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?