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Query: UMLS:C0028754 (obesity)
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Although the risk of developing congestive heart failure increases in parallel with the degree of obesity, load-dependent indexes of left ventricular function are found to be reduced in patients with morbid obesity only. We used the ratio of end-systolic wall stress to end-systolic volume index, which is load-independent, to assess myocardial contractility in 23 nonobese, 28 mildly obese and 26 moderately obese patients with mild to moderate essential hypertension. Although load-dependent indexes (i.e., ejection fraction, fractional fiber shortening and velocity of circumferential fiber shortening) were similar in the 3 groups, end-systolic wall stress to end-systolic volume index was lower in the moderately obese group (2.63 +/- 0.4, p less than 0.002) and even in the mildly obese group (2.88 +/- 0.8, p less than 0.05) than in the nonobese group (3.27 +/- 0.7). Further, there was a significant inverse relation between end-systolic wall stress to end-systolic volume index and body mass index (r = -0.34, p less than 0.005), diastolic diameter (r = -0.56, p less than 0.001) and left ventricular mass index (r = -0.55, p less than 0.001). Some obese patients have depressed myocardial contractility when compared with lean patients despite well-preserved pump function.
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PMID:Myocardial contractility and left ventricular function in obese patients with essential hypertension. 341 51

Left ventricular muscle mass is increased in the presence of large body size, high blood pressure and obesity, but the relative contributions to ventricular mass of these and other factors have not been elucidated. Accordingly, echocardiographic left ventricular mass in unmedicated employed adults (162 normotensive, 145 borderline hypertension and 317 with established essential hypertension) was related to height, weight, lean body mass, body mass index, systolic and diastolic blood pressure, age, gender, race and 24 h urinary sodium and potassium excretion. In the total population, body mass index, systolic blood pressure and height were the most significant (p less than 0.0001) independent correlates of left ventricular mass, whereas gender and age made smaller contributions. In each normotensive and hypertensive subgroup, body mass index and height remained highly significant independent predictors of left ventricular mass, systolic blood pressure became a weaker predictor (0.001 less than p less than 0.02) and only among patients with established hypertension was diastolic blood pressure a weak independent determinant (p less than 0.05) of ventricular mass. The increase in left ventricular mass attributable to obesity was due to eccentric hypertrophy because end-diastolic relative wall thickness was similar in obese and nonobese subjects in each blood pressure group. Thus obesity, as measured by body mass index, is as important a potential determinant of left ventricular muscle mass as is systolic blood pressure and it is of greater statistical significant in an adult employed population than is diastolic blood pressure, height, gender, age or dietary sodium intake.
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PMID:Relation of blood pressure and body build to left ventricular mass in normotensive and hypertensive employed adults. 341 96

An association between hyperinsulinemia and hypertension has been suggested by epidemiological surveys. To assess whether this association is independent of the presence of other hyperinsulinemic states, such as obesity and glucose intolerance, we measured the insulin response to oral glucose in a group of middle-aged moderately obese [144 +/- 4% overweight (mean +/- SEM)] patients (n = 18) with essential hypertension (174 +/- 5/104 +/- 2 mm Hg) and normal glucose tolerance. Normotensive subjects (n = 17) with normal glucose tolerance, matched for age and degree of overweight, served as the control group. The mean insulin response to glucose was twice as high in the hypertensive patients (25.8 +/- 0.2 mU/ml X 2 h) as in the normotensive subjects (11.3 +/- 0.2; P less than 0.001), yet the glucose incremental area was 3-fold higher in the former (10.9 +/- 1.0 g/dl X 2 h) than in the latter (3.5 +/- 0.7; P less than 0.001), thus indicating more severe insulin resistance. In the hypertensive group, systolic blood pressure levels were directly correlated with the 2-h plasma insulin values (r = 0.75; P less than 0.001). Furthermore, the 2-h plasma insulin value and the degree of overweight accounted for 65% of the variation in the systolic blood pressure in a multiple regression model (r = 0.81; P less than 0.001). We conclude that in obesity, the occurrence of hypertension marks the presence of additional hyperinsulinemia and insulin resistance, independent of any impairment of glucose tolerance.
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PMID:Evidence for an association of high blood pressure and hyperinsulinemia in obese man. 351 32

The most important risk factors that may predict the transition from borderline to established hypertension are revised, focusing on those pathological changes that have been investigated for their value as predictors of established hypertension. A patient commonly is diagnosed as a borderline hypertensive if several pressure values are somewhere above as well as below 140/90 mm Hg. Patients in this category generally are regarded as hypertensive when they are younger than age 40. Studies largely favor the hypothesis of polygenic inheritance of essential hypertension, yet the detailed nature of heredity continues to be disputed. Several biochemical markers reflect the hereditary etiology of established hypertension, e.g., a variation in the electrophoretic pattern of plasma proteins, urinary concentration of kallikrein, and an alteration of cell membrane transport of cations. In Western populations, arterial pressure increases throughout life. About 40% of the white population and over 50% of the black population over age 65 have hypertension (blood pressure of 160/95 mm Hg or greater) or isolated systolic hypertension (systolic blood pressure greater than 160 mmHg and diastolic blood pressure less than 95 mm Hg). Essential hypertension is more prevalent and vascular disease more severe in blacks than in whites. There is a well-documented association between obesity and hypertension; obesity increases the prevalence of hypertension 3 to 8 times. Numerous studies have been published about the relationship between arterial hypertension and excessive dietary salt intake, but the results continue to be controversial. In a cross-cultural analysis, a strong relationship was observed between salt intake and the prevalence of hypertension. Also noted was the modifying impact of sodium intake on the increasing prevalence of hypertension with age. Premenopausal women have a lower prevalence of essential hypertension and its risk factors than men of the same age because of the influence of estrogen, but if these women take oral contraceptives, arterial pressure increases and transient hypertension, often severe or even malignant, can be induced. Some behavioral patterns and personality traits appear to be associated with borderline hypertension, but evidence that these factors determine the transition from borderline to established hypertension in later life has not been demonstrated thus far. Measurements of resting heart rate and responses to dynamic exercise have some predictive value in predicting the development of hypertension. Ambulatory monitoring of blood pressure might allow for differentiation of patients with transient elevated blood pressure from those with more sustained hypertension.
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PMID:Risks for arterial hypertension. 351 34

Studies were conducted to evaluate the role of water-sodium metabolism on the hypertensive mechanisms in obese patients with essential hypertension (EHT). The obesity index correlated positively with the mean arterial pressure, plasma volume, extracellular fluid volume or total exchangeable sodium, and negatively with plasma noradrenaline concentration or plasma renin activity in EHT. Hypotensive effects of sodium restriction (Na 35 mEq, K 75 mEq) or the natriuretic response to infused dopamine (3 micrograms/kg/min) was remarkable in obese EHT. Fractional excretion of sodium (FENa), which reflects the renal tubular reabsorption of sodium, was significantly lower in obese EHT than that in non-obese or mildly obese EHT. Urinary excretion of free dopamine (UDA) had a positive relationship with simultaneously measured urinary excretion of sodium or FENa. In addition, UDA correlated positively with the obesity index in patients whose weight was under 115% of the ideal weight. On the contrary, the relation between the two parameters was significantly negative in patients whose weight was over 115% of the ideal weight. These findings suggest that the expansion of body fluid volume and sodium, which might result from the blunted natriuretic ability, at least in part, due to an attenuation of the renal dopaminergic activity, play an important role of the hypertensive mechanisms in obese EHT.
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PMID:Sympathetic nerve activity, plasma renin activity and water-sodium balance in obese patients with essential hypertension. 354 65

The examination and treatment of 547 patients with alimentary obesity revealed in them significant impairments of myocardial contractility, manifest hemodynamic disorders (in 65.5% of patients), marked changes in lipid metabolism (hypercholesterolemia, hypertriglyceridemia, hyperlipacidemia, hyperlipoproteinemia type IIa in 26,5%, type IIb in 14,5%, type IV in 32,5% of patients), as well as reduced activity of the T-immunity system, all these changes being prerequisites for the development of atherosclerosis, ischemic heart disease and essential hypertension. During examination of the patients' liver, fatty hepatosis was detected in 91.4%, chronic nonalcoholic steatohepatitis in 14% of patients, manifest shifts were found in their bile biochemical composition, leading to the development of cholelithiasis. The incretory dysfunction of the pancreas led to carbohydrate imbalance in 43%, and to diabetes mellitus in 7.5% of patients. Under the effect of the treatment (diet, exercise therapy, oxygenotherapy, hydrotherapy) conducted in the alimentary obesity patients, lessening of the pathologic process was observed in the heart, liver and pancreas, their functions being significantly improved. It has been concluded that normalization of the body weight in obese subjects is a measure preventing atherosclerosis, ischemic heart disease, essential hypertension, fatty hepatosis, steatohepatitis, cholelithiasis and diabetes mellitus.
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PMID:[Role of modern diet therapy in the prevention of visceral complications in patients with dietary obesity]. 356 80

Methods of clinico-instrumental investigation and biochemical monitoring (CPK and its membranous fraction) were employed for examination of 432 patients with acute myocardial infarction (AMI). Among them there were patients with an uncomplicated course of disease (19.4%), recurrences (13.7%) and AMI spreading (9%). Lung edema, a cardiogenic shock, ventricular fibrillation and complicated cardiac rhythm disorders were not detected on the 1st day of disease. Clinico-anamnestic data provided no opportunity for defining factors promoting AMI recurrences whereas AMI spreading frequently developed in patients with repeated AMI, suffering from essential hypertension, obesity and heart failure. Higher diastolic pressure in the pulmonary artery, an increase in the cardiac volume, a decrease in the ejection fraction and left ventricular stroke work--changes which were most pronounced in AMI spreading, were noted in patients with AMI lingering forms. Signs of disseminated intravascular blood coagulation were noted in the venous and arterial blood of patients with lingering AMI forms. A high blood enzyme level was shown to be accompanied by a low level of antibodies to LDH and CPK.
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PMID:[Clinico-pathogenetic variants of protracted forms of acute myocardial infarct]. 361 39

We report on a longitudinal study of 80 men - from 10-60 years old at the beginning of the study - in the period 1955-1975, giving the results of ECG, blood pressure, body weight, vital capacity and other measures. A striking change was noted in the ECG, with the axis deviation shifting with age to the left. It is highly significant that the QRS-complex remained stationary, giving an individual indication for the entire life-time. Heart frequency, QRS duration and wave amplitude showed a slight decrease with age, whereas PQ and QTc distances reveal a slight prolongation in the 20 years. The most serious pathologic changes are myocardial infarcts, 2 among 80 working men. Blood pressure becomes higher with age but essential hypertension was seen only in 11.25%. A real health risk is the combination of permanent hypertension and obesity (3 deaths). Vital capacity reaches its maximum between 20 and 30 years of age and then diminishes slowly. The pulse wave velocity augments with aging. Other results are reported in detail.
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PMID:[Longitudinal aging research over 20 years. Electrocardiogram, blood pressure, body weight, pulse wave velocity, accommodation latitude and retinal arteries of the eye]. 363 Mar 17

Relations between indices of mineral metabolism and blood pressure were examined in 182 subjects, comprising 58 patients with essential hypertension (EHT) and 124 healthy subjects attending a general health survey. Multivariate techniques of statistical analysis were employed to test the hypothesis of different relationships between blood pressure and calcium metabolism within the subpopulations and to eliminate confounding effects of age, sex and obesity. Plasma ionized calcium was inversely related and the urinary calcium excretion positively related to blood pressure in the total group. This was not significantly different between the groups. Serum parathyroid hormone (PTH) was, however, related to diastolic blood pressure only in the EHT group. The EHT patients had significantly lower plasma levels of ionized calcium, significantly higher levels of PTH and significantly greater excretion of calcium in the urine than the healthy subjects. The results of this investigation support the hypothesis that among patients with EHT the renal tubular reabsorption of calcium is impaired resulting in a reduction of plasma ionized calcium and thereby stimulation of PTH. The findings of linear relationships suggests the possibility of a direct association between calcium metabolism and the regulation of blood pressure.
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PMID:Relationships between calcium metabolic indices and blood pressure in patients with essential hypertension as compared with a healthy population. 366 47

Pulse wave velocity was measured in 27 obese and 25 nonobese patients with sustained essential hypertension. Pulse wave velocity was significantly increased in obese patients in comparison with nonobese patients. The result was independent of age, sex, and level of blood pressure. In the overall population, a significant positive correlation (r = 0.85; p less than 0.001) was observed between the degree of obesity and pulse wave velocity. A study of partial correlation coefficients indicated that the levels of glycemia, cholesterolemia, and triglyceridemia did not influence the relationship. After body weight was reduced, blood pressure decreased and arterial compliance increased. The results show that in patients with sustained essential hypertension: pulse wave velocity and obesity are strongly related independent of age, sex, blood pressure, and associated metabolic disorders and body weight reduction is associated with an improvement of arterial distensibility and compliance.
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PMID:Pulse wave velocity in patients with obesity and hypertension. 372 68


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