trial registration: Clinicaltrials.gov NCT03476616;EudraCT: 2018-004809-58. Results: Ethics approval has been obtained from the hospital ethic committee board and the Hellenic National Organization for Medicines. The study will initiate in May 2019. Conclusions: Preliminary data are expected in 2020–2021 and the final results are anticipated in 2022. Randomized evidence to support further large-scale trials will be provided to refine research in this field. Findings will be published in peer-reviewed medical journals.

Effect of Obesity on Sympathovagal Activities in Hypertensive Indian Population.

Decreased physical activity, increased psychosocial stress and work stress have contributed to the increased prevalence of obesity and Hypertension (HTN). Irrespective of the aetiology, sympathetic over activity has been recognized as the main pathophysiologic mechanism in the genesis of obesity and HTN. Sympathovagal imbalance or dysregulation of autonomic functions owing to sympathetic over activity and vagal withdrawal is reported to be the basis of many clinical disorders. Obesity, hypertension and diabetes mellitus are known to be associated with dysregulation of autonomic functions independently. Heart Rate Variability (HRV) has emerged as a practical, non-invasive tool to quantitatively investigate cardiac autonomic dysregulation. The present study was undertaken to ascertain whether obesity has any effect on further disruption of autonomic functions particularly in hypertensive patients. A total of 96 male and female adults aged between 40-50 years visiting the Primary Health Centre, Yelwala, Mysuru district, India were recruited for this study. They were grouped in to 3 (n=32) as Groups I (Obese hypertensive), II (non-obese hypertensive) and II (non-obese normotensive, control), HRV was determined using the One minute during deep breathing method. Data were presented as Mean ± SD, inferential statistics was by One Way ANOVA and Tukey's Post Hoc test p value <0.005 at α0.05 HRV was significantly decreased in obese hypertensive patients compared to the non-obese hypertensive patients. Our present study supports that obesity and hypertension probably has additive effect in causing autonomic dysregulation.

Efficacy and Safety of Firibastat, A First-in-Class Brain Aminopeptidase A Inhibitor, in Hypertensive Overweight Patients of Multiple Ethnic Origins

Despite existing therapy, successful control of hypertension in the United States is estimated at less than 50%. In blacks, hypertension occurs earlier, is more severe, controlled less often and has a higher morbidity and mortality than in whites. Blacks are also less responsive to monotherapy with angiotensin-I converting enzyme inhibitors or angiotensin-II receptor type 1 blockers. Obesity, higher salt-sensitivity and low plasma renin activity are possible reasons of this poor blood pressure (BP) control, especially in blacks. The aim of the study was to assess efficacy and safety of firibastat, a first-in-class aminopeptidase A inhibitor preventing conversion of brain angiotensin-II into angiotensin-III, in BP lowering in a high-risk diverse hypertensive population. Two hundred fifty-six overweight or obese hypertensive patients, including 54% black and Hispanic individuals, were enrolled in a multicenter, open-label, phase II study. After a 2-week wash-out period, subjects received firibastat for 8 weeks (250 mg BID orally for 2 weeks, then 500 mg BID if automated office blood pressure (AOBP) >140/90 mm Hg; hydrochlorothiazide 25 mg QD was added after 1 month if AOBP ≥160/110 mm Hg). The primary end point was change from baseline in systolic AOBP after 8 weeks of treatment, and secondary end points include diastolic AOBP, 24-hour mean ambulatory BP and safety. Firibastat lowered systolic AOBP by 9.5 mm Hg ( P<0.0001) and diastolic AOBP by 4.2 mm Hg ( P<0.0001). 85% of the subjects did not receive hydrochlorothiazide and were treated with firibastat alone. Significant BP reduction was found across all subgroups regardless age, sex, body mass index, or race. Systolic AOBP decreased by 10.2 mm Hg ( P<0.0001) in obese patients, by 10.5 mm Hg ( P<0.0001) in blacks, and 8.9 mm Hg ( P<0.0001) in nonblacks. Most frequent adverse events were headaches (4%) and skin reactions (3%). No angioedema was reported. No change in potassium, sodium, and creatinine blood level were observed. Our results demonstrate the efficacy of firibastat in lowering BP in a high-risk diverse population where monotherapy with angiotensin-I converting enzyme inhibitors or angiotensin-II receptor type 1 blockers may be less effective and support the strategy to further investigate firibastat in subjects with difficult-to-treat or potentially resistant hypertension. URL: https://www.clinicaltrials.gov . Unique Identifier: NCT03198793.

Effects of bariatric surgery on obese polycystic ovary syndrome: a systematic review and meta-analysis

BackgroundBariatric surgery has been widely used for the treatment of obesity and its related metabolic diseases, such as type 2 diabetes (T2D), hypertension, and sleep apnea syndrome. Polycystic ovary syndrome (PCOS) is a common reproductive endocrine metabolic disease; however, little attention has been paid to the efficacy of bariatric surgery on PCOS. ObjectiveTo evaluate the efficacy of bariatric surgery on obese PCOS patients. SettingA systematic review and meta-analysis at a university hospital. MethodsOnline databases were searched for all studies reporting the efficacy of bariatric surgery for obese patients with PCOS up to October 2018. ResultsA total of 9 studies with 234 obese PCOS patients were included in this article. The results of meta-analysis showed that after bariatric surgery, there was a significant reduction of the incidence of abnormal menstruation (relative risk [RR] .23; 95% confidence interval [CI] .13–.43; P < .00001) and hirsutism (RR .47; 95% CI .28–.79; P = .004). Bariatric surgery can also cause a decrease in the serum total testosterone level (mean difference [MD] = –25.82; 95% CI –30.06 to –21.58; P < .00001), serum free testosterone level (MD = –4.10; 95% CI –6.97 to –1.23; P = .005), and body mass index (MD = –14.51; 95% CI –17.88 to –11.14; P < .00001). It also showed a significant effect on T2D (RR .09; 95% CI .03–.32; P = .0002) and hypertension (RR .21; 95% CI .05–.98; P = .05) in obese patients with PCOS. ConclusionsBariatric surgery can reduce the incidence of abnormal menstruation, improve hyperandrogenism and its clinical manifestations, and decrease the body mass index, prevalence of T2D, and hypertension in obese patients with PCOS.

Possible Mechanisms Involved in the Vasorelaxant Effect Produced by Anorexigenic Drugs in Rat Aortic Rings

Anorexigenics are compounds capable of reducing or suppressing appetite. Their three main types act on different neurotransmitters, either norepinephrine, serotonin or a combination of both. Among the drugs that act on norepinephrine are fenproporex, amfepramone and clobenzorex. Derivatives of the thyroid hormone triiodothyronine have also been associated with weight loss and used as a controversial treatment for obesity, despite their known cardiovascular side effects. Recent data suggest a possible vasodilating effect for these four substances that might be beneficial in a subset of patients. Herein we performed a systematic review of the literature (with emphasis on recent reports) to determine the implications and mechanisms of the vasodilating effects of some anorectics, specifically fenproporex, clobenzorex, amfepramone and triiodothyronine. Data analysis showed these four drugs to be vasodilating agents for rat aortic rings. The different mechanisms of action include endothelium-dependent vasodilation via activation of the NO-cGMP-PKG pathway and the opening of calcium-activated potassium channels. The finding of vasodilating activity indicates a potential role for some anorexigenic drugs in the treatment of obesity in hypertensive patients. Further in vivo studies are needed to test the clinical benefits of these four drugs.

Analysis of the Associations between Obesity Indices and Left Ventricular Mass

The aims of this study were to investigate the association between different obesity indices and left ventricular mass (LVM) and to develop interventions for obese hypertensive patients to delay the progression of left ventricular hypertrophy (LVH). The association between the visceral adiposity index (VAI) and LVM was explored using multiple regression analysis in all subjects (n = 1,035), the subgroups of patients aged < 65 (n = 713) and ≥65 years (n = 322), and perimenopausal women (n = 319). The VAI was the only obesity index associated with LVH (OR = 1.134; 95% CI 1.025–1.254, p = 0.015). In the subgroup of patients aged < 65 years, both systolic blood pressure and VAI were risk factors for LVH. However, in the subgroup aged ≥65 years, only systolic blood pressure was a risk factor, and there was no association between VAI and LVH (p = 0.13). Perimenopause was an independent risk factor (OR = 1.786; 95% CI 1.125–2.837, p = 0.014). Reducing the VAI rather than the BMI or waist circumference may prevent LVH complications in obese hypertensive patients. For patients aged < 65 years strict control of blood pressure and obesity may be important, and for those aged ≥65 years blood pressure control should be the priority. Estrogen replacement may be useful in postmenopausal women to prevent LVH.

Effects of a dietary supplement on inflammatory marker expression in middle-aged and elderly hypertensive patients

OBJECTIVES:We aimed to explore the effects of diet on the inflammatory response in middle-aged and elderly people with hypertension.METHODS:Thirty overweight or obese patients with stage one hypertension (age range, 45-75 years) were allocated to either the intervention or control group (n=15 per group; age- and sex-matched). Patients in the intervention group consumed a food powder supplement (100 g) instead of a regular meal. The control group maintained their normal dietary habits. This study lasted for six weeks. Blood pressure, inflammatory marker levels, and energy intake were measured before and after the study.RESULTS:After 6 weeks, the diet composition of the intervention group changed significantly (p<0.05). The intake of proteins, dietary fibre, monounsaturated fat, and polyunsaturated fat increased significantly (p<0.05), while the total energy intake trended towards an increase (p>0.05). In the control group, the total energy intake decreased significantly (p<0.05). The levels of nuclear factor-κB (NF-κB), soluble intercellular adhesion molecule-1 (sICAM-1) and high sensitivity C-reactive protein (hs-CRP) decreased, and adiponectin increased significantly in the intervention group (p<0.05); however, no significant changes were observed in the inflammatory marker levels of the control group. In the intervention group, systolic blood pressure decreased significantly (p<0.05), and diastolic blood pressure also exhibited a decreasing trend. No significant change in blood pressure was observed in the control group.CONCLUSION:The consumption of a food powder supplement can improve diet composition, decrease blood pressure and reduce inflammation in middle-aged and elderly overweight or obese hypertensive patients. The food powder supplement may also have an anti-atherosclerotic effect in hypertensive patients.

Treatment of hypertension in obese patients: focus on telmisartan

The article discusses the role of telmisartan in the treatment of arterial hypertension in patients with metabolic syndrome. Telmisartan is second-generation type 1 angiotensin II receptor blocker, which has unique pleiotropic effects due to partial affinity for receptors that activate the proliferation of subtype y peroxisomes (PPARy) located in adipose tissue. The interrelation of metaflamation, a specific chronic inflammatory process with pathogenetic mechanisms of development of cardiovascular diseases, including arterial hypertension, is also described in study. The role of the adiponectin peptide is considered, which synthesis is stimulated by partial PPARy receptor agonists (as mentioned above — telmisartan). It has a positive effect on fat and carbohydrate metabolism, as well as cardioprotective properties. The conclusion contains the results of numerous randomized studies and meta-analyzes confirming the high efficacy of telmisartan in the treatment of arterial hypertension in patients with morbid obesity.

Awareness, treatment and control of hypertension among hypertensive patients aged 18 to 59 years old in the northeast of China

Hypertension not only has a high prevalence, but also brings disease burden to the affected patients. To assess the level of awareness, treatment and control of hypertension in the northeast of China, we investigated the rates of awareness, treatment and control of hypertension and identified its related factors among hypertensive patients aged 18 to 59 years old in Jilin, China. The data (n = 4632) for the present study were extracted from a cross-sectional study in Jilin. Among individuals with hypertension, the standardized rates of awareness, treatment and control of hypertension were 44.9%, 36.5%, 24.3%, respectively. The rates of awareness and treatment of hypertension among middle aged patients were higher than those among young patients. Compared to patients with normal Body Mass index (BMI), obese hypertensive patients had a higher rate of treatment (43.7% vs. 25.9%) and a lower rate of control (18.9% vs. 29.6%). Compared to patients with normal BMI, patients who were obese were more likely to take measures to treat hypertension (OR = 2.50, 95%CI: 2.05–3.05); but were less likely to have well-controlled blood pressure (OR = 0.55, 95%CI: 0.40–0.78). BMI is one of the influencing factors of hypertension awareness, treatment and control among patients 18 to 59 years old with hypertension.