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Obesity and Essential Hypertension: Hemodynamics, Intravascular Volume, Sodium Excretion, and Plasma Renin Activity
Abstract
Systemic hemodynamics, intravascular volume, and plasma renin activity were determined in 135 lean, mildly obese, or distinctly overweight subjects who were normotensive or had borderline or established essential hypertension. Cardiac output (but not index) was higher and peripheral resistance lower in obese than in lean subjects, except in borderline hypertension. intravascular volume was increased in obese patients, and more so when corrected for body height; correction for body weight led to relative volume contraction. Intravascular volume correlated directly with cardiac output in the entire population, as well as in the subgroups. Intravascular volume correlated inversely with total peripheral resistance in all subjects and in each subgroup. Both correlations remained significant when an approximation was used to correct influences of obesity on total blood volume. Sodium excretion was higher in obese than in lean subjects. Thus, despite the expanded intravascular volume in obesity, the pathophysiologic relationship between systemic hemodynamics and intravascular volumes remains unchanged. Relatively low peripheral resistance in obesity may decrease the risk of systemic vascular disease. Nevertheless, since circulating volume is increased, the greater venous return adds an additional load to a left ventricle that is already burdened by a high afterload caused by arterial hypertension. (Arch Intern Med141:81-85, 1981)
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“The metabolic, endocrine, cardiovascular, and renal changes caused by dietary-induced obesity in these experimental animals closely mimic the changes observed in obese humans5,13–16 (Table 1).”
From Obesity-Induced Hypertension: Interaction of Neurohumoral and Renal Mechanisms (2015) · cites this paper as [16]
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Predictors of Left Ventricular Dilatation in Young Adults (from the Bogalusa Heart Study)
Haji, S. A., Ulusoy, R. E., Patel, D. A., Srinivasan, S. R., Chen, W., Delafontaine, P., & Berenson, G. S. (2006) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2006.05.054 · Cited by 36
Mechanisms underlying elevated SBP differ with adiposity in young adults
Middlemiss, J. E., Miles, K. L., McDonnell, B. J., Yasmin, Y., Maki-Petaja, K. M., Cockcroft, J. R., Wilkinson, I. B., & McEniery, C. M. (2015) · Journal of Hypertension · doi:10.1097/hjh.0000000000000798 · Cited by 37
“com Previous haemodynamic studies in young adults have focused on individuals with either borderline [24] or sustained hypertension [25], and highlighted that an increased CO appears to be the key haemodynamic determinant of elevated BP in both normal-weight and obese individuals, albeit with different underlying mech…”
BackgroundObesity and hypertension in blacks
Dustan, H. P. (1990) · Cardiovascular Drugs and Therapy · doi:10.1007/bf02603183 · Cited by 34
Anesthetic Management of Patients with Obesity and Sleep Apnea
Passannante, A. N., & Rock, P. (2005) · Anesthesiology Clinics of North America · doi:10.1016/j.atc.2005.02.005 · Cited by 35
“Because blood volume increases directly with body weight, and many obese individuals will have an increased cardiac output, the vesselrich group of organs is well perfused in obese individuals [6,7].”
BackgroundHarmancey, R., Sénard, J., Pathak, A., Desmoulin, F., Claparols, C., Rouet, P., & Smih, F. (2005) · The FASEB Journal · doi:10.1096/fj.04-2868fje · Cited by 35
“In accordance with these observations, weaker peripheral vascular resistance and better cardiac output have been found in hypertensive obese patients compared with nonobese hypertensive patients (14).”
ResultObesity in hypertension: How innocent a bystander?
Messerli, F. H. (1984) · The American Journal of Medicine · doi:10.1016/0002-9343(84)90191-8 · Cited by 34
Self-citationAlp, H., Karaarslan, S., Eklioğlu, B. S., Atabek, M. E., & Baysal, T. (2014) · Journal of Hypertension · doi:10.1097/hjh.0000000000000176 · Cited by 31
“Hypertension and obesity are both associated with left ventricular geometry, leading to both dilatation and hypertrophy [4].”
BackgroundMechanisms Contributing to High Blood Pressure
Frohlich, E. D. (1983) · Annals of Internal Medicine · doi:10.7326/0003-4819-98-5-709 · Cited by 32
Lewis, A., Abdesselam, I., Rayner, J. J., Byrne, J. P., Borlaug, B. A., Neubauer, S., & Rider, O. J. (2021) · European Heart Journal - Cardiovascular Imaging · doi:10.1093/ehjci/jeab175 · Cited by 34
The obesity paradox: is it really a paradox? Hypertension
Lechi, A. (2016) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-016-0330-4 · Cited by 29
“Since many years, it has been shown that in obese subjects, there is a hyperdynamic circulation with increased heart rate, increased cardiac output, reduced peripheral resistances, and elevated pulse pressure [23].”
BackgroundThe heart in obesity-hypertension
Morse, S. A., Bravo, P. E., Morse, M. C., & Reisin, E. (2005) · Expert Review of Cardiovascular Therapy · doi:10.1586/14779072.3.4.647 · Cited by 31
Metadata
- Authors
- Messerli, F. H.
- Corresponding author
- Messerli, Franz H.
- ORCID
- Messerli, Franz H.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 1981-01-01
- Volume
- 141
- Issue
- 1
- Pages
- 81
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W4246843923
- Cited by
- 210
- References
- 0
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 1 · 2022: 8 · 2021: 4 · 2020: 3 · 2019: 7 · 2018: 4 · 2017: 3 · 2016: 8 · 2015: 5 · 2014: 7 · 2013: 7 · 2012: 10
- FWCI
- 5.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Keywords
- obesity, essential hypertension, systemic hemodynamics, intravascular volume, plasma renin activity, cardiac output, systemic vascular resistance, sodium excretion, blood volume, left ventricular afterload, venous return
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