Effectiveness of essential hypertension treatment by obesity reduction (Does overweight loss always leads to blood pressure normalization?)

Abstract

Obesity and overweight are one of the fundamental health problems of the contemporary world. The prevalence of obesity and overweight in developed countries has reached 50% and is constantly increasing. Visceral adipose tissue in obese subject releases many biologically active substances which may play a potential role in the pathogenesis of hypertension. These active substances include: angiotensin II, tumour necrosis factor, C-reactive protein, interleukin 6, resistin. Insulin resistance, typical for obese people, increases sympathetic nervous system activation and renal tubular sodium reabsorption. Epidemiological and clinical studies clearly show the relationship between obesity, overweight and prevalence of hypertension. At the same time current studies show that reduction of body mass leads to decrease or even normalization of blood pressure. Unfortunately, in most of them the duration of observation period was only 1 year or 2 years. There were only a few studies in which patients had been observed for several years, but the results were ambiguous. No data from long-term trials are available. Thus, a great interest arouse by the reports concerning long-term effect of bariatric surgery on blood pressure. Obesity reduction by bariatric surgery decreases or normalizes blood pressure values in majority of cases, but many years after the operation blood pressure often increases again.
Arterial Hypertension 2011, vol. 15, no 2, pages 118–124.