Prof. O.M. Korzh, prof. L.V. Cherkashyna, assoc. prof. L.M. Tsogoeva
Kharkiv National Medical University
Induced arterial hypertension (AH) is one of the forms of AH, the pathogenetic mechanisms of which are well studied: the main reason is the disruption of the functioning of visceral adipose tissue, which leads to activation of the renin-angiotensin-aldosterone system, imbalance of the sympathetic and parasympathetic systems, kidney damage, endothelial dysfunction of vessels and, in fact, to increased blood pressure (BP) and consolidation of AH. However, among this form of AH, additional mechanisms can be distinguished that play a special role in the formation of hypertension in obesity. This review describes such mechanisms as chronic inflammation, excessive salt intake, dysbiosis and environmental factors. Understanding these features of AH in obesity is of great importance for achieving target levels of AH. Special attention is paid to such forms of AH as masked and nocturnal hypertension, the timely diagnosis of which is critically important for effective treatment and improving prognosis.
Key words: arterial hypertension, clinical phenotype, obesity, pathogenetic mechanisms.
https://doi.org/10.15407/internalmed2025.01.096
Cite:
Корж О.М., Черкашина Л.В., Цогоєва Л.М. Артеріальна гіпертензія у пацієнтів із ожирінням: клініко-патогенетичні особливості/Східноєвропейський журнал внутрішньої та сімейної медицини. – 2025. – № 1. – С. 96-101. doi.org/10.15407/internalmed2025.01.096
Korzh OM, Cherkashyna LV, Tsogoeva LM. Arterial hypertension in obese patients: clinical and pathogenetic features. Shidnoevropejskij Zurnal Vnutrisnoi Ta Simejnoi Medicini. 2025(1):96-101. doi.org/10.15407/internalmed2025.01.096
References:
- Natsis M, Antza C, Doundoulakis I, Stabouli S, Kotsis V. Hypertension in Obesity: Novel Insights. Curr Hypertens Rev. 2020;16(1):30-36. https://doi.org/10.2174/1573402115666190415154603
- Hamjane N, Benyahya F, Nourouti NG, Mechita MB, Barakat A. Cardiovascular diseases and metabolic abnormalities associated with obesity: What is the role of inflammatory responses? A systematic review. Microvasc Res. 2020;131:104023. https://doi.org/10.1016/j.mvr.2020.104023
- Dlamini Z, Hull R, Makhafola TJ, Mbele M. Regulation of alternative splicing in obesity-induced hypertension. Diabetes Metab Syndr Obes. 2019;12:1597-1615. https://doi.org/10.2147/DMSO.S188680
- Koliaki C, Liatis S, Kokkinos A. Obesity and cardiovascular disease: revisiting an old relationship. Metabolism. 2019;92:98-107. https://doi.org/10.1016/j.metabol.2018.10.011
- Jordan J, Yumuk V, Schlaich M, et al. Joint statement of the European Association for the study of obesity and the European Society of Hypertension: obesity and difficult to treat arterial hypertension. J Hypertens. 2012;30(6):1047-55. https://doi.org/10.1097/HJH.0b013e3283537347
- Carey R, Calhoun D, Bakris G, et al. Resistant hypertension: detection, evaluation, and management: a scientific statement from the American Heart Association. Hypertension. 2018;72(5):53-90. https://doi.org/10.1161/HYP.0000000000000084
- Schiffrin E. Immune mechanisms in hypertension and vascular injury. Clin Sci (Lond). 2014;126(4):267-74. doi:10.1042/CS20130407.
- Kalathookunnel A, Lian Z, Wu H. T Cells in Adipose Tissue in Aging. Front Immunol. 2018;9:2945. https://doi.org/10.3389/fimmu.2018.02945
- Xiao L, Harrison D. Inflammation in Hypertension. Can J Cardiol. 2020;36(5):635-47. https://doi.org/10.1016/j.cjca.2020.01.013
- Ge W, Guo X, Song X, et al. The role of immunoglobulin E and mast cells in hypertension. Cardiovasc Res. 2022;118(14):2985-99. https://doi.org/10.1093/cvr/cvac010
- Mutchler S, Kirabo A, Kleyman T. Epithelial Sodium Channel and Salt-Sensitive Hypertension. Hypertension. 2021;77(3):759-67. https://doi.org/10.1161/HYPERTENSIONAHA.120.14481
- Kirabo A. A new paradigm of sodium regulation in inflammation and hypertension. Am J Physiol Regul Integr Comp Physiol. 2017;313(6):706-10. https://doi.org/10.1152/ajpregu.00250.2017
- Wenzel U, Bode M, Kurts C, Ehmke H. Salt, inflammation, IL-17 and hypertension. Br J Pharmacol. 2019;176(12):1853-63. https://doi.org/10.1111/bph.14359
- He F, Tan M, Ma Y, MacGregor G. Salt Reduction to Prevent Hypertension and Cardiovascular Disease. J Am Coll Cardiol. 2020;75(6):632-47. https://doi.org/10.1016/j.jacc.2019.11.055
- He F, Campbell N, Woodward M, MacGregor G. Salt reduction to prevent hypertension: the reasons of the controversy. European Heart Journal. 2021;42(25):2501-5. https://doi.org/10.1093/eurheartj/ehab274
- Messerli F, Hofstetter L, Syrogiannouli L, et al. Sodium intake, life expectancy, and allcause mortality. European Heart Journal. 2021;42(21):2103-12. https://doi.org/10.1093/eurheartj/ehaa947
- Mente A, O’Donnell M, Yusuf S. Sodium and health: another challenge to the current dogma. European Heart Journal. 2021;42(21):2116-8. https://doi.org/10.1093/eurheartj/ehaa1093
- O’Donnell M, Mente A, Alderman M, et al. Salt and cardiovascular disease: insufficient evidence to recommend low sodium intake. European Heart Journal. 2020;41(35):3363-73. https://doi.org/10.1093/eurheartj/ehaa586
- Grylls A, Seidler K, Neil J. Link between microbiota and hypertension: Focus on LPS/TLR4 pathway in endothelial dysfunction and vascular inflammation, and therapeutic implication of probiotics. Biomedicine & Pharmacotherapy. 2021;137:111334. https://doi.org/10.1016/j.biopha.2021.111334
- Robles-Vera I, Toral M, Duarte J. Microbiota and Hypertension: Role of the Sympathetic Nervous System and the Immune System. Am J Hypertens. 2020;33(10):890-901. https://doi.org/10.1093/ajh/hpaa103
- Asadi A, Mehr N, Mohamadi M, et al. Obesity and gut-microbiota-brain axis: A narrative review. J Clin Lab Anal. 2022;36(5):24420. https://doi.org/10.1002/jcla.24420
- Hall J, do Carmo J, da Silva A, et al. Obesity-induced hypertension: interaction of neurohumoral and renal mechanisms. Circ Res. 2015;116(6):991-1006. https://doi.org/10.1161/CIRCRESAHA.116.305697
- Kupcikova Z, Fecht D, Ramakrishnan R, et al. Road traffic noise and cardiovascular disease risk factors in UK Biobank. European Heart Journal. 2021;42(21):2072-84. https://doi.org/10.1093/eurheartj/ehab121
- Munzel T, Steven S, Hahad O, Daiber A. Noise and cardiovascular risk: nighttime aircraft noise acutely triggers cardiovascular death. European Heart Journal. 2021;42(8):844-6. https://doi.org/10.1093/eurheartj/ehaa984
- Mannucci P, Ancona C. Noise and air pollution as triggers of hypertension. European Heart Journal. 2021;42(21):2085-7. https://doi.org/10.1093/eurheartj/ehab104
- Fujiwara T, Yano Y, Hoshide S, et al. Association of Cardiovascular Outcomes With Masked Hypertension Defined by Home Blood Pressure Monitoring in a Japanese General Practice Population. JAMA Cardiol. 2018;3(7):583-90. https://doi.org/10.1001/jamacardio.2018.1233
- Penmatsa K, Biyani M, Gupta A. Masked Hypertension: Lessons for the Future. Ulster Med J. 2020;89(2):77-82.
- Tientcheu D, Ayers C, Das S, et al. Target organ complications and cardiovascular events associated with masked hypertension and white-coat hypertension. J Am Coll Cardiol. 2015;66(20):2159-69. https://doi.org/10.1016/j.jacc.2015.09.007
- Coccina F, Pierdomenico A, De Rosa M, et al. Risk of Atrial Fibrillation in Masked and White Coat Uncontrolled Hypertension. Am J Hypertens. 2021;34(5):504-10. https://doi.org/10.1093/ajh/hpaa185
- Yang W, Melgarejo J, Thijs L, et al. Association of Office and Ambulatory Blood Pressure With Mortality and Cardiovascular Outcomes. JAMA. 2019;322(5):409-20. https://doi.org/10.1001/jama.2019.9811
- Xia J, Zhang D, Kang Y, et al. The prevalence of masked hypertension and masked uncontrolled hypertension in relation to overweight and obesity in a nationwide registry in China. Hypertens Res. 2022;45:1690-700. https://doi.org/10.1038/s41440-022-01005-z
- Tadic M, Cuspidi C, Grassi G, Manci G. Isolated Nocturnal Hypertension: What Do We Know and What Can We Do? Integr Blood Press Control. 2020;13:63-9. https://doi.org/10.2147/IBPC.S223336
- Kario K. Nocturnal hypertension: new technology and evidence. Hypertension. 2018;71(6):997-1009. https://doi.org/10.1161/HYPERTENSIONAHA.118.10971
- Parodi R, Brandani L, Romero C, Klein M. Resistant hypertension: Diagnosis, evaluation, and treatment practical approach. Eur J Intern Med. 2024;123:23-28. https://doi.org/10.1016/j.ejim.2023.12.026