ABSTRACT
It is estimated that 60%–70% of hypertension in adults may be directly attributed to excess adiposity.5 In addition, excess adiposity increases the risk of resistant hypertension, which is dened as the failure to achieve target blood pressure levels despite treatment with three different agents at optimal doses. Ideally, one of the three agents should be a diuretic. For each 1 kg/m2 increase in body mass index (BMI), the risk of resistant hypertension increases by 4% (95% condence interval [CI]: 2%–5%).6 Data from the U.S. Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994 showed that the prevalence of hypertension rises in a linear fashion, from 25% in normal-weight subjects to 65% in those with moderate to severe obesity (Figure 47.1).7 This linear relationship has also been described in other populations outside the United States.8 Compared to normal-weight individuals, individuals aged <55 years with class I obesity
have a 2.5-to 3.2-fold greater prevalence of hypertension.7 This increased prevalence is attenuated in class I individuals who are ≥55 years old. Nevertheless, even in this older age group hypertension is still 1.2-to 1.4-fold more common compared to normal-weight individuals.7 Furthermore, the risk of developing hypertension increases with increasing weight gain. For example, in 46,224 women enrolled in the Nurses’ Health Study who were free of hypertension at baseline, the risk of high blood pressure increased by 20% (95% CI: 15%–25%) over a 4-year period for each 10 kg weight gained.9
