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Obesity, kidney dysfunction, and inflammation: interactions in hypertension.
John E Hall1,2,3, Alan J Mouton1,2, Alexandre A da Silva1,2
1Department of Physiology & Biophysics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 30216-4505, USA.
Cardiovascular Research
|December 1, 2020
Summary
Obesity drives essential hypertension (HT) by impairing kidney function through neurohormonal, inflammatory, and physical mechanisms. Addressing obesity is crucial to prevent severe cardiovascular and kidney damage.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Endocrinology
Background:
- Obesity is a primary driver of essential hypertension (HT), a major cause of cardiovascular and kidney diseases.
- Kidney dysfunction, characterized by increased sodium reabsorption and hyperfiltration, is central to obesity-HT pathogenesis and organ damage.
Purpose of the Study:
- To elucidate the complex interplay of mechanisms initiating and exacerbating hypertension in obesity.
- To highlight the role of kidney dysfunction in obesity-induced cardiovascular and target organ injury.
Main Methods:
- Review and synthesis of existing literature on obesity-hypertension pathophysiology.
- Analysis of neurohormonal, renal, inflammatory, and physical factors contributing to HT in obesity.
Main Results:
- Obesity-HT involves elevated renal sympathetic nerve activity (RSNA), increased antinatriuretic hormones, and deficient natriuretic hormones.
- Renal compression by fat, immune cell activation, and inflammatory cytokines exacerbate HT and contribute to vascular injury.
- Interdependent mechanisms link adiposity, leptin, RSNA, and the renin-angiotensin-aldosterone system.
Conclusions:
- Obesity-induced kidney dysfunction and inflammation create a pro-hypertensive state, often resistant to treatment.
- Progressive renal injury necessitates comprehensive management of metabolic abnormalities and inflammation alongside hypertension.
- Development of effective anti-obesity therapies is critical to mitigate the growing burden of obesity-related cardiorenal diseases.
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