Joint statement of the European Association for the Study of Obesity and the European Society of Hypertension: Obesity and difficult to treat arterial hypertension

Jens Jordan, Volkan Yumuk, Markus Schlaich, Peter M. Nilsson, Barbara Zahorska-Markiewicz, Guido Grassi, Roland E. Schmieder, Stefan Engeli, Nick Finer

Research output: Contribution to journalArticlepeer-review

Abstract

Obese patients are prone to arterial hypertension, require more antihypertensive medications, and have an increased risk of treatment-resistant arterial hypertension. Obesity-induced neurohumoral activation appears to be involved. The association between obesity and hypertension shows large inter-individual variability, likely through genetic mechanisms. Obesity affects overall cardiovascular and metabolic risk; yet, the relationship between obesity and cardiovascular risk is complex and not sufficiently addressed in clinical guidelines. The epidemiological observation that obesity may be protective in patients with established cardiovascular disease is difficult to translate into clinical experience and practice. Weight loss is often recommended as a means to lower blood pressure. However, current hypertension guidelines do not provide evidence-based guidance on how to institute weight loss. In fact, weight loss influences on blood pressure may be overestimated. Nevertheless, weight loss through bariatric surgery appears to decrease cardiovascular risk in severely obese patients. Eventually, most obese hypertensive patients will require antihypertensive medications. Data from large-scale studies with hard clinical endpoints on antihypertensive medications specifically addressing obese patients are lacking and the morbidity from the growing population of severely obese patients is poorly recognized or addressed. Because of their broad spectrum of beneficial effects, renin-angiotensin system inhibitors are considered to be the most appropriate drugs for antihypertensive treatment of obese patients. Most obese hypertensive patients require two or more antihypertensive drugs. Finally, how to combine weight loss strategies and antihypertensive treatment to achieve an optimal clinical outcome is unresolved.

Original languageEnglish
Pages (from-to)1047-1055
Number of pages9
JournalJournal of Hypertension
Volume30
Issue number6
DOIs
Publication statusPublished - Jun 2012

Keywords

  • bariatric surgery
  • cardiovascular risk
  • hypertension
  • neurohumoral
  • obesity
  • obesity paradox
  • treatment resistance

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

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