[Hypertension and obesity]

Hypertension is often associated with corpulence, an increased total and abdominal fatty mass. The fact of being corpulent exposes to the risk of error of measurement of the blood pressure which may be overestimated by 10 to 16 mmHg and lead to the unnecessary prescription of antihypertensive drugs. In order to analyse the nature of the corpulence, it is useful to define the condition as an increase in fatty and/or lean body mass. It is also useful to quantify the distribution of body fat. Hypertensive patients of increased corpulence, obese (BMI > 30) with an abdominal distribution of adipose tissue, have an increased risk of cardiovascular morbidity-mortality, especially from coronary artery disease: their cardiovascular risk factors consist not only of hypertension and corpulence, but also of metabolic abnormalities and the haemodynamic consequences of corpulence, that is to say diabetes, hypertriglyceridaemia, hypercholesterolaemia, left ventricular hypertrophy and increased glomerular filtration. In hypertension with increased corpulence, the nutritional objective is to decrease the corpulence, decrease the fatty mass without reducing the lean mass. Therefore, it is important to proceed by a progressive, even small, loss of weight with a realistic target because loss of weight is beneficial for the hypertension and its complications (cardiovascular and renal), all other risk factors and for cardiovascular mortality.