Electrolyte Blood Press.  2013 Dec;11(2):46-52. 10.5049/EBP.2013.11.2.46.

Obesity Associated Hypertension: New Insights into Mechanism

• Kang YS

• KMID: 2168400
• DOI: http://doi.org/10.5049/EBP.2013.11.2.46

Abstract

With excess nutrition, the burden of obesity is a growing problem worldwide. The imbalance between energy intake and expenditure leads to variable disorders as all major risk factors for cardiovascular disease. There are many hypothetical mechanisms to explain obesity-associated hypertension. Activation of the RAAS is a key contributing factor in obesity. Particularly, the RAAS in adipose tissue plays a crucial role in adipose tissue dysfunction and obesity-induced inflammation. The phenotypic changes of adipocytes occur into hypertrophy and an inflammatory response in an autocrine and paracrine manner to impair adipocyte function, including insulin signaling pathway. Adipose tissue produce and secretes several molecules such as leptin, resistin, adiponectin, and visfatin, as well as cytokines such as TNF-alpha, IL-6, MCP-1, and IL-1. These adipokines are stimulated via the intracellular signaling pathways that regulate inflammation of adipose tissue. Inflammation and oxidative stress in adipose tissue are important to interact with the microvascular endothelium in the mechanisms of obesity-associated hypertension. Increased microvascular resistance raises blood pressure. Therefore, a regulatory link between microvascular and perivascular adipose tissue inflammation and adipokine synthesis are provided to explain the mechanism of obesity-associated hypertension.

Keyword

Obesity; Hypertension; Renin-angiotensin-aldosterone system (RAAS); Microvascular dysfunction; Insulin resistance

MeSH Terms

Adipocytes
Adipokines
Adiponectin
Adipose Tissue
Blood Pressure
Cardiovascular Diseases
Cytokines
Endothelium
Energy Intake
Health Expenditures
Hypertension*
Hypertrophy
Inflammation
Insulin
Insulin Resistance
Interleukin-1
Interleukin-6
Leptin
Nicotinamide Phosphoribosyltransferase
Obesity*
Oxidative Stress
Resistin
Risk Factors
Tumor Necrosis Factor-alpha
Adipokines
Adiponectin
Cytokines
Insulin
Interleukin-1
Interleukin-6
Leptin
Nicotinamide Phosphoribosyltransferase
Resistin
Tumor Necrosis Factor-alpha

Figure

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  Fig. 1 The energy balance of human body.

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  Fig. 2 Putative mechanisms of obesity-associated hypertension including the renin-angiotensin-aldosterone system (RAAS), the sympathetic nervous system(SNS), and metabolic dysregulation.

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  Fig. 3 The components of renin-angiotensin-aldosterone (RAAS) and its metabolites established in adipose tissue (*: angiotensinogen, angiotensin converting enzyme, renin, renin receptor, AT1 receptor, AT2 receptor, and Mas receptor produced from adipose tissue).

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  Fig. 4 The new therapeutic target of obesity and hypertension focusing on both adipokines and neuropeptides.

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