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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Plasma aldosterone levels were measured in adults whose body mass index ranged from lean to obese. Blood was drawn while subjects rested supine for 30-90 minutes. Aldosterone was higher in obese subjects, but could not be explained by renin or K+. The best predictors of plasma aldosterone were abdominal obesity measured as waist/hip ratio or by CT scan, and insulin resistance measured by insulin or oral glucose tolerance tests, or euglycemic clamp. In one cohort, these correlations were limited to women; in the other, they were also found in men. In the women with a strong correlation between aldosterone and visceral fat, aldosterone also correlated with cortisol and DHEA-S. The data are consistent with an effect of visceral fat on adrenal steroidogenesis. Visceral adipocytes have a high rate of triglyceride turnover, and their circulation drains directly to the liver. In an experiment based on these characteristics, rat hepatocytes responded to fatty acids by releasing an unidentified secretagogue that stimulated aldosterone production by rat adrenal glomerulosa cells. The clinical data suggest that aldosterone participates in hypertension associated with the "Insulin Resistance Syndrome". The adrenal in viscerally obese subjects may be driven by a secretagogue released from the liver by fatty acids from abdominal adipocytes.
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PMID:Aldosterone in obesity. 988 79

Obesity is regarded by insurance companies as a substantial risk for both life and disability policies. This risk increases proportionally with the degree of obesity. Mortality statistics for life insurance were the earliest indicator that the cost of obesity to the individual was a decreased life span and increased illness, particularly that affecting the cardiovascular and musculoskeletal systems. The prevalence of coronary heart disease rises with increases in the body mass index in both men and women. Cigarette smoking greatly augments these risks in both sexes. Hypertension and diabetes are very common in obese persons and add further to the risks of vascular disease. Abdominal obesity (when the abdominal girth measured round the umbilicus exceeds the maximum measurement round the hips) is correlated with the risk of cardiac disease and stroke, independently of bodyweight. Insurance companies consider abdominal obesity as unfavourable and rate it accordingly. Obesity (even that of moderate degree) greatly increases the chances of disability due to cardiovascular disease or musculoskeletal illness. In one study of 51 522 adult Finns, 25% of disability pensions in women were found to result directly from obesity. Obesity causes increased health expenditure, decreased life span and productivity, and premature retirement. Insurance companies are compelled to build these risks into their policies. However, because the excess mortality occurs late in mild to moderate obesity, some companies may minimise this risk for life policies that mature early.
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PMID:Obesity and insurance risk: the insurance industry's viewpoint. 1017 79

Obesity poses a serious health hazard and its treatment is often disappointing. Major advances have been made during recent years in the understanding of body weight regulation, with the discovery of leptin, a protein produced by adipocytes and acting on the central nervous system to reduce food intake, and that of beta-3 adrenergic receptors and uncoupling proteins which contribute to stimulate energy expenditure. Numerous metabolic complications are associated with abdominal obesity and most of them, such as diabetes mellitus, dyslipidaemias and arterial hypertension, appear to be linked to insulin resistance and may be part of the socalled metabolic syndrome or syndrome X. While very-low-calorie diets are usually effective in the short-term, they cannot, in the long-term and for most patients, solve the problem of severe obesity. Pharmacological antiobesity treatment may include drugs that reduce food intake, drugs that increase energy expenditure and drugs that affect nutrient partitioning or metabolism. All of these pharmacological approaches have potential efficacy, but unfortunately serious limitations. This is also the case of mechanical means, such as intragastric balloons. Consequently, bariatric surgery may be considered as a valuable alternative therapy in well-selected patients with morbid obesity refractory to classical treatments. In conclusion, obesity is a chronic disease and should be treated as such with reasonable expectations.
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PMID:Medical aspects of obesity. 1042 50

Although plasma and 24 h urinary free cortisol (UFC) levels are normal in obese subjects, pharmacological investigations have identified minor hypothalamo-pituitary-adrenal axis differences in patients with abdominal body fat distribution (A-BFD) vs peripheral BFD (P-BFD). Using recent tools such as saliva cortisol or overnight urinary free cortisol upon creatinine ratio (UFC/UC) determinations, we have investigated a population of obese females according to their body fat distribution. In-patients subjects (no.=82) were subjected to routine biochemical testing, 24 h and overnight UFC/UC, basal and post-1 mg overnight dexamethasone-suppressing test plasma and saliva cortisol determinations. Central obesity defined by a waist-to-hip ratio (WHR) >0.85 was found in 64% of the subjects vs 87% when defined by waist girth (WG) corrected for age. Despite identical body mass index, A-BFD subjects were more prone to hypertension using both classifications and had higher triglycerides (WHR classification) or higher triglycerides, cholesterol and glycemia (WG classification). Plasma cortisol levels were similar but saliva cortisol levels were lower in the A-BFD group using the WG classification. The 24 h UFC/UC were similar but the overnight UFC/UC were higher in the A-BFD group using the WHR classification. These mild differences in cortisol nocturnal secretion and free cortisol indexes in subjects with different body fat mass distribution suggest that their hypothalamo-pituitary-adrenal axis has a spontaneously subtly different regulation.
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PMID:Abdominal obesity increases overnight cortisol excretion. 1043 57

The association of several risk factors, obesity, dyslipoproteinemia, hepatic steatosis, insulin resistance and hypertension with Type 2 (non-insulin-dependent) diabetes mellitus and myocardial infarction has long been known and has been termed the "metabolic syndrome". In 1988 Reaven introduced syndrome X as the link between insulin resistance and hypertension. It has been suggested that a critical factor in the association between obesity, Type 2 diabetes and cardiovascular morbidity is the mass of intraabdominal fat. Striking similarities exist between the metabolic syndrome and untreated growth hormone (GH) deficiency in adults. The central findings in both these syndromes are abdominal/visceral obesity and insulin resistance. Other features common to both conditions are premature atherosclerosis and increased mortality from cardiovascular diseases. These similarities indicate that undetectable and low levels of GH may be of importance in the metabolic aberrations observed in both these conditions. Recent investigations have found that abdominal/visceral distribution of adipose tissue is associated with endocrine disturbances including increased activity of the hypothalamic-pituitary-adrenal axis and a blunted secretion of GH and sex steroids. Theoretically, these endocrine perturbations can be a consequence of obesity, but the endocrine aberrations may have causal effects. We studied moderately obese, middle-aged men with a preponderance of abdominal body fat. As a group, they had slight to moderate metabolic changes known to be associated with abdominal/visceral obesity. Nine months of GH treatment reduced their total body fat and resulted in a specific and a marked decrease in both abdominal subcutaneous and visceral adipose tissue. Moreover, insulin sensitivity improved and serum concentrations of total cholesterol and triglyceride decreased. Diastolic blood pressure also decreased. The finding that GH replacement in men with abdominal obesity can diminish the negative metabolic consequences of visceral obesity suggests that low levels of this hormone are of importance for the metabolic aberrations associated with visceral/abdominal obesity.
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PMID:Growth hormone and the metabolic syndrome. 1044 70

Of the major risk factors of coronary heart disease dyslipoproteinemia, obesity, hypertension, and diabetes are nutrition related and can be considered of metabolic origin. Dyslipoproteinemia affects 2/3 of the adult population. The risk of coronary heart disease can be decreased 2-5 fold by lowering hypercholesterinemia; atherosclerosis in the coronaries may regress and total mortality may decrease. Atherogenic dyslipidemia (i.e. hypertriglyceridaemia, low HDL cholesterol levels, elevated concentrations of small dense LDL) increases the risk as part of the metabolic syndrome. Obesity is already highly prevalent, and it is affecting ever growing proportions of the adult population. Abdominal obesity furthermore predisposes patients to complications. No effective therapy is available for obesity. 3/4 of hypertensive patients are obese and more than half of them have insulin resistance. By decreasing blood pressure, the risk of stroke decreases by about 40%, that of coronary heart disease by 14-30%. Slimming cures are the most important non-pharmacological way of treating hypertension. 5% of the population has diabetes mellitus, and a further 5% has impaired glucose tolerance. Type 2 diabetes predisposes patients to macrovascular complications. The risk of coronary heart disease can be decreased by controlling diabetes by e.g. metformin.
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PMID:[Major nutrition-related risk factors of ischemic heart disease: dyslipoproteinemia, obesity, hypertension, glucose intolerance]. 1044 32

There is a strong relation between diet and risk factors for cardiovascular diseases. Generally a high fat consumption will increase the serum cholesterol level. Different fatty acids have different effects on total cholesterol, LDL and HDL lipoproteins and therefore on the risk for cardiovascular diseases. This knowledge was translated into guidelines for a healthy diet and in advices to use less fat. In reality it was not easy for physicians to reach a substantial reduction in total cholesterol by limiting the fat consumption. A recent investigation in Belgium showed that the median reduction obtained by dietary changes through general practitioners was only 3.5%. In medical education not much attention is paid to the communication of the "fat message". In addition, individual patients have frequently multiple risk factors e.g. abdominal obesity, insulin resistance, diabetes, hypertension and a sedentary lifestyle. Therefore in the clinical setting an integrated approach is needed, in which dietary advice is supported by behavioural therapy and suggestions to increase physical activity. Currently there is a debate on the preference of a low fat or a modified fat diet. A low fat diet is rich in carbohydrates and a modified fat diet is rich in mono-unsaturated fatty acids. Recent investigations in diabetic patients are in favour of a modified fat diet. This has the advantage that in practice the possibilities for realizing a low saturated fat diet are increased.
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PMID:Clinical approaches to healthier diet modifications. 1047 73

Increased serum insulin is related to abdominal obesity and high blood pressure in affluent societies where insulin, weight, and blood pressure typically increase with age. The increased insulin level has been thought to reflect insulin resistance, a well-known associated factor in the metabolic syndrome. In most nonwesternized populations, body weight and blood pressure do not increase with age and abdominal obesity is absent. However, it is not known whether serum insulin likewise does not increase with age in nonwesternized societies. Fasting levels of serum insulin were measured cross-sectionally in 164 subsistence horticulturalists aged 20 to 86 years in the tropical island of Kitava, Trobriand Islands, Papua New Guinea, and in 472 randomly selected Swedish controls aged 25 to 74 years from the Northern Sweden WHO Monitoring Trends and Determinants in Cardiovascular Diseases (MONICA) Study. In Kitava, the intake of Western food is negligible and stroke and ischemic heart disease are absent or rare. The body mass index (BMI) and diastolic blood pressure are low in Kitavans. The main outcome measures in this study were the means, distributions, and age relations of serum insulin in males and females of the two populations. Serum fasting insulin levels were lower in Kitava than in Sweden for all ages (P < .001). For example, the mean insulin concentration in 50- to 74-year-old Kitavans was only 50% of that in Swedish subjects. Furthermore, serum insulin decreased with age in Kitava, while it increased in Sweden in subjects over 50 years of age. Moreover, the age, BMI, and, in females, waist circumference predicted Kitavan insulin levels at age 50 to 74 years remarkably well when applied to multiple linear regression equations defined to predict the levels in Sweden. The low serum insulin that decreases with age in Kitavans adds to the evidence that a Western lifestyle is a primary cause of insulin resistance. Low serum insulin may partly explain the low prevalence of cardiovascular disease in Kitavans and probably relates to their marked leanness.
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PMID:Low serum insulin in traditional Pacific Islanders--the Kitava Study. 1053 81

Five decades of epidemiologic research have established that blood pressure elevation is a common and powerful contributor to all of the major cardiovascular diseases, including coronary disease, stroke, peripheral artery disease, renal disease, and heart failure. The common variety of hypertension designated benign essential hypertension was not shown to be either benign or essential. Although clinicians favor the diagnosis and treatment of hypertension in terms of diastolic blood pressure elevation and categoric cut points, epidemiologic data show a more important influence of systolic blood pressure, and a continuous, graded influence of blood pressure even within what is regarded as the normotensive range. An important revelation in epidemiologic hypertension research is that hypertension usually occurs in conjunction with other metabolically linked risk factors; therefore, less than 20% occurs in isolation. The other risk factors that tend to accompany hypertension include glucose intolerance, obesity, left ventricular hypertrophy, and dislipidemia (elevated total, LDL, and small dense LDL cholesterol levels, raised triglyceride, and reduced HDL cholesterol levels). Clusters of three or more of these additional risk factors occur at four times the rate expected by chance. This clustering is attributed to an insulin resistance syndrome promoted by abdominal obesity. The amount of risk factor clustering accompanying elevated blood pressure was observed to increase with weight gain. Based on Framingham Study data the prevalence of insulin resistance syndrome in the general population could be as high as 22% in men and 27% in women. Risk of coronary disease, the most common and most lethal sequel to hypertension, increased stepwise with the extent of risk factor clustering. Among persons with hypertension, about 40% of coronary events in men and 68% in women are attributable to the presence of two or more additional risk factors. Only 14% of coronary events in hypertensive men and 5% of those in hypertensive women occurred in the absence of additional risk factors. Other important features of risk stratification of hypertension are the presence of an elevated heart rate and left ventricular hypertrophy, and an elevated fibrinogen that often accompany hypertension. Recent population-based data reported suggest that elevated renin accompanying hypertension may independently enhance the risk of coronary events. Because clustering of other major risk factors with hypertension is the rule, the prudent physician should routinely screen for the presence of these other factors. Multivariate risk assessment profiles are now available for coronary disease, stroke, peripheral artery disease, and heart failure, to enable physicians to pool all the relevant risk factor information so as to arrive at a composite risk estimate. Hypertensive patients are more appropriately targeted for therapy by such risk stratification and the goal of the therapy should be to improve the multivariate risk profile.
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PMID:Risk stratification in hypertension: new insights from the Framingham Study. 1067 82

In westernized societies there is a consistent and continuous gradient between the prevalence of cardiovascular disease (including both coronary heart disease and stroke) with SES, such that people from lower SES have more disease. Several studies have examined the roles of the major cardiovascular risk factors for explaining this gradient. There is a strong SES gradient for smoking, which parallels the gradient in disease, but the gradients for hypertension and cholesterol are weak or absent. Central obesity and physical inactivity may also be contributory factors. In the United States there is a strong association between SES and race, and it is suggested that the higher prevalence of hypertension and cardiovascular disease in blacks may be attributed to psychosocial factors, including those related to SES. The possible pathways by which SES affects cardiovascular disease include effects of chronic stress mediated by the brain, differences in lifestyles and behavior patterns, and access to health care. At the present time, the second of these is the strongest candidate; the effects of stress have been little studied.
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PMID:Cardiovascular pathways: socioeconomic status and stress effects on hypertension and cardiovascular function. 1068 3


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