Fostering Friendships - Enhancing Social Bonds in the Classroom
Hypertension and obesity
1. HYPERTENSION
Relation Between Hypertension and Obesity
Mohammad Ilyas, M.D.
Assistant Clinical Professor
University of Florida / Health Sciences Center
Jacksonville, Florida USA
6/24/2014
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2. Outline
1. Definition, Regulation and Pathophysiology
2. Measurement of Blood Pressure, Staging of Hypertension and Ambulatory
Blood Pressure Monitoring
3. Evaluation of Primary Versus Secondary
4. Sequel of Hypertension and Hypertension Emergencies
5. Management of Hypertension (Non-Pharmacology versus Drug Therapy)
6. The Relation Between Hypertension: Obesity, Drugs, Stress and Sleep
Disorders.
7. Hypertension in Renal diseases and Pregnancies
8. Pediatric, Neonatal and Genetic Hypertension
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3. Obesity
Definition: excessive weight that may impair health
How do we measure If someone is obese?
Body mass index (BMI) – the weight in kilograms divided by the
square of the height in meters (kg/m2)
BMI Categories:
Underweight BMI < 18.5
Normal weight = 18.5-24.9
Overweight = 25-29.9
Obesity = BMI of 30 or greater
Morbid Obesity = BMI > 40
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4. Just the Facts! As of 2008 WHO
Globally, More than 1.4 billion adults are overweight
More than half a billion obese (>500,000,000)
2.8 million people each year die as a result of being overweight
or obese.
40 million preschool children were overweight
overweight and obesity kills more people than underweight
Projects by 2015, 2.3 billion will be overweight and 700 million
obese
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6. Childhood Obesity
Rates of childhood obesity are alarming
Problem is worldwide
Estimated in 2010, 42 million children
under age 5 are considered overweight
Tripled in past 30 years
Age 6-11 6.5% to 19.6%
Age 12-19 5.0% to 18.1%
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7. Childhood Obesity
Genetic Link
Multi-factorial condition related to sedentary lifestyle,
too much food intake and choice of
foods actually alter genetic make-up, creating higher risk
of obesity
Behavioral
Children will more likely choose healthier foods
if they are offered to them at young ages and
in the home
Environment
In homes where healthy food is not available, or the food
choices are not healthy, obesity can occur
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8. Childhood Obesity
Why does this matter?
Premature death
Developing heart disease at younger ages
Developing diabetes type 2 at younger ages
What can be done?
Childhood obesity is preventable
Role of the schools
Role of health care professionals
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9. Cause of Obesity
Simple equation…when you eat more than
you use, it is stored in your body as “fat”.
Causes
Global shift in how we eat
Western diet of processed food
Higher sugar, fat and calories in what we eat
Less nutrients
Reduced intake of vitamins and minerals
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11. What does obesity do to our bodies?
With more people gaining too much weight..there
are health issues to consider
Cardiovascular disease
Diabetes type 2
Musculoskeletal disorders
Cancers-endometrial, cervical and colon
Infertility
Gallstones
Premature death and disability
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12. Heart Disease and Diabetes
Heart Disease
The world’s number #1 cause of death
Kills 17 million each year around the world
Heart attack
Stroke
Diabetes type 2
Becoming global epidemic
WHO projects diabetes will increase by 50% across the
world
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13. Hypertension
Weight gain raises blood pressure
Obesity further enhances total cardiovascular risk and all-
cause mortality
Excess body weight accounted for approximately 26 percent
of cases of hypertension in men and 28 percent in women
Approximately 23 percent of cases of coronary heart disease
in men and 15 percent in women
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14. BMI (>/= 25kg/m2)
Essential hypertension
78%-in male
65%-in female
(Vasant RS, Larson MG et al, 2001)
Dolls, Bovet P et al, 2002
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17. PATHOGENESIS OF HYPERTENSION
Initially, an elevation in cardiac output and a relatively normal
systemic vascular resistance (SVR).
Later, obese subjects is an elevation in SVR in hypertensive.
Increased activation of the renin-angiotensin aldosterone system.
These hemodynamic alterations plus abnormalities in lipid and
glucose metabolism appear to be related to fat distribution as
well as to total body weight.
In particular, the risk is greatest in those patients with abdominal
obesity, which is a major component of the metabolic syndrome.
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20. Hyperinsulinemia and Hypertension
The mechanism by which obesity raises the BP is not well
understood.
A variety of mechanisms have been proposed to explain how
hyperinsulinemia might increase BP
Increased sympathetic activity
Volume expansion due to increased renal sodium reabsorption
Endothelial dysfunction
Up regulation of angiotensin II receptors, and
Decreased cardiac natriuretic peptide .
Genetic susceptibility
Despite these observations, the role of insulin resistance or
hyperinsulinemia as a cause of hypertension remains unproven
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21. Sleep apnea syndrome
The sleep apnea syndrome is an additional contributing
factor to the development of hypertension in obese
patients.
Activation of the sympathetic nervous system,
Enhanced aldosterone levels, and
Increased levels of endothelin by repeated episodes of hypoxia
are thought to be responsible in part for the elevation in
blood pressure in this disorder
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22. Leptin-melanocortin pathway
The correlation between the serum concentration of leptin, a
protein that signals the brain about the quantity of stored fat,
and body fat content
With increasing adiposity, leptin acts as a negative feedback
"adipostatic" signal to brain centers controlling energy intake
The melanocortin receptor, which is expressed on downstream
targets of leptin and insulin responsive-neurons, is involved in
the regulation of energy balance and may also modulate blood
pressure
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25. EFFECTS OF WEIGHT REDUCTION
Weight loss may lead to a significant fall in systemic BP.
A mean fall in blood pressure of 6.3/3.4 mmHg with weight loss diets.
Weight reducing drugs, particularly orlistat, can also reduce blood
pressure,
Weight loss surgery (eg, Roux-en-Y gastric bypass), in addition to lifestyle
interventions, also reduces blood pressure,
The fall in blood pressure with weight loss is accompanied by a decrease
in arterial stiffness
The decline in BP induced by weight loss can also occur in the absence of
dietary sodium restriction; however, modest sodium restriction (a
decline in intake of 20 to 40 meq/day) may produce an additive
antihypertensive effect
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26. EFFECTS OF WEIGHT REDUCTION
Calorie expenditure > Calorie intake by 10%
Net 3500 kcal energy burning gives 0.45 kg body fat loss.
A meta analysis by staessen et al. showed that mean SBP & DBP
reductions were 1.6/1.1 mmHg per kg of body weight by aerobic
program.
18 month weight loss program associated with 77% reduction in
incidence of hypertension.
(He J, Whelton PK et al.2000)
The exact mechanism by which weight reduction lowers blood
pressure is not known.
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28. Resistance Training
Strength exercise can even be used for lowering blood
pressure.
The actual blood pressure response depends on:
• isometric component
• exercise intensity
• Muscle mass activated
• number of repetitions
• duration of contraction
• involvement of valsalva maneuver
Bjarnason – Wehrens B, Mayer – Berger W et al, 2004
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29. However, a need exists for additional well designed studies on this
topic before a recommendation can be made regarding the efficacy
of resistance exercise as a non pharmacologic therapy for reducing
the resting blood pressure in hypertensive individuals.
Kelley G et al, 1997
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30. Isometric Exercise
Isometric exercise such as weight lifting can have a pressor
effect and therefore should be avoided. Thus it is strictly
contraindicated.
(Krousel Wood MA, Muntner P et al, 2004)
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31. Long-term effects of weight reduction
The persistence of weight loss provides substantial benefits
Sustained weight loss of 6.8 kg or more was associated with a 22 -
26 % reduction in relative risk of developing hypertension
Weight loss of 10 to 20 percent was associated with a reduction in
total and resting energy expenditure
Increase in physical activity should always be added to diet
Markedly obese patients may require surgical therapy to produce
and maintain an adequate degree of weight loss.
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32. SUMMARY AND RECOMMENDATIONS
Obesity is an important risk factor for hypertension and all-cause
mortality.
Weight loss can lead to a significant fall in blood pressure.
Antihypertensive agents will often be necessary if adequate
weight loss cannot be achieved or sustained.
Angiotensin converting enzyme inhibitors, angiotensin receptor
blockers, or dihydropyridine calcium channel blockers may be the
antihypertensive agents of choice.
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34. Stress and Anxiety Control
Meditation was in one study to reduce SBP and DBP by 10.7 mm Hg
and 6.4 mm Hg over a period of 3 months
Schneider RH Alexander CN et al, 1995
Progressive muscle relaxation lower SBP by 4.7 mm Hg and DBP by
3.3mm Hg.
Yoga is also widely believed to reduce blood pressure
Damodaran A, Patil N, Suryavanshi et al, 2002
However, these interventions are with limited and uncertain efficacy.
Therefore more trials are needed to confirm its effect.
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36. Conclusion
Hypertension is a silent killer.
Cardiopulmonary Physiotherapy is an integral part of
health service.
Evidence supports that exercise is the cornerstone for
hypertension control, then why it is not being utilized.
This is the time, physiotherapist must emerge and show
their potential to beat paramount disorder like
hypertension where even pharmacological management
fails.
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