This Article Full Text Full Text (PDF) All Versions of this Article: 44/1/12    most recent 01.HYP.0000132568.71409.a2v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sharma, A. M. Search for Related Content PubMed PubMed Citation Articles by Sharma, A. M. Related Collections Obesity Primary prevention Type 2 diabetes Clinical Studies

(Hypertension. 2004;44:12.)
© 2004 American Heart Association, Inc.

Brief Reviews

Is There a Rationale for Angiotensin Blockade in the Management of Obesity Hypertension?

From McMaster University, Hamilton General Hospital, Hamilton, Canada.

Correspondence to Arya M. Sharma, MD, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton, ON, Canada, L8L 2X2. E-mail sharma{at}ccc.mcmaster.ca

Obesity, currently affecting >20% of the adult population in most Western countries, is a major risk factor for the development of hypertension. Hypertension in obese patients is, in the majority of instances, further complicated by the concomitant presence of dyslipidemia and insulin resistance. The latter is reflected by derangement of glucose homeostasis, ranging from hyperinsulinemia to frank type 2 diabetes. Hypertension in obese patients is also associated with an increased risk for left ventricular hypertrophy, endothelial dysfunction, renal hyperfiltration, microalbuminuria, and elevated markers of inflammation. Sodium retention, volume expansion, and increased cardiac output are common findings in obese individuals. These changes are largely attributable to increased activity of the sympathetic nervous system and insufficient suppression of the renin-angiotensin system. Recent data show increased expression of angiotensin II–forming enzymes in adipose tissue, and increased activity of the renin-angiotensin system has recently been implicated in the development of insulin resistance and type 2 diabetes. Accordingly, antihypertensive agents that block the renin-angiotensin system might be a beneficial strategy for treatment of obesity-related hypertension. Both angiotensin-converting enzyme inhibitors and angiotensin type-1 receptor blockers have been associated with favorable metabolic properties and end-organ protection in addition to their antihypertensive effects. Data from ongoing large trials will provide an indication of the protective and preventive effects of these treatment strategies while offering insights into the mechanisms linking obesity, hypertension, and other facets of the metabolic syndrome.

Key Words: obesity • hypertension, obesity • angiotensin • renin-angiotensin system • angiotensin-converting enzyme • diabetes mellitus

This article has been cited by other articles:

				N. Deji, S. Kume, S.-i. Araki, M. Soumura, T. Sugimoto, K. Isshiki, M. Chin-Kanasaki, M. Sakaguchi, D. Koya, M. Haneda, et al. Structural and functional changes in the kidneys of high-fat diet-induced obese mice Am J Physiol Renal Physiol, January 1, 2009; 296(1): F118 - F126. [Abstract] [Full Text] [PDF]

				E. Yamamoto, Y.-F. Dong, K. Kataoka, T. Yamashita, Y. Tokutomi, S. Matsuba, H. Ichijo, H. Ogawa, and S. Kim-Mitsuyama Olmesartan Prevents Cardiovascular Injury and Hepatic Steatosis in Obesity and Diabetes, Accompanied by Apoptosis Signal Regulating Kinase-1 Inhibition Hypertension, September 1, 2008; 52(3): 573 - 580. [Abstract] [Full Text] [PDF]

				M. W. Brands and H. Labazi Role of Glomerular Filtration Rate in Controlling Blood Pressure Early in Diabetes Hypertension, August 1, 2008; 52(2): 188 - 194. [Full Text] [PDF]

				A. W. Krug and M. Ehrhart-Bornstein Aldosterone and Metabolic Syndrome: Is Increased Aldosterone in Metabolic Syndrome Patients an Additional Risk Factor? Hypertension, May 1, 2008; 51(5): 1252 - 1258. [Full Text] [PDF]

				Y. Takata, J. Liu, F. Yin, A. R. Collins, C. J. Lyon, C.-H. Lee, A. R. Atkins, M. Downes, G. D. Barish, R. M. Evans, et al. PPAR{delta}-mediated antiinflammatory mechanisms inhibit angiotensin II-accelerated atherosclerosis PNAS, March 18, 2008; 105(11): 4277 - 4282. [Abstract] [Full Text] [PDF]

				I. Biaggioni Should We Target the Sympathetic Nervous System in the Treatment of Obesity-Associated Hypertension? Hypertension, February 1, 2008; 51(2): 168 - 171. [Full Text] [PDF]

				H. J Milionis, M. S Kostapanos, K. Vakalis, I. Theodorou, I. Bouba, R. Kalaitzidis, I. Georgiou, M. S Elisaf, and K. C Siamopoulos Impact of renin-angiotensin-aldosterone system genes on the treatment response of patients with hypertension and metabolic syndrome Journal of Renin-Angiotensin-Aldosterone System, December 1, 2007; 8(4): 181 - 189. [Abstract] [PDF]

				C. Schindler Review: The metabolic syndrome as an endocrine disease: is there an effective pharmacotherapeutic strategy optimally targeting the pathogenesis? Therapeutic Advances in Cardiovascular Disease, October 1, 2007; 1(1): 7 - 26. [Abstract] [PDF]

				L. F. Lien, A. J. Brown, J. D. Ard, C. Loria, T. P. Erlinger, A. C. Feldstein, P.-H. Lin, C. M. Champagne, A. C. King, H. L. McGuire, et al. Effects of PREMIER Lifestyle Modifications on Participants With and Without the Metabolic Syndrome Hypertension, October 1, 2007; 50(4): 609 - 616. [Abstract] [Full Text] [PDF]

				A. Remuzzi and G. Remuzzi Review: Potential protective effects of telmisartan on renal function deterioration Journal of Renin-Angiotensin-Aldosterone System, December 1, 2006; 7(4): 185 - 191. [Abstract] [PDF]

				M. Esler, N. Straznicky, N. Eikelis, K. Masuo, G. Lambert, and E. Lambert Mechanisms of Sympathetic Activation in Obesity-Related Hypertension Hypertension, November 1, 2006; 48(5): 787 - 796. [Full Text] [PDF]

				Y.-J. Gao, K. Takemori, L.-Y. Su, W.-S. An, C. Lu, A. M. Sharma, and R. M.K.W. Lee Perivascular adipose tissue promotes vasoconstriction: the role of superoxide anion Cardiovasc Res, July 15, 2006; 71(2): 363 - 373. [Abstract] [Full Text] [PDF]

				A. M. Sharma Telmisartan: The ACE of ARBs? Hypertension, May 1, 2006; 47(5): 822 - 823. [Full Text] [PDF]

				S. B. Ahmed, N. D.L. Fisher, R. Stevanovic, and N. K. Hollenberg Body Mass Index and Angiotensin-Dependent Control of the Renal Circulation in Healthy Humans Hypertension, December 1, 2005; 46(6): 1316 - 1320. [Abstract] [Full Text] [PDF]

				A. M. Sharma Managing weighty issues on lean evidence: the challenges of bariatric medicine Can. Med. Assoc. J., January 4, 2005; 172(1): 30 - 31. [Full Text] [PDF]

				K. Rahmouni, M. L.G. Correia, W. G. Haynes, and A. L. Mark Obesity-Associated Hypertension: New Insights Into Mechanisms Hypertension, January 1, 2005; 45(1): 9 - 14. [Abstract] [Full Text] [PDF]

				S. P. Bagby Obesity-Initiated Metabolic Syndrome and the Kidney: A Recipe for Chronic Kidney Disease? J. Am. Soc. Nephrol., November 1, 2004; 15(11): 2775 - 2791. [Full Text] [PDF]