[Hypertension and cardiomyopathy in obesity. Treat the heart simultaneously]

The prevalence of hypertension among the obese is twice as high as that in persons of normal weight. Not only the BMI, but, and in particular, the circumference of the waist correlates with blood pressure. A relationship also obtains between BMI and left-ventricular muscle mass, with left-ventricular hypertrophy occurring twelve times more often among the obese than among slim persons. Obesity puts a strain on both the hemodynamics and metabolism of the heart. On the one hand, long-term sequelae include disordered cardiac function extending to cardiomyopathy, on the other, obesity is responsible for sympatho-adrenergic stimulation considered to be a cause of insulin resistance, and is thus, in particular in the hypertensive, closely associated with metabolic syndrome. Specific nondrug treatment options include weight reduction, a low-salt diet and physical exercise. In some cases, Sibutramine and Orlistat may have a supporting role. For the antihypertensive treatment of the obese, drugs with a favorable hemodynamic and metabolic effect should be used.