Obesity Related Hypertension

increased systemic and pulmonary hypertension. Increased sympathetic activity. Hypoxia, cardiac arrhythmias, and sleep disturbance.

Adverse effects of obstructive sleep apnea ?

Weight loss can lead to significant fall in BP Increase physical activity should always be added to diet in order to provide more sustained weight loss 30 minutes or more of moderately intense physical activity four or more times per week

Always start with life style modification even if drug therapy is also needed = ?

increase waist to hip ratio

At any given level of the BMI the risk of development of cardiovascular disease, DM or DLP increased by greater amount of abdominal fat result in ?

normal

BMI 18.5 - 24.5

obese Class 1&2

BMI 30-39.9

Obese

BMI > or equal 95th percentile for age and sex

Sever obesity

BMI > or equal 99th percentile

extreme obesity

BMI >40 or = 40

Normal weight

BMI between 5th and 85th percentile for age and sex

Over weight

BMI between 85th and 95th percentile for age and sex

sodium and water reabsorption

Circulating angiotensin ll promotes

HTN

Diabetes mellitus (DM) is commonly associated with ?

>= 180 / >= 110

Hypertension: severe (grade 3)=

140-159 90-99

Hypertension: Mild (grade 1) =

>160 / >100

Hypertension: Moderate (grade 2)

Achieve blood pressure control

Identification of the patient with OSA and effective treatment with weight loss, continuous positive airway pressure, or surgical intervention may be necessary to ? Reduction in cardiovascular events and hypertension and improvements in quality of life may result from management of this frequently overlooked disorder (OSA)

(BP 183/93 mmHg) consider stage 2

If systolic and diastolic BP follow in different stages the higher stage is used

They grow in weight and height. The amount of body fat differs between boys and girls

In children and teens, *BMI age-sex specific percentiles are used* for what reasons ?

Volume Expansion

Increase renal sodium reabsorption one passible contribute factor is enhance sympathetic tone which produce renal vasoconstriction and directly promotes sodium retention

increase risk of morbidity and mortality

Increasing central adiposity is associated with an ?

regulating appetite, body weight and energy balance.

Leptin important in ?

Increased activation of renin - angiotensin - aldosterone system (RAAS). Increased sympathetic nervous system activation(SNS). Insulin resistance. Volume expansion. Renal structural change. Endothelial dysfunction, Leptin, obstructive sleep apnea.

Mechanisms of Obesity Related Hypertension ?

Older age Being African American Family history of hypertension

Non Reversible risk Factor For Hypertension

< 120 / < 80

Normal BP =

the *expected metabolic action* of leptin which lead to reduction food intake and increase energy expenditure *are absent*.

Obese patients have high level of leptin but ?

tubular sodium reabsorption and shift pressure naturesis toward higher pressure

Obesity increase ?

afferent renal artery vasodilation and increased glomerular filtration rate

Obesity is associated with marked ? which are compensatory response help to overcome the increased tubular sodium reabsorption.

Obstructive Sleep Apnea (OSA)

Obesity is major risk factor for ? - results from partial or complete collapse of upper respiratory air way. wide spectrum of manifestation ranging from intermittent snoring to frequent episode of apnea, hypoxia and frequent arousal.

activation of sympathetic nervous system enhanced aldosterone level endothelium dysfunction (increase level of endotheline) attenuate baroreflex.

Obstructive Sleep Apnea (OSA) can increase BP in obese patient through ?

120-139 / 80-89

Pre-hypertensive =

Obese BMI

Question 1: A person with a BMI of 32 is considered?

• B: Being African American

Question 2: which of the Following is a Non Reversible risk Factor For Hypertension?

increased parasympathetic activity

Question 3: which of the following is NOT an adverse effect of OSA ?

Over weight Sedentary lifestyle High sodium, low potassium diet Excessive alcohol intake Metabolic syndrome

Reversible Risk Factor For Hypertension

impaired nitric oxide bioavailability

Some of hypertensive patient have increased endotheline -1 (EN-1) which in addition to direct vasoconstrictor effects of ET1 it cause ?

Baroreflex dysfunction Hyperinsulinemia Hyperleptinemia elevated circulating angiotensin II concentration

There are several mechanisms linking between obesity and activation of SNS these include: ?

dose-response association

There is a ? association between the severity of OSA and hypertension. • Individuals with mild to moderate OSA had a 42% greater probability of having hypertension than did persons with normal sleep patterns. • Those with more severe OSA had two to three times the probability of hypertension than those without evidence of OSA

Renin - angiotensin - aldosterone system (RAAS )

There is evidence suggest that activation of ? plays an important role in obesity related HTN has crucial role in regulating fluid volume and vascular tone Activation of ? can cause increased sodium reabsorption

obesity related HTN

There is evidence that abnormal kidney function plays key role in ?

renal sodium retention sympathetic overactivity proliferation of vascular smooth muscle cells endothelial dysfunction

Varity of mechanism have been proposal to explain how Hyperinsulinemia might increase BP include ?

greater risk of HTN, DM, Dyslipidemia and CHD

Waist circumference *>102 cm (40in) in men* and *88 cm (35in) in women* associated with ?

*>102 cm (40in) in men*

Waist circumference in men = greater risk of HTN, DM, Dyslipidemia and CHD

*88 cm (35in) in women*

Waist circumference in women = greater risk of HTN, DM, Dyslipidemia and CHD

Hyperleptinemia

another link for HTN and obesity. involves leptin ?

increase hydrostatic pressure that may cause glomerulosclerosis and loss nephron function in obese patient

compensatory response of chronic renal vasodilation in obesity unfortunately cause ?

Hypertension

defined as BP of 140/90 mmHg or higher applies to patient not taking antihypertensive medication and without acute illness

Metabolic syndrome

defined by presence of 3 or more of follow specific cardiovascular risk factor Abdominal obesity (>102 cm in men and 88 cm in women). Impaired fasting blood sugar >100 mg/dl or drug for elevated blood sugar. High level of triglyceride >150 mg/dl (1.7mmol/L) or drug treatment for elevated triglyceride. Low level of HDL < 40 mg/dl in men and <50 mg/dl in women or drug treatment for low HDL. Blood pressure 130/85 mmHg or more or drug treatment for elevated BP.

less vasodilation more inflammation more coagulation

impaired nitric oxide bioavailability and less NO = ?

The body mass index (BMI)

is acceptable standard to measure of overweight and obesity

Obesity

is chronic disease that increasing in prevalence in adult, adolescence and children important risk factor for hypertension, diabetes mellitus, dyslipidemia, heart disease, stroke and all cause mortality

Hypertension

is major risk factor for premature cardiovascular disease morbidity and mortality (MI , CHF) , chronic kidney disease , stroke and dementia

Leptin

is peptide hormone secreted from adipose tissue in direct proportion to adipose tissue mass. important in regulating appetite, body weight and energy balance. Obese patients have high level of it but the *expected metabolic action* of it which lead to reduction food intake and increase energy expenditure *are absent*. also lead to activation of the sympathetic tone.

endothelial dysfunction

obesity represent state of inflammation that can cause ?

Hyperinsulinemia

one link between DM and HTN may be ?

Sympathetic nervous system activation

play major role which can increase cardiac output and arterial vasoconstriction

Blood pressure

product of cardiac out put (co) and systemic vascular resistance (SVR)

Obesity:

refers to an excess of fat

BMI calculation

weight (in kilogram) divided by height (in meter) squared

β-blocker

which antihypertensive drugs makes it harder to lose weight?