Summary
Obesity shows a strong association with hypertension, primarily due to secretion of an abundance of para- and endocrine peptides by the visceral adipose tissue that play a key role in the pathogenesis of high blood pressure and are responsible for the accelerated atherothrombosis encountered in overweight individuals. Increased activity of the RAAS and the sympathetic nerve system are the main pathophysiologic factors; hypertension in obese subjects is characterized by increased peripheral arterial resistance, high cardiac output, hypervolemia and salt sensitivity. Medical therapy sees blockade of the RAAS in front. Priority in treatment should be given to improvements in life style, primarily in increasing physical activity and decreasing caloric intake, and to medical treatment of associated risk factors according to the modern concept of global risk management.
Zusammenfassung
Adipositas zeigt eine starke Assoziation mit Hypertonie, wobei das viszerale Fett über eine Vielzahl von para- und endokrin wirksamen Peptiden eine Schlüsselrolle in der Pathogenese des erhöhten Blutdrucks und der akzelerierten Atherothrombose übergewichtiger Personen spielt. Pathophysiologisch kommt der erhöhten Aktivität des RAAS und des sympathischen Nervensystems eine zentrale Bedeutung zu; neben dem erhöhten peripheren Widerstand ist die Kreislaufsituation durch hohes Herzminutenvolumen und Hypervolämie charakterisiert. Der Hypertonus des Übergewichtigen ist salzsensitiv und spricht medikamentös auf Hemmung des RAAS in der Regel gut an. Vorrangig in der Behandlung sind Lebensstilverbesserungen mit mehr Bewegung und weniger Kalorienzufuhr als wichtigste Maßnahmen und Mitbehandlung der häufigen begleitenden Risikofaktoren im Sinne des heute geforderten totalen Risiko Managements.
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Slany, J. Hochdruck und Adipositas. Wien Med Wochenschr 158, 370–372 (2008). https://doi.org/10.1007/s10354-008-0560-9
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DOI: https://doi.org/10.1007/s10354-008-0560-9