Hemodynamics in patients with overweight and hypertension

  • Efrain Reisin
  • Edward D. Frohlich
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 98)


Several epidemiological studies, cross-sectional [1–3] and longitudinal [1, 4–6], have shown that obesity and hypertension are two directly related pathological disorders at any age [1, 7], and the overweight condition is a predicting and predisposing factor for future development of elevated systolic and diastolic pressures [4–6]. More recent studies, however, have concluded that in determining the risk profile of obese subjects, assessment of body fat distribution is important [8–11]. Thus, considerably evidence suggests that fat distribution is a relatively constant characteristic of human beings, even after major weight changes [8, 9]. By a variety of techniques, such as skinfold thickness measurements [10], circumference measurements [10–12], and computed tomography [13], estimates of fat distribution in different body regions support the concept that an increased waist-hip circumference ratio (upper-body obesity or hypertrophic obesity) shows a preponderance of fat in the abdominal region. This specific type of obesity, in contrast to subjects having low waist-hip circumference ratios (lower-body obesity or hyperplastic obesity), is associated with increased risk of hypertension, impaired glucose tolerance, and hyperinsulinemia [14–17]. This finding is true across race and gender groups and is independent of age [16, 17].


Weight Reduction Caloric Restriction Plasma Renin Activity Sodium Intake Total Peripheral Resistance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kannel W, Brand N, Skinner J, Dawber J, MacNamera P (1976): Relation of adiposity of blood pressure and development of hypertension: The Framingham Study. Ann Intern Med 68: 48–59.Google Scholar
  2. 2.
    Stamler R, Stamler J, Riedlinger WE, Algera G, Roberts RH (1978): Weight and blood pressure findings in hypertension screening of a million Americans. J Am Med Assoc 240: 1607–1610.Google Scholar
  3. 3.
    Epstein FM (1965): Prevalence of chronic disease and distribution of selected physiological variables in a total community of Tecumseh, Michigan. Am J Epidemiol 81: 307–322.PubMedGoogle Scholar
  4. 4.
    Levi RL, White PD, Stroud WD (1946): Overweight: A prognostic significance in relation to hypertension and cardiovascular-renal diseases. J Am Med Assoc 131: 951–953.Google Scholar
  5. 5.
    Hsu PH, Mathewson FAL, Rabkin SW (1977): Blood pressure and body mass index patterns a longitudinal study. J Chronic Dis 30: 93–113.PubMedGoogle Scholar
  6. 6.
    Rabkin SW, Mathewson FAL, Hsu PH (1977): Relation of body weight to development of ischemic heart disease in a cohort of young North American mean after a 26 year observation period: The Manitoba Study. Am J Cardiol 39: 452–458.PubMedGoogle Scholar
  7. 7.
    Goldring D, Londe S, Sivakoff M (1977): Blood pressure in a high school population standards for blood pressure and the relation of age, sex, weight, height and race to blood pressure in children 14 to 18 years of age. J Pediatr 91: 884–889.PubMedGoogle Scholar
  8. 8.
    Garn SM (1969): Relative fat patterning: An individual characteristic. Hum Biol 26: 75–89.Google Scholar
  9. 9.
    Edwards DAW (1950): Observations on the distribution of subcutaneous fat. Clin Sci 9: 259–270.Google Scholar
  10. 10.
    Vogue J (1956): The degree of masculine differentiation of obesities: A factor determining predisposition to diabetes, atherosclerosis, gout and uric calculus disease. Am J Clin Nutr 4: 20–34.Google Scholar
  11. 11.
    Albrink MJ, Meigs JW (1965): The relationship between serum triglycerides and skinfold thickness in obese subjects. Ann NY Acad Sci 131: 673–683.PubMedGoogle Scholar
  12. 12.
    Hartz AJ, Rupley D, Kalkhoff RK, Rimm AA (1983): Relationships of obesity to diabetes: Influence of obesity level and body fat distribution. Prev Med 12: 351–357.PubMedGoogle Scholar
  13. 13.
    Ashwell M, Cole TJ, Dixon AK (1985): Obesity new insight into the antropometric classification of fat distribution shown by computed tomography. BMJ 290: 1692–1694.PubMedGoogle Scholar
  14. 14.
    Berglund G, Ljungman S, Hartford M, Wilhemsen L, Bjorntorp P (1982): Type of obesity and blood pressure. Hypertension 4: 692–696.PubMedGoogle Scholar
  15. 15.
    Seidell JC, Bokx JC, Deboer R, Deurerberg P, Heutvast JGAJ (1985): Fat distribution of overweight persons in relation to morbidity and subjective health. Int J Obesity 9: 363–374.Google Scholar
  16. 16.
    Jarret RJ, Keen H, McCartney J, Fuller JH: Hamilton PJS, Reid DD, Rose G (1978): Glucose tolerance and blood pressure in two populations sample their relation to diabetes mellitus and hypertension. J Epidemiol 7: 15–34.Google Scholar
  17. 17.
    Butler WJ, Ostrander LD, Jr, Carmen WJ, Lamphlear DE, (1982): Diabetes mellitus in Tecumseh, Michigan: Prevalence in incidence and associated conditions. Am J Epidemiol 7:116, 971–980.Google Scholar
  18. 18.
    Reisin E, Abel R, Modan M, Silverberg DS, Eliahou HE, Modan B (1978): Effects of weight loss without salt restriction on the reduction of blood pressure. New Engl J Med 298: 1–5.PubMedGoogle Scholar
  19. 19.
    Gillum RF, Prineas RJ, Jeffery RW, Jacobs DR, Elmer PJ, Gomez O, Blackburn H (1983): Nonpharmacological therapy of hypertension: The independent effect of weight reduction and sodium restriction in overweight borderline hypertensive patients. Am Heart J 105: 128–133.PubMedGoogle Scholar
  20. 20.
    Tuck MJ, Sowers J, Dornfeld L, Kledzik G, Maxwell MH (1981): The effect of weight reduction on blood pressure, plasma renin activity and plasma aldosterone levels in obese patients. New Engl J Med 304: 12–13.Google Scholar
  21. 21.
    Reisin E, Frohlich ED (1982): Effects of weight reduction on arterial pressure. J Chronic Dis 35: 887–891.PubMedGoogle Scholar
  22. 22.
    Messerli FH, Christie B, DeCarvalho GR, Aristimuno GG, Suarez DH, Dreslinski GR, Frohlich ED (1981): Obesity and essential hypertension, intravascular volume, sodium excretion and plasma renin activity. Arch Intern Med 141: 81–85.PubMedGoogle Scholar
  23. 23.
    Hiramatzu K, Yamada T, Ichikawa K, Izumiyama T, Nagata H (1981): Changes in endocrine activities relative to obesity in patients with essential hypertension. J A Geriatr 29: 25–30.Google Scholar
  24. 24.
    Bull MB, Hillman RS, Cannon PJ, Laragh JH (1970): Renin and aldosterone secretion in man as influenced by changes in electrolyte balance and blood volume. Circ Res 27: 953–960.PubMedGoogle Scholar
  25. 25.
    Rocchini AP, Katch VL, Grekin R, Moorehead C, Anderson J (1986): Role for aldosterone in blood pressure regulation of obese adolescents. Am J Cardiol 57: 613–617.PubMedGoogle Scholar
  26. 26.
    Scavo D, Borgia C, Isacobelli A (1968): Aspetti di funzione corticosurenalica nell obesita Nota VI, II: Comportamento della secrezione di aldosterone e della escrezione dei suoi metabolite nel corso di alcune prove dinamiche. Folia Endocrinol 21: 591–602.PubMedGoogle Scholar
  27. 27.
    Kalkroff RK, Hartz AH, Rupley D, Kissebah AH, Kelber S (1983): Relationship of body fat distribution to blood pressure, carbohydrate tolerance and plasma lipids in healthy obese women. J Lab Clin Med 621–627.Google Scholar
  28. 28.
    Migeon CJ, Green OC, Eckert JP (1963): Study of adrenocortical function in obesity. Metabolism 12: 718–739.PubMedGoogle Scholar
  29. 29.
    Prezio JA, Carreon G, Clerkin E, Meloni CR, Kyle LH, Canary JJ (1964): Influence of body composition on adrenal function in obesity. J Clin Endocr Metab 24: 481–485.PubMedGoogle Scholar
  30. 30.
    Modan M. Halkin H, Almog S, Lusky A, Eshkol A, Shefi M (1985): Hyperinsulinemia: A link between hypertension obesity and glucose intolerance. J Clin Invest 75: 809–817.PubMedGoogle Scholar
  31. 31.
    Lopez A, Kerhl WA (1967): A possible interrelation between glucose-6-phosphate dehydrogenose and dehydroepiondrosterone in obesity. Lancet 1967/2: 485–487.Google Scholar
  32. 32.
    Evans DJ, Hoffman RG, Kalkhoff RK, Kissebah AH (1983): Relationship of adrogenic activity to body fat topography, fat cell morphology, and metabolic aberrations in premenopausal women. J Clin Endocr Metab 57: 304–310.PubMedGoogle Scholar
  33. 33.
    Hediger ML, Katz SH (1986): Fat patterning, overweight, and adrenal androgen interactions in black adolescent females. Hum Biol 58: 985–600.Google Scholar
  34. 34.
    Landsberg L, Young JB (1978): Fasting, feeding and regulation of the sympathetic nervous system. New Eng J Med 298: 1295–1301.PubMedGoogle Scholar
  35. 35.
    Young JB, Landsberg L (1982): Diet induced changes in sympathetic nervous system activity, possible implication for obesity and hypertension. J Chronic Dis 35: 879–886.PubMedGoogle Scholar
  36. 36.
    Young JB, Landsberg L (1977): Catecholamines and intermediary metabolism. J Clin Endocrinol Metabol 6: 559–631.Google Scholar
  37. 37.
    Danforth JE, Horton ES, O’Connell M, Sims EAH, Burger AG, Ingbar SH, Braverman L, Vagenakis AG (1979): Dietary induced alterations in thyroid hormone metabolism during overnutrition. J Clin Invest 64: 136–1347.Google Scholar
  38. 38.
    Sims EAH (1982): Mechanisms of hypertension in the overweight. Hypertension 4(Suppl III): III 43–III 49.Google Scholar
  39. 39.
    Sowers JR, Whitfield LA, Catania RA, Stern N, Tuck ML, Dornfeld L, Maxwell M (1982): Role of the sympathetic nervous system in blood pressure maintenance in obesity. J Clin Endocrinol Metabol 54: 1181–1186.Google Scholar
  40. 40.
    Boehringer K, Beretta Picoli C, Weidmann P, Meier A, Ziegler W (1982): Pressor factors and cardiovascular pressor responsiveness in lean and overweight normal or hypertensive subjects. Hypertension 4: 697–708.PubMedGoogle Scholar
  41. 41.
    Pickering G (1980): Salt intake and essential hypertension. Circ Reviews & Reports 1: 13–17.Google Scholar
  42. 42.
    Tobian L (1979): The relationship of salt to hypertension. Am J Clin Nutr 32: 2739–2748.PubMedGoogle Scholar
  43. 43.
    Page LB, Danion A, Moellerung Jr RC (1974): Antecedents of cardiovascular disease in six Solomon Island Societies. Circulation 49: 1132–1146.PubMedGoogle Scholar
  44. 44.
    Takahashi E, Sasaki N, Takeda J, Ito H (1957): The geographic distribution of cerebral hemorrhage and hypertension in Japan. Hum Biol 29: 130–166.Google Scholar
  45. 45.
    Dahl KK, Silver L, Christie RW (1958): Role of salt in the fall of blood pressure accompanying reduction of obesity. New Engl J Med 258: 1186–1192.PubMedGoogle Scholar
  46. 46.
    Tobian L (1978): Salt and hypertension. Ann NY Acad Sci 304: 178–202.PubMedGoogle Scholar
  47. 47.
    DeChamplain J (1977): The sympathetic system in hypertension. J Clin Endocrinol Metabol 6: 633–655.Google Scholar
  48. 48.
    Cole FE, Frohlich ED, MacPhee AA (1978): Angiotensin binding affinity and capacity in the midbrain area of spontaneously hypertensive and normotensive rats. Brain Res 154: 178–181.PubMedGoogle Scholar
  49. 49.
    Garay RP, Meyer P (1979): A new test showing abnormal net Na+ and K+ ATPase in erythrocytes of essential hypertensive patients. Lancet 1979/1: 349–353.Google Scholar
  50. 50.
    Avenell A, Leeds AR (1981): Sodium intake, inhibition of Na+-K+-ATPase and obesity. Lancet 1981/1: 836.Google Scholar
  51. 51.
    Whittman R, Blond DM (1965): Respiratory control by an adenosine triphosphatase involved in active transport in brain cortex. Biochem J 92: 117–158.Google Scholar
  52. 52.
    DeLuise M, Blackburn GL, Flier JS (1980): Reduced activity in the red cell sodium-potassium pump in human obesity. New Engl J Med 303: 1017–1022.Google Scholar
  53. 53.
    Klimes I, Nagulesparan M, Unger RH, Aronoff SL, Mott DM (1982): Decreased Na+-K+-ATPase activity in erythrocyte membranes and intact erythrocytes from obese men. J Clin Endocrinol 54: 721–724.Google Scholar
  54. 54.
    Mir MA, Charalambons BM, Morgan K, Evans PJ (1981): Erythrocyte sodium-potassium-ATPase and sodium transport in obesity. New Engl J Med 305:: 1264–1261.PubMedGoogle Scholar
  55. 55.
    Blaustein MP (1977): Sodium ions, calcium ions, blood pressure regulation and hypertension: A reassessment and a hypothesis. Am J Physiol 232: C-165–173.Google Scholar
  56. 56.
    Baumgart AV, Zidek W, Losse H, Karoff C, Wehling M, Vetter W, Vetter H (1983): Obesity, hypertension and intracellular electrolytes. Klin Wochenschr 6: 803–805.Google Scholar
  57. 57.
    Bjorntorp P (1986): Hypertension and other complications in human obesity. J Clin Hypertension 2: 163–165.Google Scholar
  58. 58.
    Krotkiewski M, Bjorntorp P, Sjostrom L, Smith V (1983): Impact of obesity on metabolism in men and women: Importance of regional adipose tissue distribution. J Clin Invest 72: 1150–1162.PubMedGoogle Scholar
  59. 59.
    DeFronzo RA, Cooke CR, Andres R, Faloona GR, Davis PJ (1975): The effect of insulin or renal handling of sodium, potassium, calcium and phosphate in man. J Clin Invest 55: 845–855.PubMedGoogle Scholar
  60. 60.
    Voors AW, Webber LS, Frerichs RR, Berenson GS (1981): Body height and body mass as determinants of basal blood pressure in children: The Bogalusa Heart Study. Am J Epidemiol 106: 101–108.Google Scholar
  61. 61.
    Winquist RJ, Webb RC, Bohr DF (1982): Vascular smooth muscle in hypertension. Fed Proc Am Soc Exp Biol 41: 2386–2393.Google Scholar
  62. 62.
    Christensen NJ (1983): Acute effects of insulin on cardiovascular function and noradrenaline uptake and release. Diabetologia 25: 377–381.PubMedGoogle Scholar
  63. 63.
    Friedman SM (1983): Monovalent and divalent ions in vascular tissue. Ann Intern Med 98: 753–758.PubMedGoogle Scholar
  64. 64.
    Alexander JK (1963): Obesity and the circulation. Mod Cardiovasc Dis 32: 799–803.Google Scholar
  65. 65.
    Alexander JK, Dennis EW, Smith WG, Amad KH, Austin RC (1963): Blood volume, cardiac output and distribution of systemic blood flow in extreme obesity. Cardiovasc Res Cent Bull, Suppl II: 39–44.Google Scholar
  66. 66.
    Backman L, Freyschuss V, Hollberg D, Melcher A (1973): Cardiovascular function in extreme obesity. Acta Med Scand 193: 437–446.PubMedGoogle Scholar
  67. 67.
    Knopp TR (1983): A methodological critique of the ‘ideal weight’ concept. J Am Med Assoc 250: 506–510.Google Scholar
  68. 68.
    Reisin E, Frohlich ED (1986): Hemodynamics in obesity, in: Zanchetti A, Tarazi RC (eds), Handbook of Hypertension, Vol 7: Pathophysiology of hypertension. Cardiovascular aspects, p. 281. Amsterdam: Elsevier Science Publishers.Google Scholar
  69. 69.
    Tarazi RC, Dustan HP, Frohlich ED, Gifford Jr RW, Hoffman GC (1970): Plasma volume and chronic hypertension relationship to arterial pressure levels in different hypertensive diseases. Arch Intern Med 125: 835–842.PubMedGoogle Scholar
  70. 70.
    Raison J, Achimastos A, Bouthier, London G, Safar M (1983): Intravascular volume, extracellular fluid volume and total body water in obese and nonobese hypertensive patients. Am J Cardiol 51: 165–170.PubMedGoogle Scholar
  71. 71.
    Raison J, Achimastos A, Asmar R, Simon A, Safar M (1986): Extracellular and interstitial fluid volume in obesity with and without associated systemic hypertension. Am J Cardiol 57: 223–226.PubMedGoogle Scholar
  72. 72.
    Alexander JK, Amad KH, Cole VW (1962): Observations on some clinical features of extreme obesity, with particular reference to cardiorespiratory effects. Am J Med 32: 512–523.Google Scholar
  73. 73.
    Frohlich ED, Messerli FH, Reisin E, Dunn FG (1983): The problem of obesity and hypertension. Hypertension 5(suppl III): III 71–III 78.Google Scholar
  74. 74.
    Toto-Moukouo JJ, Achimastos A, Asmar RG, Hughes CJ, Safar ME (1986): Pulse wave velocity in patients with obesity and hypertension. Am Heart J 21: 136–140.Google Scholar
  75. 75.
    Mujais SK, Tarazi RC, Dustan HP, Fouad FM, Bravo EL (1982): Hypertension in obese patients hemodynamic and volume studies. Hypertension 4: 84–92.PubMedGoogle Scholar
  76. 76.
    Dustan HP (1983): Mechanisms of hypertension associated with obesity. Ann Intern Med 98: 860–864.PubMedGoogle Scholar
  77. 77.
    Messerli FH, Sundgaard-Riise K, Reisin E, Dreslinski GR, Dunn FG, Frohlich ED (1983): Disparate cardiovascular effects of obesity and essential hypertension. Am J Med 74: 808–812.PubMedGoogle Scholar
  78. 78.
    Messerli FH, Sundgaard-Riise K, Reisin E, Dreslinski GR, Ventura HO, Oigman W, Frohlich ED, Dunn FG (1983): Dimorphic cardiac adaptation to obesity and arterial hypertension. Ann Intern Med 99: 757–761.PubMedGoogle Scholar
  79. 79.
    Reisin E, Messerli FH, Ventura HO, Frohlich ED (1987): Renal hemodynamic studies in obesity-hypertension. J Hypertension 5: 397–400.Google Scholar
  80. 80.
    Barret-Connor E, Kow KT (1985): Is hypertension more benign when associated with obesity? Circulation 72: 53–60.Google Scholar
  81. 81.
    MacMahon SW, Bernstein L, MacDonald GS, Andrew SG, Blacket RB (1985): Comparison of weight reduction with metoprolol in treatment of hypertension in young overweight patients. Lancet 1985/1: 1233–1250.Google Scholar
  82. 82.
    Cohen N, Flamenbaum W (1985): Obesity and hypertension. Demonstration of a ‘floor effect’. Am J Med 80: 177–181.Google Scholar
  83. 83.
    Dornfeld LP, Maxwell MH, Waks AV, Schroth P, Tuck ML (1985): Obesity and hypertension: Long-term effect of weight reduction on blood pressure. Int J Obesity 9: 381–389.Google Scholar
  84. 84.
    Reisin E (1986): Weight reduction in the management of hypertension: Epidemiologic and mechanistic evidence. Can J Physiol Pharmacol 64: 818–824.PubMedGoogle Scholar
  85. 85.
    Sowers JA, Nyby M, Naftali BS, Beck F, Baron S, Catania R, Vlachis N (1983): Blood pressure and hormone changes associated with weight reduction in the obese. Hypertension 4: 686–691.Google Scholar
  86. 86.
    Kolanowski J (1981): Influence of insulin and glucagon on sodium balance in obese subjects during fasting and refeeding. Int J Obesity 5: 5105–5114.Google Scholar
  87. 87.
    Weder AB, Toneti BA, Skatch VL, Rochini AP (1984): The antihypertensive effect of caloric restriction in obese adolescents: Dissociation of effect on erythrocyte countertransport and cotransport. J Hypertension 2: 507–514.Google Scholar
  88. 88.
    Boulter PR, Spark RF, Arky RA (1973): Dissociation of the renin aldosterone system and refractoriness to the sodium-retaining action of minerolocorticoid during starvation in man. J Clin Exp Metab 38: 248–254.Google Scholar
  89. 89.
    Marks P, Wilson B, Delasalle A (1985): Aldosterone studies in obese patients with hypertension. Am J Med Sci 289: 224–228.PubMedGoogle Scholar
  90. 90.
    Garnett ES, Cohen H, Nehmias C, Viol G (1973): The roles of carbohydrate, renin and aldosterone in sodium retention during and after total starvation. Metabolism 22: 867–874.PubMedGoogle Scholar
  91. 91.
    Reisin E, Frohlich ED, Messerli FH, Dreslinski GR, Dunn FG, Jones MM, Batson HM Jr (1983): Cardiovascular changes after weight reduction in obesity hypertension. Ann Intern Med 98: 315–319.PubMedGoogle Scholar
  92. 92.
    Shetty PS, Jung RT, James WPT (1979): Effect of catecholamine replacement with levodopa on the metabolic response to semistarvation. The Lancet 1979/1: 77–79.Google Scholar
  93. 93.
    Alexander JK, Peterson KL (1972): Cardiovascular effects of weight reduction. Circulation 69: 310–318.Google Scholar
  94. 94.
    Backman L, Freyschuss V, Hallberg D, Melcher A (1979): Reversibility of cardiovascular changes in extreme obesity: Effects of weight reduction through Yeyunoicleostomy. Acta Med Scand 205: 367–373.PubMedGoogle Scholar
  95. 95.
    Achimastos A, Raison J, Levenson J, Safar M (1984): Adipose tissue cellularity and hemodynamic indexes in obese patients with hypertension. Arch Intern Med 144: 265–268.PubMedGoogle Scholar
  96. 96.
    Young JB, Landsberg L (1977): Stimulation of the sympathetic nervous system during sucrose feeding. Nature 269: 615–617.PubMedGoogle Scholar
  97. 97.
    Jung RT, Shetty PS, Barrand M (1979): Role of catecholamine in hypotensive response to dieting. Br Med J 1: 12–13.PubMedGoogle Scholar
  98. 98.
    MacGregor GA, Best FE, Conn JM, Markandu ND, Elder DM, Sagnella GA, Squires M (1982): Double blind randomized crossover trial of moderate sodium restriction in essential hypertension. Lancet 1982/1: 351–354.Google Scholar
  99. 99.
    Sowers JR, Whitfield LA, Beck IWJ, Catania RA, Tuck ML, Donfeld L, Maxwell M (1982): Role of enhanced sympathetic nervous system activity and reduced Na-K dependent adenosine triphosphatose activity in maintenance of elevated blood pressure in obesity: Effect of weight loss. Clin Sci 63: 1215–1245.Google Scholar
  100. 100.
    Bogardus C, Ravussin E, Robbins DC, Wolfe RR, Horton ES, Sims EAH (1984): Effects of physical training and diet therapy on carbohydrate metabolism in patients with glucose intolerance and noninsulin dependent diabetes. Mellitus Diabetes 33: 311–318.Google Scholar
  101. 101.
    Grey N, Kipinis DM (1971): Effect of diet composition on the hyperinsulinemia of obesity. New Engl J Med 385: 827–831.Google Scholar
  102. 102.
    MacMahon SW, Wilcken DEL, MacDonald GJ (1986): The effect of weight reduction on left ventricular mass: A randomized controlled trial in young overweight hypertensive patients. New Engl J Med 314: 334–339.PubMedGoogle Scholar
  103. 103.
    Keys A, Henschel A, Taylor HL (1947): The size and function of the human heart at rest in semi-starvation and in subsequent rehabilitation. Am J Physiol 150: 153–169.PubMedGoogle Scholar
  104. 104.
    Page IH (1987): The Mosaic Theory, in: Hypertension Mechanisms, p. 914. Grune Stratton, Inc.Google Scholar

Copyright information

© Kluwer Academic Publishers 1989

Authors and Affiliations

  • Efrain Reisin
  • Edward D. Frohlich

There are no affiliations available

Personalised recommendations